Femoral neck fractures are a common clinical injury in orthopedics, and it is now recognized that surgical treatment is significantly more effective than conservative treatment, with the patient generally being able to get out of bed 3-4 days after surgery. However, for femoral neck fractures in patients over 70, the risk of complications increases with advancing age, and because elderly patients are more often associated with decompensation of vital organs and complications, there are higher requirements for perioperative treatment than in younger patients. Some complications after total hip replacement are unique to the procedure, and some are common to any major surgery in the elderly. Complications specific to total hip replacement include neurovascular injury, peripheral organ injury, bleeding and hematoma, limb inequality, postoperative joint instability and dislocation, heterotopic ossification, thromboembolism, fracture, late loosening, infection, osteolysis, and prosthetic stem fracture.Clohisy et al. reviewed the causes of revision in hip revision patients between 1996 and 2003 and found that aseptic loosening accounted for 55 percent, instability 14 percent, infection 7 percent, periprosthetic fracture 5 percent, and prosthetic fracture 1 percent. Among them, aseptic loosening is the most important cause of revision. Some of these complications can seriously affect postoperative function, such as fractures, dislocations, and infections; while others may endanger the patient’s life, such as pulmonary embolism due to thromboembolism. The occurrence of many complications can be prevented, and many of them are related to the technical level of the surgeon, so clinicians should strive to improve their knowledge and technical level to minimize the occurrence of complications. What systemic complications should I be aware of during the perioperative period of total hip replacement? Like other major surgeries, total hip arthroplasty can cause systemic complications that can sometimes endanger the patient’s life, so clinicians should pay close attention to them. Commonly, such as peptic stress ulcers, postoperative gastric mucosal protective agents, such as omeprazole, should be given, and fecal occult blood tests should be performed if necessary. Myocardial infarction and heart failure are the most common life-threatening complications, and a detailed preoperative assessment of previous cardiac history and current cardiac status should be performed to avoid the occurrence of hypoxia and sudden increases and decreases in blood volume during surgery. Local placement of bone cement usually causes blood pressure fluctuations and occasional reports of arrhythmias and cardiac arrest, so fluid infusion should be accelerated to raise blood pressure while bone cement is being placed. Central venous pressure monitoring is performed if necessary. Fat embolism is not uncommon and is mostly transient, but in severe cases it can cause respiratory failure and lead to patient death. This complication should be considered and the appropriate department consulted if there is a postoperative decrease in oxygen saturation. Pulmonary embolism due to thromboembolism can lead to death within a short period of time and should be prevented. The average mortality rate of total hip replacement is about 1%, mostly due to the above-mentioned systemic complications. Therefore, careful preoperative evaluation is necessary to avoid the above-mentioned complications by comprehensive evaluation of the surgical risk according to the ASA score. Our hospital has a comprehensive preoperative preparation program for these complications, and as a result, there are very few perioperative joint replacement deaths each year, and no deaths have occurred in the past 20 years. Blood and urine routine, liver and kidney function, coagulation, blood group, ECG, echocardiography and chest x-ray were performed in all patients after hospitalization. Preoperative coexisting conditions: coexisting medical diseases such as hypertension, coronary heart disease; diabetes mellitus, post-stroke, respiratory diseases such as chronic emphysema. After preoperative cardiopulmonary function tests, supportive treatment such as antihypertensive, anti-infection and albumin infusion was given to correct the water-electrolyte imbalance. For hypertensive patients, blood pressure was controlled below 150/100 mmHg, and for diabetic patients, blood glucose was controlled below 9.0 mmol/L. Intraoperative and postoperative insulin was continued to control blood glucose to the basic normal level. Postoperatively, patients were given continuous analgesia for 48 h, continued treatment of coexisting conditions, protection of cardiopulmonary function, maintenance of water-electrolyte balance, and use of broad-spectrum antibiotics to prevent infection. The preoperative surgical tolerance assessment is based on the preliminary determination of cardiopulmonary function based on the pre-injury outdoor activity ability, and the cardiovascular and anesthesiology consultation is required if there is serious cardiopulmonary disease. Many physicians have concerns about whether elderly patients can tolerate surgery and survive the perioperative period, but our experience is that surgery is safe and feasible as long as preoperative coexisting conditions are actively treated, preoperative tolerance assessment is performed, and the timing of surgery is well chosen. Perioperative infections and postoperative deep vein thrombosis are the main focus of prevention, usually with 3-5 days of antibiotics and thromboprophylactic drugs. Early removal from bed will reduce complications and will also reduce the cost of treatment. We use the direct lateral approach and repair the joint capsule technique, the postoperative artificial joint has good stability and is not easy to dislocate This year, two 92-year-old elderly patients with femoral neck fracture both got out of bed and supported themselves after 4-5 days after surgery and were able to take care of themselves after 2 months.