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Objective This study was performed to compare the clinical and radiological outcomes of displaced femoral neck fractures (FNFs) treated with either hemiarthroplasty or total hip arthroplasty (THA) in elderly patients. Morbidity and mortality were also evaluated.Methods Twenty-two patients who underwent hemiarthroplasty and 16 patients who underwent THA for treatment of Garden type 3–4 FNFs from 2012 to 2015 were enrolled in this study. All patients were >65 years of age. Cox regression analysis was performed for mortality evaluation.Results The postoperative blood loss volume, decrease in the hemoglobin level, and transfusion rate were significantly higher in the THA group. The univariate mortality risk was higher in patients with a Charlson comorbidity score of >4, American Society of Anesthesiologists score of >2, Singh index of <3, and postoperative hospitalization of >1 week.Conclusion This study revealed no significant difference in the short-term clinical and radiological results between cementless hemiarthroplasty and THA in elderly patients with displaced FNFs. However, morbidity and mortality were associated with the presence of additional systemic diseases. THA is the preferred surgical technique in patients with displaced FNFs and low comorbidities.