Cemented Vs Cementless Femoral Fixation for Total Hip Arthroplasty After Displaced Femoral Neck Fracture: A Nationwide Analysis of Short-Term Complications and Readmission Rates



      Active patients with displaced femoral neck fractures are often treated with total hip arthroplasty (THA). However, optimal femoral fixation in these patients is controversial. The purpose of this study was to compare early complication and readmission rates in patients with hip fracture treated with THA receiving cemented vs cementless femoral fixation.


      The National Readmissions Database was queried to identify patients undergoing primary THA for femoral neck fracture from 2016 to 2017. Postoperative complications and unplanned readmissions at 30, 90, and 180 days were compared between patients treated with cemented and cementless THA. Univariate and multivariate analyses were performed to compare differences between groups and account for confounding variables.


      Of 17,491 patients identified, 4427 (25.3%) received cemented femoral fixation and 13,064 (74.7%) cementless. The cemented group was significantly older (77.2 vs 71.1, P < .001), had more comorbidities (Charlson comorbidity index: 4.44 vs 3.92, P < .001), and had a greater proportion of women (70.5% vs 65.2%, P < .001) compared with the cementless group. On multivariate analysis, cemented fixation was associated with reduced rates of periprosthetic fracture (odds ratio: 0.052, 95% confidence interval: 0.003-0.247, P = .004) at 30 days but similar readmission rates at 30, 90, and 180 days (odds ratio range: 1.012-1.114, P > .05) postoperatively compared with cementless fixation. Cemented fixation was associated with greater odds of medical complications at 180 days postoperatively (odds ratio:: 1.393, 95% confidence interval: 1.042-1.862, P = .025).


      Cemented femoral fixation was associated with a lower short-term incidence of periprosthetic fractures, higher incidence of medical complications, and equivalent unplanned readmission rates within 180 days postoperatively compared with cementless fixation in patients undergoing THA for femoral neck fracture.

