OBJECTIVE: To compare the clinical efficacy of total hip arthroplasty (THA) with or without dual mobility cup (DMC) vs. hemiarthroplasty (HA) in elderly Asian patients with acute femoral neck fracture (FNF). METHODS: Data of 284 elderly FNF patients treated at our institution from January 2017 to December 2021 were retrospectively collected. Patients were divided into the DMC-THA group (THA with DMC, RESULTS: The Harris Hip Scores in the DMC-THA group were significantly higher than those in the C-THA and HA groups at 3 months, 6 months, and 1 year postoperatively ( CONCLUSION: THA with DMC offers superior joint function recovery, a lower dislocation rate, and improved quality of life compared to conventional THA and HA, positioning it as a preferred surgical option for elderly patients with acute FNF.