A meta-analysis was performed using 20 fully-randomized RCTs comparing arthroplasty and internal fixation in the treatment of elderly patients suffering from displaced femoral neck fractures. Mortality rates (at one year and three years), revision surgery rates (at one year and five years), major surgical complications (at one year and five years) and function (assessed by the ability to walk, the need for walking aids, the Harris hip score, Eq-5d score, and the Barthel index) were analyzed for both groups. Those treated with arthroplasty showed reduced risks of major surgical complications at one year and at five years, reduced rates of reoperation at one year and at five years, increased function and decreased reported pain compared to those treated with internal fixation. However, there was no difference in mortality at one year and at three years in patients treated with arthroplasty compared to internal fixation.