Between 1980 and 1989 in 195 elderly patients with fractures of the femoral neck a duo-cup endoprosthesis was inserted. The average age was 78 years, most of them were high risk patients with sometimes more than 2 preexisting diseases. The hospital mortality after hip replacement was 9.7%, specific complications like protrusio acetabuli and shaft fractures were not observed. In 2 cases immediate postoperative luxation required reintervention. The incidence of infection was significantly reduced to 2.4% after antibiotic therapy. When discharged from hospital, 86% had a good functional result. We regard hemiarthroplasty with duo-cup endoprosthesis as an acceptable alternative to total hip replacement in elderly patients with fractures of the femoral neck.