Aim: To compare the clinical and functional outcome of patients who had total hip replacement using a conventional offset stem versus a high offset stem. Material and methods:This research is a retrospective comparative analysis that included 60 patients who had high grade Avascular necrosis of the hip and were treated with primary total hip replacement. Patients aged 18 years and older, of both genders, who had total hip replacement surgery for high-grade avascular necrosis of the hip using either a standard offset or high offset stem during the last 12 months were included in the study. Patients will be divided into two groups, with 30 patients in each group, for standard offset and high offset stem complete hip replacement operations. Serial follow-ups were conducted to record post-operative recovery, satisfaction, and pain level. Clinical progress was measured by physical examination and functional assessment, specifically focusing on the restoration of mobility and correction of deformities. The evaluation of deformity correction will be based on the Harris hip score. The research reviewed the data collected from patients' usual post-operative follow-ups at 6 weeks, 12 weeks, and 18 weeks.Results:Pre-operatively, the mean VAS score was 7.8 ± 1.2 in the Standard Offset Stem group and 7.9 ± 1.1 in the High Offset Stem group, with no significant difference between the groups (p=0.82). At 6 weeks post-operatively, the VAS score decreased to 4.5 ± 1.3 in the Standard Offset Stem group and 4.0 ± 1.2 in the High Offset Stem group, although this difference was not statistically significant (p=0.28). At 12 weeks, the VAS scores further decreased to 3.2 ± 1.0 in the Standard Offset Stem group and 2.8 ± 0.9 in the High Offset Stem group, with a trend towards significance (p=0.14). By 18 weeks, the VAS scores were 2.5 ± 0.8 in the Standard Offset Stem group and 2.0 ± 0.7 in the High Offset Stem group, showing a significant difference (p=0.05). Pre-operatively, the mean Harris Hip Score was 40.2 ± 7.5 in the Standard Offset Stem group and 41.0 ± 8.0 in the High Offset Stem group, with no significant difference between the groups (p=0.62). At 6 weeks post-operatively, the scores improved to 65.3 ± 10.2 in the Standard Offset Stem group and 68.0 ± 11.0 in the High Offset Stem group, though this difference was not statistically significant (p=0.34). At 12 weeks, the scores further improved to 72.5 ± 9.5 in the Standard Offset Stem group and 75.8 ± 9.8 in the High Offset Stem group (p=0.18). By 18 weeks, the scores were 78.0 ± 8.2 in the Standard Offset Stem group and 82.0 ± 7.9 in the High Offset Stem group, showing a significant difference (p=0.04).Conclusion: We concluded that augmenting femoral offset with high-offset stems enhances functional results and biomechanics in total hip arthroplasty, underscoring the need of taking into account the patient's individual anatomical characteristics.