Abstract: Objective: To explore the feasibility and safety of hip arthroplasty in treatment of femoral neck fracture and propose the perioperative approach and the methods of arthroplasty. Methods: Retrospective analysis of the efficacy and complications of artificial joint replacement in 26 patients aged more than 70 years old with fractures of the femoral neck from March 2000 to September 2006 were performed. The average duration of hospitalization, the surgical time, the intraoperative and postoperative bleeding, the blood transfusion, Harris score, the time to get out of bed were compared between the hemiarthroplasty group of 20 patients and total hip replacement group of 6 patients. Results: No patients in the two groups died intraoperatively and postoperatively. Harris score improved by an average of 38.2 and the excellent rate was 88.46%. The complications occurred in 5 patients with the incidence of 19.23%. The operative time, the intraoperative and postoperative bleeding, blood transfusion, the incidence of complications in hemiarthroplasty group were significantly lower than those in the total hip replacement group (P<0.01-P<0.001). There were no significant differences in Harris and the score, time to get out of bed, the average length of stay between the two groups (P<0.001-P<0.01). Conclusions: Elderly patients with femoral neck fracture, artificial joint replacement for effective treatment, can significantly improve the patient's quality of life. The correct perioperative management can help such patients pass through the perioperative period and achieve good results. For the two surgical approaches, hemiarthroplasty is more suitable for 80 older patients with femoral neck fracture.