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Abstract Fracture neck of femur has always been a great challenge to orthopedic surgeons, the aim of the management is early ambulation and good functional outcome also avoiding complications and reoperation as the elderly patients often have several comorbidities. THA is a more complex procedure, takes longer, and is at higher risk of subsequent dislocation 58 However, some small randomized controlled trials (RCTs) have reported better functional outcomes, fewer wound complications, and less need for secondary procedures after THA compared to hemiarthroplasty59 Several benefits such as early recovery and a low incidence of dislocation may result from a minimally invasive approach to the muscle and the joint capsule. In a word, BHA has favor in decrease blood loss and surgery time and THA has favor in decrease the length of hospital stay , the incidence of pneumonia and renal failure. National guidelines therefore recommend offering THA to the fittest patients who are most likely to tolerate a bigger operation and also to benefit from better functional outcomes 61; 60, However, these recommendations have not been universally implemented. There are clear institutional challenges to widespread provision of THA 61 However, use of THA might also be affected by surgeons’ preferences, judgment, and interpretation of the research evidence 62,63. |