Femoral neck fractures in the elderly are common injuries associated with significant morbidity and mortality. Arthroplasty has emerged as the standard of care for displaced femoral neck fractures, as well as certain nondisplaced fracture patterns. Favorable outcomes following hemiarthroplasty and total hip arthroplasty are dependent on patient selection, timing of surgery, surgical approach, implant selection, and postoperative protocols. Furthermore, the surgeon should take steps to minimize the risk of complications such as dislocation and periprosthetic fracture. This chapter reviews the key surgical decisions and technical considerations necessary to avoid complications when performing hemiarthroplasty and total hip arthroplasty for femoral neck fractures.