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Elective total hip arthroplasties (THA) were performed in 91 patients (101 hips) older than 80 years of age at operation. A control group of 87 patients (102 hips) aged 64 to 67 years who had elective THA was chosen statistically to represent the average THA patient. There were 51 minor and eight major perioperative complications in the elderly group and 26 minor and two major complications in the control group. The only in-hospital death was in the control group. The mean hospital stay was two days longer in the elderly group. Five years postoperatively, 83% of the patients in both groups were ambulating without pain. The mean hip score improved from 49 to 84 points in the elderly group and from 52 to 88 points in the control group. These functional results justify elective THA in patients older than 80 years of age.