Total hip arthroplasty (THA) is indicated for completely displaced femoral neck fractures (FNF) in elderly community ambulators. Compared to open reduction internal fixation (ORIF) and hemiarthroplasty (HA), THA has favorable outcomes in this population. Cementless fixation with prophylactic cabling is the technique of choice. THA is costlier for hip fractures than for osteoarthritis, but is cost effective for FNF given its lower rate of revision than HA or ORIF. Postoperative home discharge with a home exercise program in appropriate patients may effectively control costs while optimizing outcome.