Ninety older adult patients (aged ≥ 60 years) with either femur bone necrosis or femoral neck fractures undergoing total hip arthroplasty (THA) were randomized to receive either an enhanced recovery after surgery (ERAS) nursing strategy (n=45) or regular nursing care (n=45). The primary outcome was postoperative pain (VAS score). Secondary outcomes included hip function (Harris score), daily living ability (Barthel index), length and cost of hospitalization, incidence of complications, and patient satisfaction. Outcomes were assessed at 24, 48, and 72 hours postoperatively and up to three months. Overall, the results of the study revealed that the ERAS group had significantly lower VAS scores, earlier ambulation, and better functional recovery with higher Harris scores and Barthel index scores. Hospital stay duration, costs, and complication rates were all significantly lower in the ERAS group. These findings suggest that ERAS nursing strategies significantly improve postoperative recovery outcomes compared with regular nursing care in older adults undergoing THA.