【Abstract】 Objective To evaluate the clinical efficacy of total hip arthroplasty (THA) and hemiarthroplasty (HA) in the treatment of displaced femoral neck fractures in the elderly. Methods From June 2005 to June 2015, 102 patients over 60 years with displaced femoral neck fractures in Xinxiang City First People's Hospital were selected, including 44 males and 58 females. The initial admission age rage was 60-91 [average (73.3 ± 9.2)] years. The selected cases were divided into THA group and HA group according to the surgical method. The THA group was treated with THA, a total of 56 patients, 26 males and 30 females; aged 60-90 [average (73.7 ± 9.3)] years. The HA group was treated with HA, a total of 46 cases, 18 males and 28 females; aged 60-91 [average (72.9±9.2)] years. The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, postoperative hip function and complications were compared between two groups. And the Harris evaluation system was applied to evaluate the hip joint function in two groups in terms of pain, function, and range of motion at 1 month, 1 year, 2 years, and 3 years after surgery. Results All of the patients in 2 groups successfully completed the operation without surgery-related complications. 102 patients were followed up, and the follow-up period was 37-57 [average (46.2±6.0)] months. After surgery, there were 0 deaths within 3 years and 4 deaths within 5 years. The operation time in the THA group was (100.3±17.9) min, which was significantly longer than that in the HA group [(81.3+15.1) min], and the difference had statistical significance (t=5.72, P<0.000 1). The volume of intraoperative blood loss in the THA group [(395.0±75.9) mL] was also significantly more than that in the HA group [(279.8±85.0) mL], and the difference had statistical significance (t=7.23, P<0.000 1). During the follow-up period, at 2 year and 3 year after surgery, the hip Harris scores of the THA group were significantly higher than those in the HA group (P<0.05), while no significant difference was found in the 2 groups at 1 month and 1 year after operation (P>0.05). In terms of postoperative complications, the postoperative dislocation rate was higher in the THA group than that in the HA group, and the hip pain rate was higher in the HA group, but the total postoperative complications in the THA group (26.8%) were significantly lower than those in the HA group (45.7%), and the difference had statistical significance (X2=3.94, P<0.05). Conclusion In the treatment of displaced femoral neck fractures in the elderly, THA and HA have their own advantages and disadvantages, both of them have good short-term effects, but the long-term effect of THA is better than HA. Therefore, the patient's condition was considered comprehensively to choose an appropriate surgical procedure.