Comparison of Cemented and Cementless Hemiarthroplasty Outcomes: A Retrospective Analysis of Mortality, Complications, and Subsidence

Abstract

Aim: This study aimed to compare the clinical and radiological outcomes of cemented versus cementless femoral stems in patients undergoing hemiarthroplasty for femoral neck fractures.
Material and Methods: This study included patients who underwent hemiarthroplasty. Patients with pathological fractures, intertrochanteric fractures, secondary hemiarthroplasty after failed internal fixation, or total hip arthroplasty were excluded. Demographic, perioperative, and postoperative data were collected from hospital records. Radiographic evaluation included Dorr classification, leg length discrepancy, and femoral stem subsidence.
Results: A total of 364 patients were included. 212 (58.2%) patients underwent cemented and 152 (41.8%) cementless hemiarthroplasty. At final assessment, 131 (36.0%) patients were alive, 152 (41.8%) had died within one year, and 81 (22.3%) had died after one year. Cement use was not significantly associated with mortality (p=0.515), while 89 (42.0%) patients in the cemented group had died within the first year, this rate was 63 (41.4%) in the cementless group. Stem subsidence ≥5 mm was observed in 33 (15.6%) cemented patients and 19 (12.5%) cementless patients, without a statistically significant difference (p=0.410). Preoperative waiting time was significantly associated with one-year mortality (p<0.001).
Conclusion: Cemented and cementless hemiarthroplasty showed comparable outcomes with respect to mortality, implant-related complications, and stem subsidence in elderly patients with femoral neck fractures. Preoperative waiting time, rather than cement use, appeared to be the factor most strongly associated with early mortality. These findings highlight the importance of timely surgical management and careful patient selection based on bone quality.

Keywords

• Femoral neck fractures
• hemiarthroplasty
• bone cements
• mortality
• prosthesis failure

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