This meta-analysis identified 8 randomized trials, comparing the use of total hip arthroplasty (THA) or hemiarthroplasty (HA) for the treatment of displaced femoral neck fractures in the elderly. The primary outcome assessed was the rate of re-operation, with secondary outcomes being mortality and dislocation rate, pain, function and quality of life. Results from the analysis indicated that THA provided better functional and pain outcomes using the Harris Hip score compared to HA. However, THA was associated with a greater risk of dislocation. Further large scale randomized trials are needed to establish an optimal treatment for femoral neck fractures in the healthy elderly.