Introduction: Femoral neck fractures are one among the leading causes of death in elderly patients. Magnitude of fracture displacement, patient's age, comorbid disorders, and prefracture activity level are some of the critical factors in determining the clinical practice for treating femoral neck fracture. In this study, we have studied the functional outcome and survivorship in fracture neck of femur in the elderly population operated with both internal fixation (IF) and cemented hemiarthroplasty (HA). Material and Method: All 100 patients were reviewed clinically and radiologically at 15 days, 1 month, and then subsequent 1 year. Out of 100 patients, 54 have been operated with HA and 46 have been operated with screw fixation. Results: Overall reoperation rate in HA group was 5.05%, with total mortality rate being 7.4% compared to 6.5% of IF group. Out of 46 patients of screw fixation, the overall reoperation rate was 20% with 4 patients being developed avascular necrosis and 13 being developed nonunion, and rest of the patients have average Harris hip score of 60–65 with 34%, while patients having poor Harris hip score compared to those of HA with Harris hip score of 80–90 with 88.2% having excellent to fair. Conclusion: Hip arthroplasty as compared to Internal fixation for the treatment of femoral neck fractures significantly reduces the risk of reoperation at the cost of higher superficial infection and blood loss. Furthermore, postoperative function as evaluated by the Harris hip score was significantly higher in the arthroplasty compared to the IF group up to the 6-month evaluation.