Objective: This study aims to compare the therapeutic efficacy of Hardinge approach and SuperPATH approach on the treatment of femoral neck fractures with total hip arthroplasty (THA). Methods: A total of 120 patients with femoral neck fractures who underwent THA treatment at Beijing Longfu Hospital from January 2017 to January 2020 were retrospectively analyzed. The patients were randomly divided into a SuperPATH (SP) group and a Hardinge (HD) group, 60 patients in each group. Patients in the HD group underwent THA through Hardinge approach, and patients in the SP group underwent THA through SuperPATH approach. Age, gender, body mass index (BMI), fracture site, Harris score, surgical status, postoperative complications and functional recovery were collected and compared between the two groups. Results: There were no statistically significant differences in gender, age, BMI, fracture site and Harris score between the two groups (P>0.05). Compared with the HD group, patients in the SP group had shorter incision length, less intraoperative blood loss, lower complication rate, earlier getting out of bed and shorter length of hospital stay, but the operation time of SP group was longer than that of the HD group. The implants were finely placed in both groups. The hip function of the SP group was better than that of the HD group at 6 months after surgery, while the difference was not statistically significant at 12 months after surgery (P>0.05). Conclusion: SuperPATH approach for total hip arthroplasty has less trauma, fewer complications, and faster recovery, and it is suitable for clinical promotion.