Abstract:[Objective] To compare the clinical efficacy of hemiarthroplasty (HA) versus total hip arthroplasty (THA) for femoral neck fracture accompanied with left heart failure in the elderly. [Methods] A retrospective study was conducted on 45 elderly patients who re- ceived surgical treatment for displaced femoral neck fracture complicated with left heart failure in our hospital from 2017 to 2019. Accord- ing to preoperative doctor-patient communication and cardiac function status, 30 patients underwent HA, while the remaining 15 patients underwent THA. The documents regarding to clinical conditions, cardiac function and radiographs were compared between the two groups. [Results] The HA group proved significantly superior to the THA group in terms of operation time, intraoperative blood loss, postoperative drainage, decline of hemoglobin and hospital stay (P＜0.05) . The Harris scores increased significantly over time postoperatively in both groups (P＜0.05) . Although there were no significant differences in Harris score between the two groups at 3 and 6 months after surgery (P＞ 0.05) , the THA group was significantly better than HA group in Harris score at 12 months after operation (P＜0.05) . In terms of cardiac function, the ejection fraction remained unchanged before and after surgery in both groups (P＞0.05) , whereas which in the HA group were significantly inferior to those in the THA group at any corresponding time point (P＜0.05) . Postoperative radiographs showed that the pros- thesis in both groups was in good position, without clear band around the prosthesis, osteolysis, infection, subsidence and other adverse man- ifestations. [Conclusion] Hemiarthroplasty is safe and effective for the patients with heart failure and abnormal ejection fraction, whereas to- tal hip arthroplasty should be considered for those with heart failure but normal ejection fraction to achieve better long-term hip function.