Ninety cognitively intact patients with hip fractures were randomized to undergo hemiarthroplasty using either the anterior approach (n=45) or the lateral approach (n=45). The primary outcome of interest was patient-reported outcomes measured by the Visual Analogue Scale (VAS), Barthel-20, and EQ-5D scores. Secondary outcomes included surgical time, transfusion requirements, serious adverse events, hip-related complications, length of stay (acute and rehabilitation), and radiographic parameters. Outcomes were assessed at 2, 6, 12, 26, and 52 weeks. Overall, the results revealed no significant differences between groups in primary outcome scores at any time point (p>0.05). The anterior approach resulted in a slightly longer surgical time (96±19 vs. 88±15 min; p<0.05), but blood loss, complications, and length of stay were similar. These findings suggest that the anterior approach does not provide superior outcomes in elderly hip fracture patients undergoing hemiarthroplasty and may not warrant widespread adoption in this population.