Cemented versus uncemented hemiarthroplasty for femoral neck fracture in patients aged 75 years or older: A retrospective cohort study with 3-year follow-up.

INTRODUCTION

Optimal femoral stem fixation for hemiarthroplasty in older adults with displaced intracapsular fractures remains controversial. Cemented stems may reduce mechanical failure, but cementation carries risks. This study compared mortality and complications after cemented versus uncemented hemiarthroplasty in patients aged 75 years or older.

METHODS

We performed a retrospective study of consecutive patients aged 75 years or older who underwent hemiarthroplasty for intracapsular fracture between January 2015 and April 2022. Patients were grouped by stem fixation and followed until death or censoring in December 2025, allowing at least three years of follow-up. Outcomes included periprosthetic femoral fracture, dislocation, periprosthetic joint infection, a composite of any complication, and all-cause mortality from the early postoperative period to 3 years. Multivariable Cox regression was used for 3-year mortality, and a Fine-Gray competing risk model, with death as the competing event, was used for 3-year complications.

RESULTS

We included 531 patients (266 cemented, 265 uncemented). Periprosthetic femoral fracture was more frequent with uncemented stems (4.5% vs. 1.5%, p = 0.042), whereas dislocation was more frequent with cemented stems (6.4% vs. 2.6%, p = 0.038). Periprosthetic joint infection and any complication did not differ significantly between groups at 1 or 3 years, and mortality did not differ at any assessed time point (all p > 0.05). Cemented fixation was not independently associated with 3-year mortality (HR 0.84, 95% CI 0.66-1.07; p = 0.166) or 3-year any complication (sHR 1.01, 95% CI 0.59-1.74; p = 0.977). Older age, male sex, and ASA class 3 to 4 independently predicted higher 3-year mortality.

DISCUSSION: In patients aged 75 years or older, stem fixation was associated with different complication patterns, with more periprosthetic fractures after uncemented fixation and more dislocations after cemented fixation. Despite these differences in specific complications, cemented fixation was not independently associated with 3-year mortality.