During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA). A single-center, observational retrospective study including 20 patients affected by COVID-19 infection (7 males, 13 females) who underwent HA between April 2020 to April 2021 was performed. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO2), fraction of the inspired oxygen (FiO2), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO2/FiO2), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients treated by this surgical approach. The reduction in the surgical time emerged in patients treated with DAA was extensively described in scientific literature. Patients  treated by DAA had a significantly lower blood loss, and supine decubitus seems to preserved respiratory function in HA surgery. For these reasons the DAA seems the optimal approach for COVID-19 affette patients.