AIM: To explore the way and therapeutic effect of one stage total hip replacement (THR) in treating rheumatoid arthritis-induced ischemic necrosis of the femoral head combined with intertrochanteric fracture. METHODS: From July 1998 to September 2006, one stage THR was performed in 12 cases with ischemic necrosis of the femoral head combined with the fresh intertrochanteric fracture in Department of Orthopedics, Henan Provincial Traditional Chinese Medicine Hospital, including 8 males and 4 females aged 28-65 years with disease course of 5-20 years. The prosthesis of biology was provided by Pu Lusi (Switzerland). RESULTS: All cases were followed up for 2 to 9 years. The fracture ends well healed, showing good form and position of prosthesis postoperatively 4 month by X-ray reexamination. No acetabulum wear or prosthesis dislocation was found. They could walk without help and take care of themselves after 5 months. The results were excellent in 7 cases, good in 3, fair in 1, and bad in 1 according to Harris evaluation standard of THR. The average value of Harris evaluation was 90.8 two years postoperatively, and the excellent and good rate was 83.3%. CONCLUSION: One stage THR for rheumatoid arthritis-caused ischemic necrosis of the femoral head combined with intertrochanteric fracture is an ideal method to restore function of the hip joint.