The surgeon is faced with several choices for arthroplasty for a femoral neck fracture.

The first is whether to fix the fracture or to perform an arthroplasty.

If arthroplasty is chosen, the next issue is what kind of arthroplasty. The two major types are hemiarthroplasty (replacement of the femoral head and neck) or total hip arthroplasty, in which both the femoral head and neck and the acetabular surface are replaced.

Hemiarthroplasty is a less complicated operation and provides generally satisfactory results for less active elderly patients. Hemiarthroplasty is cheaper and has a lower risk of dislocation than total hip arthroplasty but may lead to acetabular pain and erosion, requiring revision surgery at a later date.

Reported results of total hip arthroplasty for femoral neck fractures are improving, so that total hip arthroplasty is increasingly favored for displaced femoral neck fractures, particularly for more active elderly patients. In patients with preexisting osteoarthritis, total hip arthroplasty is also indicated. Total hip arthroplasties performed for femoral neck fractures should only be performed by surgeons that are competent in doing the procedure.

For a comparison between total hip arthroplasty and hemiarthroplasty, see, eg, Ekhtiari et al 2020, Tang et al 2020.