Objective To follow up a series of elderly patients who had acute femoral neck fracture, and to examine the performance of the combination of cemented stem and acetabular cup. Methods Forty-one elderly patients were followed up.The average age at operation was 72.1 years and follow-up was 3.2 years. Evaluations on the outcomes of hybrid hip arthroplasty included morphologic feature of bone, quality of cement mantle,and implant stability. Results No cement-related death intra- or postoperatively was documented and systemic diseases did not deteriorate peri-operatively. The total Harris Hip Score was 81.1 points. The bone type was evaluated as Type A, 20%; Type B,56%;Type C,24%. Quality of cement mantle was evaluated as Grade A, 37%; Grade B, 49%;and Grade C, 4%. Conclusion Hybrid total hip replacement is preferred in the elderly with acute femoral neck fracture.The immediate postoperative stability enables quicker rehabilitation of elderly patients and lowers the incidence of complications.Contemporary cementing techniques are mandatory in the operation.