Background <p>To investigate the risk factors for mortality in elderly patients who underwent hemiarthroplasty for femoral neck fractures over a five-year follow-up period.</p> Methods <p>A retrospective analysis of clinical data from 80 elderly patients treated with hemiarthroplasty between January 2015 and December 2018. Kaplan–Meier survival analysis was conducted, and both univariate and multivariate logistic regression analyses identified independent mortality risk factors, including age, preoperative mobility, BMI, cardiovascular comorbidities, and fracture type.</p> Results <p>Of the 80 patients, 38 (47.5%) died within the follow-up period. Kaplan–Meier analysis showed significantly reduced survival in patients with cardiovascular comorbidities, unstable fractures (Garden III and IV), and limited pre-fracture mobility (<i>p</i> &lt; 0.05). Univariate analysis identified age, pre-fracture mobility, BMI, cardiovascular comorbidities, and fracture type as significant factors associated with mortality (<i>p</i> &lt; 0.05). Multivariate analysis confirmed age, pre-fracture mobility, cardiovascular comorbidities, and unstable fractures as independent mortality predictors (<i>p</i> &lt; 0.05).</p> Conclusions <p>Advanced age, limited mobility before fracture, cardiovascular comorbidities, and unstable fractures significantly increase mortality risk in elderly patients undergoing hemiarthroplasty. Tailored fracture management and optimized cardiovascular care could improve survival.</p>