Aims: To evaluate a new treatment protocol for femoral neck fractures based on our own and other authorsñ randomised studies concerning choice of surgical treatment. Methods: Consecutive study of 358 patients, 1-year follow-up. According to our new program all undisplaced fractures and all fractures in patients under 70 years were treated with close reduction and Hansson hook pins. Active, independent patients aged 70 Ð 80 years with displaced fractures received a total arthroplasty, the frailer patients in this age group and all those over 80 years received a hemi-arthroplasty. Internal þxation could be chosen for patients with life threatening diseases. Results: Introducing primary arthroplasty in our new program instead of internal þxation for a majority of the displaced fractures reduced the failure rate for patients over 70 years from 42% to 5%. Internal þxation for displaced fractures in patients under 70 years had a 48% failure rate, but risk factors for failure were frequent among these patients. Undisplaced fractures had a failure rate of 14%. The study compromises the þrst year with this new protocol and in 4% of the cases the surgeon did not adhere to the protocol. Mortality for women was 5% at 1 month and 21% at 1 year; for men 12 and 32% respectively. Conclusions: We consider the treatment regime successful and feasible and 1 year follow up shows adherence to the new program. Primary arthroplasty for displaced fractures for a great majority of all patients over 70 years has signiþcantly reduced the failure rate compared to earlier results after internal þxation.