83 elderly patients with femoral neck fractures were randomized to receive a bipolar hip hemiarthroplasty via a direct anterior approach (DAA; n=40) or an anterolateral approach (ALA; n=43). The outcomes of interest included mobility measured with the Barthel Index, pain on a Visual Analog Scale (VAS), and heterotopic ossification occurrence, all measured up to 1 year post-operation. Pain scores in the first 2 weeks were significantly lower in the DAA group compared to the ALA group. While mobility was significantly better on post-operative day 1 in the DAA group, the ALA group showed superior mobility from week 6 to end of follow-up (1 year post-operation). The rate of heterotopic ossification was also significantly higher in the ALA group in the first 3 months post-operation. The results suggest that DAA may provide superior outcomes in the early post-operative phase, particularly with respect to early mobilization and pain scores. However, mobility may be better in the ALA group as the time from surgery increases.