59 patients with displaced femoral neck fractures and severe cognitive dysfunction were randomized to receive internal fixation (IF) with 2 cannulated screws or a cemented Exeter hemiarthroplasty (HA). Over 24 months after the fracture, 7 patients in the IF group required reoperation compared to only 1 patient in the HA group. At 12 months, the HA group had significantly higher health related quality of life scores than the IF group. However, this difference was not maintained at 24 months. Based on the incidence of reoperation, HA seems to be the safest treatment for displaced femoral neck fractures. Further research is required to replicate these findings.