Forty-nine thousand, five hundred and ninety-seven patients aged 60 years or older from Ontario who underwent either total hip arthroplasty or hemi-arthroplasty for the treatment of displaced femoral neck fractures were included in this retrospective study examining clinical outcomes and associated factors with each procedure. A matched cohort of 9,238 patients was used to compare clinical outcomes. Outcomes of interest included the risk of hip dislocation, revision surgery, and death. Results of the study found a higher risk of 1-year revision surgery and dislocation in the total hip arthroplasty group compared to the hemi-arthroplasty group. The risk of death at 1-year post-operation and the risk of revision surgery at 1.5-years post-operation were, however, significantly lower in the total hip arthroplasty group.