Clinical and radiological studies were performed on 58 patients with rheumatoid arthritis (RA) who had sustained 64 femoral neck fractures. All but one patietns werre female, the mean age was 66.5 years, and mean duration of RA was 17 years. Only 3 hips showed rheumatoid changes. Sixteen fractures of 14 patietns were spontaneous fractures without trauma. Ipsilateral total knee replacements were performed on 5 patients with spontaneous fractures. Results of treatment were analyzed on 47 fractures in 43 patients that could be followed up for more than 1 year (mean 42 months). Clinical results were evaluated by ability of ambula-tion and complications such as nonunion and avascular necrosis of the femoral head. All 4 fractures treated conservatively and 5 of 9 displaced fractures treated by internal fixation developed complications. Femoral head replacements had a high rate of proximal migration (23.8%) and distal migration (76.2%), and ambulation ability was lowered significantly in 10 patients with distal migration for more than 5 mm. On the other hand, satisfactory results were obtained on all 6 fractures treated by total hip replacements (THR). THR is advisable for tratmetn of displaced femoral neck fracture in patients with RA.