      Level of Evidence

      Level III.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Filipov O.
        Epidemiology and social burden of the femoral neck fractures.
        J IMAB--Annu Proceeding Sci Pap. 2014; 20: 516-518
        • Brauer C.A.
        • Coca-Perraillon M.
        • Cutler D.M.
        • Rosen A.B.
        Incidence and mortality of hip fractures in the United States.
        JAMA. 2009; 302: 1573-1579
        • Kazley J.
        • Bagchi K.
        Femoral neck fractures.
        in: StatPearls. StatPearls Publishing, Treasure Island, FL2020
        • Chammout G.
        • Kelly-Pettersson P.
        • Hedbeck C.-J.
        • Stark A.
        • Mukka S.
        • Sköldenberg O.
        HOPE-Trial: hemiarthroplasty compared with total hip arthroplasty for displaced femoral neck fractures in octogenarians: a randomized controlled trial.
        JB JS Open Access. 2019; 4: e0059
        • Heetveld M.J.
        • Rogmark C.
        • Frihagen F.
        • Keating J.
        Internal fixation versus arthroplasty for displaced femoral neck fractures: what is the evidence?.
        J Orthop Trauma. 2009; 23: 395-402
        • Bhandari M.
        • Einhorn T.A.
        • Health Investigators
        Total hip arthroplasty or hemiarthroplasty for hip fracture.
        N Engl J Med. 2019; 381: 2199-2208
        • Blomfeldt R.
        • Törnkvist H.
        • Eriksson K.
        • Söderqvist A.
        • Ponzer S.
        • Tidermark J.
        A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients.
        J Bone Joint Surg Br. 2007; 89: 160-165
        • Lehil M.S.
        • Bozic K.J.
        Trends in total hip arthroplasty implant utilization in the United States.
        J Arthroplasty. 2014; 29: 1915-1918
        • Heckmann N.
        • Ihn H.
        • Stefl M.
        Early results from the American joint replacement registry: a comparison with other national registries.
        J Arthroplasty. 2019; 34: S125-S134.e1
        • Okike K.
        • Chan P.H.
        • Prentice H.A.
        • Paxton E.W.
        • Burri R.A.
        Association between uncemented vs cemented hemiarthroplasty and revision surgery among patients with hip fracture.
        JAMA. 2020; 323: 1077-1084
        • Murray D.W.
        Cemented femoral fixation: the North Atlantic divide.
        Bone Joint J. 2013; 95-B: 51-52
        • Ling R.S.M.
        • Charity J.
        • Lee A.J.C.
        • Whitehouse S.L.
        • Timperley A.J.
        • Gie G.A.
        The long-term results of the original Exeter polished cemented femoral component: a follow-up report.
        J Arthroplasty. 2009; 24: 511-517
        • Lewthwaite S.C.
        • Squires B.
        • Gie G.A.
        • Timperley A.J.
        • Ling R.S.M.
        The Exeter Universal hip in patients 50 years or younger at 10-17 years’ followup.
        Clin Orthop Relat Res. 2008; 466: 324-331
        • Stauffer R.N.
        Ten-year follow-up study of total hip replacement.
        J Bone Joint Surg Am. 1982; 64: 983-990
        • Deangelis J.P.
        • Ademi A.
        • Staff I.
        • Lewis C.G.
        Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: a prospective randomized trial with early follow-up.
        J Orthop Trauma. 2012; 26: 135-140
        • Parker M.I.
        • Pryor G.
        • Gurusamy K.
        Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures: a randomised controlled trial in 400 patients.
        J Bone Joint Surg Br. 2010; 92: 116-122
        • Taylor F.
        • Wright M.
        • Zhu M.
        Hemiarthroplasty of the hip with and without cement: a randomized clinical trial.
        J Bone Joint Surg Am. 2012; 94: 577-583
        • Langslet E.
        • Frihagen F.
        • Opland V.
        • Madsen J.E.
        • Nordsletten L.
        • Figved W.
        Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial.
        Clin Orthop Relat Res. 2014; 472: 1291-1299
        • Moerman S.
        • Mathijssen N.M.C.
        • Niesten D.D.
        More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up.
        BMC Musculoskelet Disord. 2017; 18: 169
        • Phillips J.R.A.
        • Moran C.G.
        • Manktelow A.R.J.
        Periprosthetic fractures around hip hemiarthroplasty performed for hip fracture.
        Injury. 2013; 44: 757-762
        • Frenken M.R.M.
        • Schotanus M.G.M.
        • van Haaren E.H.
        • Hendrickx R.
        Cemented versus uncemented hemiarthroplasty of the hip in patients with a femoral neck fracture: a comparison of two modern stem design implants.
        Eur J Orthop Surg Traumatol. 2018; 28: 1305-1312
        • Tsai M.-C.
        • Ng Y.-Y.
        • Chen W.-M.
        • Tsai S.-W.
        • Wu S.-C.
        The effects of cement fixation on survival in elderly patients with hip hemiarthroplasty: a nationwide cohort study.
        BMC Musculoskelet Disord. 2019; 20: 628
        • Viberg B.
        • Overgaard S.
        • Lauritsen J.
        • Ovesen O.
        Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture: 12- to 19-year follow-up of patients aged 75 years or more.
        Acta Orthop. 2013; 84: 254-259
        • Luo X.
        • He S.
        • Li Z.
        • Huang D.
        Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients.
        Arch Orthop Trauma Surg. 2012; 132: 455-463
        • Veldman H.D.
        • Heyligers I.C.
        • Grimm B.
        • Boymans T.A.E.J.
        Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: a systematic review and meta-analysis of current generation hip stems.
        Bone Joint J. 2017; 99-B: 421-431
        • Berry D.J.
        Epidemiology: hip and knee.
        Orthop Clin North Am. 1999; 30: 183-190
        • Springer B.D.
        • Etkin C.D.
        • Shores P.B.
        • Gioe T.J.
        • Lewallen D.G.
        • Bozic K.J.
        Perioperative periprosthetic femur fractures are strongly correlated with fixation method: an analysis from the American joint replacement registry.
        J Arthroplasty. 2019; 34: S352-S354
        • Liu T.
        • Hua X.
        • Yu W.
        Long-term follow-up outcomes for patients undergoing primary total hip arthroplasty with uncemented versus cemented femoral components: a retrospective observational study with a 5-year minimum follow-up.
        J Orthop Surg Res. 2019; 14: 371
        • Hailer N.P.
        • Garellick G.
        • Kärrholm J.
        Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register.
        Acta Orthop. 2010; 81: 34-41
        • Mäkelä K.T.
        • Matilainen M.
        • Pulkkinen P.
        Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations.
        BMJ. 2014; 348: f7592
        • Hooper G.J.
        • Rothwell A.G.
        • Stringer M.
        • Frampton C.
        Revision following cemented and uncemented primary total hip replacement: a seven-year analysis from the New Zealand Joint Registry.
        J Bone Joint Surg Br. 2009; 91: 451-458