Objective To analyze the characteristic features of total hip replacement after acetabular fracture and provide experience in treatment of these patients. Methods The acetabular fracture patients who were treated by total hip replacement in this hospital since September 2008 to October 2010 were recruited and the Results of treatment were reviewed. Results Totally 58 cases (59 hip), male 39 cases (40 hip), 19 female cases (19 hip). ORIF 46 cases, non-ORIF 7 cases, conservative treatment 5 cases. 13 cases (28%) had infection before total hip replacement and were treated by eradication, spacer implant and second stage revision. Other patients received replacment directly. Average follow-up time was 45 months (20-58 months). Harris score was 48.2 before total hip replacement and increased to 87.3 till the final follow-up. 6 cases had complications. 3 cases had dislocation and were treated by closed reduction, plaster fixation and all were cured. 2 cases had deep infection and were successfully treated by two stage revision. Conclusions Acetabular fracture is treated by open reduction and internal fixation in acute stage. In later stage, patients with non-union, malformation union, osteoarthritis, and infection need total hip replacement. Total hip replacement can achieve good results. But the infection should be eliminated before total hip replacement and postoperative complication should be prevented.