Objective To investigate the efficacy of hip implants by using porous tantalum coating in the treatment of elderly femoral neck fractures with osteoporosis patients. Methods A prospective study of 30 cases (30 hips) of elderly femoral neck fractures with osteoporosis patients who underwent total hip arthroplasty in Dalian University Afifliated Zhongshan Hospital from January 2010 to December 2012. The patients were divided into two groups by the operation methods:Group A, 15 cases (15 hips) accepted ordinary cementless hip implants;Group B, 15 cases (15 hips) accepted hip implants by using porous tantalum coating. Follow ups were performed at 6 months, 12 months, 36 months after the operation. Operation time, intraoperative bleeding, average of stay in hospital, time to weight bearing were compared between the two groups. According to Harris hip score, functioning hips of the two groups were evaluated. Evaluation of hip prosthesis stability based on DeLee and Charnley and Gruen partitioning. Results All patients were followed up for 36 to 64 months, with an average of 48±9 months. Harris score for hip function was signiifcantly better in Group B than Group A at 12 months and 36 months postoperation (F=?2.483, P<0.05;F=?2.412, P<0.05). In Group A, three cases affected osteolysis at 36 months and one case experienced prosthesis loosening at 49 months after arthroplasty. In Group B, imaging examination showed that bone ingrowth of the femoral prosthesis and stability of acetabular prosthesis were observed in all patients, no osteolytic lesion, no sinking or loosening. Conclusions Hip prosthesis by using porous tantalum coating can achieve early bone ingrowth, enhance the stability, and decrease the incidence of complications such as prosthesis sinking. It is a good choice for the treatment of elderly femoral neck fractures with osteoporosis patients.