Total hip arthroplasty (THA) is indicated patients with late stage avascular necrosis (osteonecrosis) of the femoral head. Patients with avascular necrosis of the femoral head that require arthroplasty are typically younger and have more active lifestyle than patients with osteoarthritis. Advances in surgical technique and implant design in recent years have significantly improved the survival of THA in patients with avascular necrosis of the femoral head. Patients should be screened and optimized accordingly to reduce the risk of complication following THA, especially who have poor bone quality and systemic comorbidities. THA is an effective and successful choice for end stage avascular necrosis of the femoral head.