Femoral neck fracture is a common disease in orthopedics, with an incidence of about 30%-40% in people over 60 years of age. The traditional treatment of femoral neck fractures in the elderly by internal fixation has a high incidence of bone failure and femoral head necrosis. The use of artificial femoral head replacement or total hip arthroplasty can reconstruct the function of the hip joint more rapidly, which is a more ideal and reliable method for treating femoral neck fracture in the elderly. The two methods are briefly introduced: artificial femoral head replacement is divided into unipolar artificial femoral head replacement and bipolar artificial femoral head replacement. The bipolar artificial femoral head has been continuously improved and its application has been expanded. Its advantage is that it has two movable centers, the second center can withstand and and all the force of
70 %. It is relatively simple to operate, less traumatic, less bleeding, shorter operation time, and faster functional recovery after surgery because it does not require treatment of the acetabulum. Therefore, it is more suitable for patients with no obvious acetabular lesions, no serious osteoporosis, and older patients with other serious medical disorders. However, there are problems with the wear and tear of the acetabular cartilage, the displacement of the central protrusion of the artificial head and the sinking of the stem of the prosthesis, especially in the case of unipolar artificial head replacements. Some unipolar artificial femoral head replacements are associated with significant pain and claudication, and significant limitation of hip movement. Therefore, strict measurements should be taken for each patient before surgery to select a suitable femoral head, and artificial femoral head replacement should be avoided for patients with significantly more osteoporotic bones. Artificial femoral head replacement has more hip pain and loosening of the prosthetic stem than total hip replacement, and the acetabulum is prone to wear and tear, making it unsuitable for relatively young patients with a high level of activity, who often need revision to total hip replacement due to loosening, pain and acetabular wear. The advantages of total hip replacement are less postoperative pain, better postoperative function, no acetabular wear, and low postoperative revision rate. The main complication is postoperative hip dislocation, which is related to the poor condition of soft tissues and the relatively poor awareness of dislocation prevention in the elderly; another complication is deep vein thrombosis, which should be taken seriously and measures should be taken to prevent it. The choice of artificial femoral head replacement or total hip replacement for femoral neck fractures is still controversial. Both total hip replacement and artificial femoral head replacement are effective methods for treating femoral neck fractures in the elderly, and should be analyzed specifically according to the patient’s age, fracture type, surgical tolerance and degree of osteoporosis. For patients of advanced age, with low activity and poor physical condition who cannot tolerate larger surgery, it is not necessary to force total hip replacement, and it is better to apply bipolar artificial femoral head replacement than total hip replacement. For fractures that are not contraindicated and are in good health, or for old fractures, total hip replacement can be considered. The choice of internal fixation or artificial joint replacement should take into account not only the patient’s age and fracture type, but also the patient’s general health condition, the degree of osteoporosis, as well as his or her own medical technology and treatment cost. At present, with the improvement of surgical instruments, the operation time of hip replacement has been significantly shortened, and the design of prosthesis and cement technology have also made great progress. Therefore, in order to get out of bed early to bear weight, reduce bedside complications, and avoid the risk and pain of secondary surgery, it is indisputable that artificial arthroplasty can achieve excellent clinical results when the technical strength and the patient’s general condition permit. Since there is no absolutely suitable treatment for femoral neck fracture, different treatment methods should be chosen according to age, fracture site, degree of displacement, duration of injury and general condition, and family requirements. The hollow pressurized threaded nail method has the advantages of less injury, secure internal fixation and early functional recovery, and is suitable for the treatment of all types of fractures, but for subtrochanteric or severely displaced transcervical fractures, there is a possibility of bone discontinuity or head ischemic necrosis with internal fixation treatment, and artificial arthroplasty is appropriate.