11 randomized control trials, with a minimum of 4 years follow-up, comparing arthroplasty (either total hip arthroplasty or hemiarthroplasty) to internal fixation for the treatment of displaced femoral neck fractures were included for analysis. The primary purpose of the study was to determine whether treatment with arthroplasty resulted in long-term differences in mortality and/or re-operation risk compared to internal fixation. Secondary outcomes included a comparison of long-term effects on hip function and risk of complications. Pooling of results indicated that treatment with arthroplasty resulted in a significantly decreased risk of re-operation, a significantly increased risk of hip dislocation, and no significant difference to mortality up to 10 years after treatment, as compared to internal fixation. Functional improvement was significantly greater for patients receiving arthroplasty up to 6 years after treatment, but no difference in function was seen between groups at 6-10 years after treatment.