Objective: To compare the efficacy of total hip arthroplasty for osteonecrosis of the femoral head after internal fixation of femoral neck fracture and non-traumatic osteonecrosis of the femoral head in adults. Methods: From January 2015 to June 2016, a retrospective study was performed on 44 cases of osteonecrosis of the femoral head. Trauma group was 14 patients with osteonecrosis of the femoral head after internal fixation of femoral neck fracture, Control group was 30 patients with non-traumatic osteonecrosis of the femoral head. The disease course, stage of Ficat classification and Harris score, operative time, intraoperative blood loss, postoperative drainage, acetabular abduction, anteversion, Harris score at the 3rd, 6th and 12th month, incidence after surgery were compared among groups. Results: All patients were followed up, the average time was 23.6 months, from 15 to 36 months. Without hip infection, periprosthetic fracture, loosening, heterotopic ossification and other complications, Trauma group: 1 case had intravenous gastrocnemius embolism. Control group: 2 cases had intravenous embolism and 1 case had dislocation of hip joint. Hip joint function improved significantly after surgery (P<0.01). The operative time of two groups was [(99.6±9.85) min vs (96.6±7.68), t=0.52, P=0.64], intraoperative blood loss [(220±94.3) mL vs (217±89.9) mL, t=0.79, P=0.99], acetabular abduction (P>0.05), anteversion (P>0.05) and Harris score (P>0.05) at the 3rd, 6th and 12th month after surgery ,the differences were not statistically significant between the two groups. Conclusion: The result is satisfactory of total hip arthroplasty for osteonecrosis of the femoral head after internal fixation of femoral neck fracture. Compared with non-traumatic osteonecrosis of the femoral head, there is no significant difference in operative difficulty and incidence.