Objective： To compare the clinical effects between total hip arthroplasty (THA) and hemiarthroplasty (HA) for elderly femoral neck fracture. Methods: From 2007-2013, 385 elderly femoral fracture patients were treated by HA in the authors’ affiliated hospital. Among these patients, 82 patients (aged 80-85 years old) with the fracture type of Garden Ⅲ and Ⅳ were followed-up. According to these patients’ age, sex, height, weight and the classification of femoral neck fracture, we picked up 82 patients treated by THA for paired analysis. Preoperative Charlson comorbidity index(CCI), operation time, incision length, blood loss, complications, Harris hip score(HHS) of the last follow-up, hospital stay and expenses were recorded. Results: The mean follow-up time was 4.7 years. The difference of preoperative CCI between the two groups was statistically significant(P＜0.05). In the comparison of dominant blood loss, hidden blood loss, incision length, operative time, length of stay, and hospitalization costs, HA patients were better than THA patients (all P＜0.05). There were no significant differences in complication and HHS. Conclusion: HA can reduce blood loss, incision length, hospital stay and expenses, and is a good treatment for elderly patients with femoral neck fracture.