Abstract Introduction: Total Hip Arthroplasty (THA) is one of the most successful orthopaedic surgical interventions, providing effective pain relief and restoration of function in patients with advanced hip pathology. Despite widespread use, comprehensive data on indications and postoperative functional outcomes from Indian tertiary centres remain limited.Material and Methods: This prospective observational study enrolled 80 patients who underwent THA at a tertiary orthopaedic centre over 24 months (January 2022–December 2023). Functional outcomes were assessed using the Harris Hip Score (HHS), Visual Analogue Scale (VAS), and WOMAC index preoperatively and at 3, 6, and 12 months postoperatively.Result: Mean age was 62.4 ± 10.2 years with male predominance (55%). Primary osteoarthritis was the most common indication (47.5%). Mean HHS improved significantly from 38.3 ± 7.4 preoperatively to 86.9 ± 6.3 at 12 months (p<0.001). VAS pain scores decreased from 7.8 ± 1.2 to 1.3 ± 0.9. Overall complication rate was 20%, with DVT being most common (5%). Excellent or good outcomes (HHS ≥80) were achieved in 82.5% of patients at 12 months.Conclusion: THA provides substantial and sustained improvement in pain relief and functional outcomes at 12 months. Primary osteoarthritis remains the dominant indication. Careful patient selection, standardised surgical technique, and structured rehabilitation are key determinants of success.