Abstract:[Objective]To compare the clinical outcomes of total hip arthroplasty (THA) and hemiarthroplasty (HA)in elderly patients with femoral neck fracture complicated with left heart failure. [Methods]A retrospective study was done on 45 elderly patients with displaced femoral neck fracture combined with left heart failure in our hospital from 2017 to 2019 , including 30 cases of HA group and 15 cases of THA group, to compare the statistical differences between the two groups in terms of the operation time,intraoperative blood loss during operation, postoperative drainage volume,decreased hemoglobin, hospitalization time, postoperative follow-up Harris score and ejection fraction typing level.[Results]All the patients had surgical procedures performed smoothly. The operation time, intraoperative blood loss, postoperative drainage volume,decreased hemoglobin and hospitalization time of HA group were lower than those of THA group, and the difference was statistically significant (P < 0.05). There was no statistical difference between the two groups in terms of Harris score at 3 and 6 months after surgery (P >0.05). However the Harris score of THA group was better than that of HA group at 12 months after surgery (P < 0.05).The Harris score in postoperative follow-up was compared within each group, .The Harris score significantly increased in both groups over time postoperatively (P<0.05) .The comparison of the ejection fraction of left heart failure between the two groups before operation, 3 days after operation and the last follow-up showed that the THA group was higher than the HA group, and the difference was statistically significant (P<0.05). There was no statistically significant difference between the two groups at each time point (P>0.05).[Conclusions]The method of total hip arthroplasty or hemiarthroplasty can be evaluated with appropriate reference to the left heart failure ejection fraction classification, and hemiarthroplasty can be considered for patients with heart failure and abnormal ejection fraction, which has certain safety and effect. For patients with heart failure but normal ejection fraction, total hip arthroplasty may be considered as a better long-term curative effect on hip joint function