Objective To investigate the mid- and long-term effects of total hip arthroplasty and percutaneous compression plate for displaced femoral neck fractures. Methods A retrospective analysis was made of medical data on 128 patients with displaced femoral neck fracture treated in the Beijing Electric Power Hospital from January 2016 to May 2018, of whom 68 were treated by total hip arthroplasty (THA group) and 60 by percutaneous compression plate (PCP group). The two groups were compared in the perioperative indexes, hip function improvement on Aubigné-Postel score, quality of life, occurrence of postoperative complications, and cost of treatment. SPSS 19.0 was used for data analysis. Depending on the data type, t-test or χ² test was used for comparison between groups. Results The THA group had more intraoperative blood loss and intraoperative blood transfusion, and longer postoperative hospital stay than PCP group, the difference being statistically significant (P<0.005). The postoperative 3-year follow-up showed significantly higher Zuckerman functional recovery scale(FRS) score and lower rates of total complications in the THA group than PCP group (P<0.005). There was no significant difference in European quality of life 5-dimensions (EQ-5D) between the two groups (P>0.05). During postoperative 3 years, the costs for initial surgery and all associated treatment were higher in the THA group than those in the PCP group, and the cost for the second surgery and associated medical services were lower in the THA group than those in the PCP group (P<0.05), the differences being statistically significant. Conclusion In the treatment of displaced femoral neck fractures, total hip arthroplasty has better hip recovery and fewer mid- and long-term postoperative complications but longer operation time, more blood loss, larger trauma surface, and higher cost than percutaneous compression plate. The choice should be made after considering the patient′s own situation.