Objective: To explore the clinical application of artificial femoral head replacement under multi-disciplinary team (MDT) mode through different approaches in elderly patients with unilateral femoral neck fracture. Methods: A total of 60 elderly patients with unilateral femoral neck fracture admitted to the hospital were enrolled between June 2023 and June 2024. According to random number table method, they were divided into group A [artificial femoral head replacement through posterolateral (PLA) approach] and group B (artificial femoral head replacement through modified Harding approach), 30 cases in each group. The perioperative indexes (operation time, intraoperative blood loss, incision length, the first leaving bed time, length of hospital stay), pain [visual analogue scale (VAS)] at 3d and 7d after surgery, hip function [Harris hip scale (HHS)] and activities of daily living [Barthel index (BI)] at 3 months after surgery, and occurrence of postoperative complications were compared between the two groups. Results: The intraoperative blood loss, incision length, the first leaving bed time, length of hospital stay and incidence of complications in group B were lower than those in group A (P<0.05), VAS scores were lower than those in group A at 3d and 7d after surgery (P<0.05), and scores of HHS and BI were higher than those in group A at 3 months after surgery (P<0.05). Conclusion: Compared with PLA approach, artificial femoral head replacement under MDT mode through modified Harding approach can improve perioperative indexes, pain, hip function and activities of daily living, and reduce the incidence of postoperative complications.