Oxidized zirconium may have improved wear characteristics against polyethylene, but its performance against native cartilage is unknown. Between 1996 and 1998, 52 patients received an oxidized zirconium hemiarthroplasty for the treatment of a hip fracture. Twelve patients (23%) died within 1 year of surgery, and 24 (46%) were surviving at 5 years. In 38 patients with minimum 2-years follow-up, clinical evaluation after surgery averaged 4.5 years with Harris hip scores averaging 78 (range, 55-92). Three patients radiographically showed acetabular protrusion or significant wear, with 2 undergoing revision surgery. An explanted prosthesis demonstrated no appreciable damage by spectrum analysis. Because of the high mortality rate after hip fracture, the clinical benefits of oxidized zirconium hemiarthroplasty in this population, if existent, are difficult to appreciate and currently show no benefits over standard prostheses.