559 patients undergoing hemiarthroplasty for femoral neck fractures were randomized to undergo either the posterolateral approach (PLA; n=275) or the direct lateral approach (DLA; n=284). The randomized controlled trial RCT) was done alongside a natural experiment (NE), which included 288 patients (n=172 DLA; n=116 PLA). The primary outcome of interest was quality of life at 6 months, measured using the Euro-Qol 5-Dimensions (EQ-5D-5L) questionnaire. Secondary outcomes of interest included EQ-5D-5L scores at 3 months, EuroQol Visual Analog Scale (EQ-VAS) at 3 and 6 months, and the incidence of dislocation, reoperation, good mobility, ADL independence, falls, and mortality, all at 6 months. In the RCT, all outcomes were similar at all time points between the two groups, except for the incidence of dislocation which was significantly higher in the PLA group. Similar quality of life scores and a higher rate of dislocation was also observed in the natural experiment, corroborating the findings from the RCT.