## 7 Discussion  
In this paper, we aimed to assess the pros and cons of HA and DM-THA, and we wanted to offer our opinion about the best treatment in elderly (over 65 years old) patients with femur neck fractures. Usually, hip HA has been the first choice in patients with age >65 years and several comorbidities. With the current trend of healthy aging, many individuals over the age of 65 who sustain hip fractures remain physically active and maintain high functional demands. For this population, total hip arthroplasty (THA) has emerged as the most suitable treatment, offering superior medium-term functional outcomes, enhanced quality of life, and a lower rate of acetabular erosion. In contrast, hemiarthroplasty (HA) is associated with shorter hospital stays, reduced operative time, less blood loss, and a lower incidence of dislocations [31]. Dual mobility total hip arthroplasty (DM-THA) may represent an optimal solution to address the issue of dislocation. This technique allows for a greater range of motion, increased jump distance, and a reduced risk of postoperative instability. [PERSON] et al. [32], in a retrospective case-control study, found that frail patients undergoing DM-THA had a low dislocation rate without a corresponding increase in one-year mortality. In contrast, for non-frail individuals, no significant differences were observed in outcomes between HA and standard THA. Similarly, [PERSON] et al. [33], through a retrospective cohort analysis, reported that the DM-THA group achieved better clinical outcomes, as measured by the Harris Hip Score (HHS), without increased rates of mortality or dislocation during short-term follow-upwhen compared to HA. [PERSON] et al. [34] also supported the use of DM-THA as a primary treatment in relatively younger, active elderly patients with displaced femoral neck fractures. Their findings indicated improved functional recovery without added mortality or morbidity compared to HA. [PERSON] et al. [35] observed significantly lower rates of dislocation and reoperation in patients treated with DM-THA versus those receiving HA. [PERSON] et al. [36], in a case-control study assessing surgical duration and hemoglobin loss, noted that although DM-THA procedures were, on average, 12 min longer, they were associated with less blood loss. Importantly, DM-THA did not result in higher mortality, morbidity, bleeding, or dislocation rates compared to bipolar HA. Based on these findings, the authors proposed that DM-THA could be considered the preferred approach for managing displaced femoral neck fractures, especially in healthy and functionally active elderly patients. [PERSON] et al. [37] found a significant difference in dislocation rates and postoperative HHS in a case-control study. Rates were better in the DM-THA group compared to the HA group. No significant differences were found in operative time and hemoglobin loss in either group. [PERSON] et al. [38] found a lower cumulative incidence of reoperation for any reason in the DM-THA group (9%) than in the HA group (19%) with femur neck fracture. They did not find higher postoperative mortality in the DM-THA group compared to the HA group. [PERSON] et al. [39] conducted a systematic review and meta-analysis of the literature, reporting a lower overall risk of dislocation with DM-THA compared to both THA and HA. Additionally, they found that DM-THA was associated with lower rates of revision surgery compared to HA. Other case studies have also demonstrated positive outcomes and high patient satisfaction [40; 41; 42; 43; 44; 45; 46; 47]. [PERSON] et al. [48] reported favorable clinical outcomes in patients with femoral neck fractures treated with dual mobility total hip arthroplasty (DM-THA) using a direct anterior approach. These patients experienced rapid recovery of walking ability, no dislocations, and a low one-year mortality rate. [PERSON] et al. [49] examined the impact of DM-THA on clinical and functional outcomes in a population engaged in specific rituals involving extreme hip positions as part of their daily activities.