Aims: To find out if osteosynthesis (OS) or hemiarthroplasty (HA) is better in terms of functional outcome. Patients and methods: In 1989–1996, all displaced cervical hip fractures were prospectively, using the same forms, registered at the University Hospitals of Oulu in Finland and Lund in Sweden. Cross-matchings was performed for age, sex, preoperative residence, and ambulatory capacity. Results: The first study comprised 357 pairs (OS with two hook pins and cementless Austin-Moore HA): OS was associated with a better functional outcome and lower mortality, but a higher re-operation rate than hemiarthroplasty. The second study had 446 pairs (OS two hook pins and cemntless HA): OS was associated with better function and lower mortality than HA, especially in younger patients, and it is recommended as the primary treatment for cervical non-pathological hip fractures in patients younger than 80 years and with good ambulatory capacity, whereas the oldest patients can also be safely treated by HA. The third study comprised 82 pairs (OS with three screws and cementless HA): Functional recovery is slightly better after OS with three screws than after uncemented HA, although no significant differences were seen in a sample of this size. On the other hand, OS is associated with a higher re-operation rate. Conclusion: OS seemed somewhat better in terms of functional outcome.