We present the clinical and radiographic outcome of 49 Exeter bipolar hemiarthroplasties for femoral neck fractures in 49 patients with a median age of 71 years at the time of operation. Median length of follow-up was 7.1 years (5 to 13). There was one dislocation, and one peri-prosthetic fracture. There were no revisions for infection, acetabular erosion or stem loosening. Twenty-six patients had died by the time of final follow-up with an overall 5 year cumulative survival of 60.2%. Thirty day mortality was 36% in patients with an ASA score of 3. We present excellent clinical and radiological medium to long term results with no evidence of acetabular erosion. However, careful patient selection is necessary to avoid high early mortality rates.