One hundred and twenty octogenarian patients with acute, displaced femoral neck fractures were randomized to receive a hemiarthroplasty (HA; n=60) or a total hip arthroplasty (THA; n=60). The primary outcomes of interest included hip function status assessed with the Harris Hip Score (HHS) and health-related quality of life assessed with the Euro-QoL-5 Dimensions (EQ-5D) questionnaire. Secondary outcomes of interest included pain on a numeric rating scale (NRS), the proportion of patients with full independence in activities of daily living, and the incidence of complications and re-operation. Outcomes were assessed at 3 months, 1 year and 2 years post-operation. Results revealed no statistically significant differences between the THA and HA groups in HHS scores, EQ-5D scores, NRS pain scores, and proportion of patients able to fully perform activities of daily living at all time-points (p>0.05 for all). In the HA group, 4 cases of hip complication, 2 cases of major re-operation, 7 cases of pneumonia, 1 case of pulmonary embolism, 1 case of myocardial infarction, and 3 cases of cerebral vascular lesion were reported. In the THA group, 4 cases of hip complication, 1 case of major re-operation, 4 cases of pneumonia, 1 case of pulmonary embolism, 2 cases of myocardial infarction, 6 cases of cerebral vascular lesion, and 1 case of acute kidney failure were reported.