Purpose: The aim of this study is to compare the functional outcomes and complication rates of early total hip replacement (THR) for acetabular fractures in the young versus the elderly populations, in a trial to reach a higher level of evidence to know whether to expand or limit the application of early THR to young patients. Methods: This was a multicenter retrospective comparative study that included patients who underwent early THR for an acetabular fracture in the period from February 2012 to December 2018 in one of three level one trauma centers. Patients were divided into an “elderly group” that included patients 65 years or older (seven males and seven females), and a “young group” that included patients younger than 65 years (11 males and three females). The mean period of follow up was 33.57 months (range 12-84). Results: The mean Harris Hip Score (HHS), at the final follow up, in the elderly group was 82.4 (range 75-92) while the mean HHS in the young group was 91.5 (range 72-100). The mean and median HHS in the young group were significantly higher than those in the elderly group. There was no statistically significant difference in the complication rate between the elderly and young patient groups. Conclusion: Significantly superior functional outcomes are expected from young patients managed with early THR for acetabular fractures compared to elderly patients, with comparable complication rates between both age groups. Therefore, there is more confidence to apply this procedure to younger patients when indicated.