AIM: There is a controversial argument about the choice of total hip replacement (THR) and bipolar artificial femoral head replacement (FHR) for elderly patients with femoral neck fracture. This study was designed to explore the long-term biocompatibility and functional recovery of joints in patients over 70 years with femoral neck fracture by THR and bipolar artificial FHR. METHODS: Sixty patients with femoral neck fracture over 70 years were enrolled from the First Department of Bone and Joint Surgery in the First Hospital of Jilin University from January 2002 to December 2006. There were 21 cases (8 males and 13 females) receiving THR, with a mean age of (72.1?3.5) years, and 18 of them were complicated with internal diseases. While 39 cases (16 males and 23 females) received bipolar artificial FHR, their average ages was (75.1?6.4) years, and 35 of them were complicated with internal disease. ①Choice of artificial prosthesis: Sixteen prosthesis were produced by Germany Link Company and American Zimmer Company, 44 artificial joints were offered by Beijing Mengtaiyin Medical Instrument Co., Ltd. ②All the patients were operated by senior doctors who were qualified for post technique owing to more than 10-years working experience about artificial joints. ③The mean time of follow-ups for all patients was 37 months. The difference was compared in biocompatibility between materials and host, joint function, Harris scoring, time of operation, blood loss, time of hospitalization, cost of hospitalization and adverse effect. RESULTS: ①Comparison of biocompatibility: Two revisions for abrasion of acetabular wall were carried out 5 years after bipolar artificial FHR, and there was no infection of incision, dislocation of hip joint or loose of artificial joint in other patients of these two groups. ②Comparison of adverse effect: There was one patient with complications of pain and red swelling of hip in each group. No infection occurred around the prosthesis, and these two patients recovered after symptomatic treatment. ③Comparison of follow-ups for joint function: The average Harris scores was 89.8?8.6 in THR group and 72.7?9.5 in bipolar artificial FHR group, and there were significant differences in these two groups (P 0.05). ⑤Comparison of operation time and blood loss: The average operation time were (150.2?24.3) minutes in THR group and (105.8?22.1) minutes in bipolar artificial FHR group, with significant differences (P