Objective To evaluate the perioperative safety and efficacy of hip arthroplasty in elderly(≥80) femoral neck fracture.Methods Seventy-eight patients over 80 years old who received hip arthroplasty,including total hip arthroplasty(THA,11 cases)and hemiarthroplasty(HA,67 cases),between Nov 1997 and Nov 2007 were analyzed retrospectively.Results Of the patients,aged(83.7±3.59) years in average,with Garden Ⅲ(42 cases) and Garden Ⅳ(36 cases) respectively,ASA classification showed that 80.8% patients belonged to high risk group preoperatively.There was no statistical difference between predicted values and observed values by Physiological and Operative Severity Score for the Enumeration of Mortality and Mobility scoring system(32 cases and 24 cases,P=0.205),and THA group or HA group had no statistical difference.The satisfaction index of easement of pain was 96.2%,and indoor activities with or without brace rate was 76.9% at two weeks after operation.Conclusion By the necessary intervention to the physiological status and operation methods for improving the prognosis,hip arthroplasty is a safe and effective procedure to treat the femoral neck fracture in elderly patients.