Cemented versus uncemented femoral stem fixation in hip arthroplasty for displaced femoral neck fractures in elderly patients: A systematic review and meta-analysis of randomized controlled trials.

Abstract

The optimal method of femoral stem fixation in hip arthroplasty for displaced femoral neck fractures in elderly patients remains controversial. While cemented stems provide immediate fixation, concerns persist regarding perioperative risks. Uncemented stems avoid cement-related complications but may be associated with mechanical instability in osteoporotic bone. This systematic review and meta-analysis included randomized controlled trials comparing cemented and uncemented femoral stem fixation in elderly patients undergoing hemiarthroplasty or total hip arthroplasty for displaced femoral neck fractures. A comprehensive literature search of major databases was conducted from inception to July 2025. Outcomes of interest included mortality, periprosthetic fracture, dislocation, and wound infection. Data were pooled using a random-effects model, and subgroup analyses were performed based on follow-up duration and type of arthroplasty. To avoid duplication, only one dataset per study was included in the overall analysis. Sixteen randomized controlled trials involving 3776 patients were included. Cemented fixation was associated with a statistically significant reduction in overall mortality compared with uncemented fixation (odds ratio 0.83, 95% confidence interval 0.70-0.97). The risk of periprosthetic fracture was substantially lower with cemented stems (odds ratio 0.22, 95% confidence interval 0.12-0.41). No significant differences were observed between fixation methods for dislocation (odds ratio 0.96, 95% confidence interval 0.53-1.72) or wound infection (odds ratio 0.89, 95% confidence interval 0.58-1.35). Findings were consistent across subgroup analyses. Cemented femoral stem fixation in elderly patients undergoing arthroplasty for displaced femoral neck fractures is associated with a lower risk of periprosthetic fracture and a modest reduction in mortality, without increasing the risk of dislocation or infection. These findings support the use of cemented fixation as a reliable and safe strategy in this population.