Objective To compare the short-term clinical effects of total hip arthroplasty with dual-mobility cup and hemiarthroplasty for the elderly femoral neck fracture. Methods Forty-seven elderly patients with femoral neck fracture admitted in our department from June 2016 to June 2019 were enrolled in this study. According to the surgical treatments, they were divided into observation group (total hip arthroplasty with dual-mobility cup, n=19) and control group (hemiarthroplasty, n=28). The operation time, blood loss volume, and length of hospital stay, Harris hip score (HHS), incidence of complications, and postoperative mortality within 1 year were recorded and evaluated, and compared between the two groups. Results All patients were followed up for 9 to 40 months (mean 23 months). The operation time and blood loss were better in the control group than the observation group, but no significant difference was seen in length of hospital stay between the two groups (P<0.05). The postoperative HHS scores were improved in both groups after operation. The observation group had better HHS scores than the control group at the subsequent follow-up time points, and obtained predominantly better excellent rates of hip function recovery till the last follow-up. The incidence of postoperative complications was 5.3%(1/19) in the observation group and 17.9%(5/28) in the control group, and the mortality within 1 year was 5.3%(1/19) in the former and 7.1%(2/28) in the latter group, with significant difference between them (P>0.05). Conclusion Hemi-arthroplasty has the advantages of short operation time, less blood loss and simple operation, but the rates of postoperative hip pain, dislocation and reoperation are higher than those of dual-mobility total hip arthroplasty, which can also provide better joint function and prosthesis stability. So we recommend the latter operation to be the first choice for femoral neck fracture in the elderly.