Total hip replacement is increasingly being considered as a potential standard of care for certain femoral neck fractures, particularly in older, active patients. Emerging evidence suggests that, compared with internal fixation or hemiarthroplasty, total hip arthroplasty may provide improved functional outcomes, greater mobility, and lower rates of revision in appropriately selected individuals. While concerns remain regarding dislocation risk and surgical complexity, advances in implant design and surgical technique are helping mitigate these issues. These findings reflect a shift toward prioritizing long-term function and quality of life in fracture management, with treatment decisions increasingly guided by patient activity level, comorbidities, and life expectancy rather than a one-size-fits-all approach.