Background: Hip hemiarthroplasty (HHA) is the selected procedure among patients with femoral neck fracture and aged over 70 years old. Lots of different approaches have been proposed for this operation. However, neither of them is confirmed to be superior.
Objectives: The purpose of this study was to compare the posterolateral vs. direct lateral approach with regard to dislocation and mortality rates.
Methods: For this retrospective study, 154 patients with femoral neck fracture were assessed from 2012 to 2018. Demographic data, surgical sheet reports, and plain radiography were evaluated. Postoperative dislocation, reoperation, infection, thromboembolic events, one-year mortality and total mortality rates were extracted through interviews and medical documents.  
Results: There was no significant difference between these two surgical approaches in terms of age, gender, time delayed to perform the surgery, Garden classification, and the etiology of fracture. The duration of the surgery was longer in the posterolateral approach without statistical significance. 36 months later, dislocation, infection, and one-year mortality rates were higher in the direct lateral approach. Recurrent dislocation and total mortality rates were higher in the posterolateral approach. No statistical significance was found between the two groups regarding the above-mentioned variables.  
Conclusion: The two HHA approaches were similar in terms of the duration of the surgery, dislocation, reoperation, and mortality rates. None of the approaches was superior to the other.