The hot spot stress approach is usually adopted in the fatigue design and analysis of tubular welded joints. To apply the hot spot stress approach for fatigue evaluation of long span suspension bridges, the FEM is used to determine the hot spot stress of critical fatigue location. Using the local finite element models of the Tsing Ma Bridge, typical joints are developed and the stress concentration factors are determined. As a case for study, the calculated stress concentration factor is combined with the nominal representative stress block cycle to obtain the representative hot spot stress range cycle block under traffic loading from online health monitoring system. A comparison is made between the nominal stress approach and the hot spot stress approach for fatigue life evaluation of the Tsing Ma Bridge. The comparison result shows that the nominal stress approach cannot consider the most critical stress of the fatigue damage location and the hot spot stress approach is more appropriate for fatigue evaluation.