Objective To compare the clinical efficacy of hemiarthroplasty （HA）, total hip arthroplasty （THA） and open reduction and internal fixation in the treatment of elderly patients with femoral neck fracture.Methods A total of 149 cases of elderly patients with femoral neck fracture were collected, 53 cases underwent HA （group A）, 41 cases underwent THA （group B） and 55 cases underwent open reduction and internal fixation （group C）. Operating time, volume of blood loss in the surgery, time of staying in bed and 1-3 years of follow-up clinical efficacy of the three groups were observed and analyzed with Harris hip scores. Results The time of staying in bed of A and B was shorter than that of C group with significant difference （P〈0.05）; the operation time and the blood volume of group A and B were more than those of group C with significant difference （P〈0.05）; Harris score of group A, B and C were （893±6.5）、（86.2±5.8）、（84.4±4.4）; respectively, the good rate of group A, B and C were 94.34 %, 85.4 % and 64.8 % respectively, Harris score andgood rate of group A and B compared with group C with significant difference （P〈0.05）. Conclusions HA and THA were better than internal fixation operation in surgical injury and Harris score, we recommended HA and THA with fracture type, patients state and economic conditions allowed.