The objectives of the study were to: 1) evaluate satisfaction with the new 2023 National Institute of Health and Care Excellence (NICE) criteria for selecting total hip arthroplasty (THA) over hemiarthroplasty (HA) and surgical recommendations for treatment of displaced intra-capsular hip fractures; 2) describe why THA is performed when NICE criteria are not met; and 3) determine whether satisfaction with these guidelines is associated with improved outcomes. A retrospective chart review of patients who had a displaced intra-capsular hip fracture treated with THA at a single tertiary academic center between 2010 and 2022 was performed. Pre-operative patient characteristics were reviewed to determine if the indication for THA met NICE criteria. Operative details, peri-operative complications, re-operation, and revision arthroplasty within 12 months of surgery were recorded. Data from 196 patients (63% women; age 67 ± 10 years) were used. There were 161 THAs (82.1%) that satisfied NICE criteria. The two most common reasons for performing a THA when NICE criteria were not met (n = 35) included pre-operative radiographic osteoarthritis (Tönnis grade ≥ 2; 48.6%) and decreased patient age (< 65 years; 31.5%). Satisfaction with the NICE criteria was associated with fewer peri-operative complications (0.6 versus 37.1%; P < 0.001), re-operations (0.6 versus 31.4%; P < 0.001), and revisions (0.6 versus 28.6%; P < 0.001). The most common reason for revision was periprosthetic fracture, possibly secondary to the use of uncemented femoral stems (171 of 196, 87.2%). Satisfaction with the new NICE criteria is associated with improved perioperative outcomes. Further studies are necessary to determine if pre-existing hip osteoarthritis and younger age merit consideration in patient selection.