We report our experience in unstable fractures of the femoral neck in a consecutive series of patients who underwent total hip arthroplasty. Over a period of 12 years, 88 patients were treated with a cemented total hip arthroplasty; 3 patients were lost to follow-up, leaving 86 fractures (85 patients) for retrospective analysis. Seven patients had dislocations, all but 1 of which were treated successfully without reoperation. Four patients required reoperation in the same hip undergoing arthroplasty. There was a graded increase in mortality rates across the continuum of risk groups at the time of surgery. The low incidence (4.6%) of a second procedure on the hip repaired initially, as well as low mortality rates, makes this treatment strategy quite satisfactory.