As the population continues to live longer and be in better health low energy neck of femur fractures continue to rise annually in incidence. Such injuries are common enough that many orthopedic surgeons doubtlessly feel confident in their management. Despite this the topic retains importance to the practicing surgeon and the health system because these injuries require rapid and judicious management and are still plagued with complications and consequences for patients and their families. Optimizing indications and excellence in technical execution remain the surgeons’ best tools to maximize outcomes. The current review provides an update on four technical considerations during replacement (arthroplasty) for these injuries: Approach, fixation, head type (hemiarthroplasty), and hemiarthroplasty versus total hip arthroplasty.