Title : 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:
Background: The optimal method of femoral stem fixation for arthroplasty after a displaced femoral neck fracture remains debated. Cemented stems offer immediate stability in osteoporotic bone, whereas concerns persist regarding cement-related perioperative complications. This review compared clinically important outcomes following cemented and uncemented fixation in older adults.
Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidance. CENTRAL, Embase, MEDLINE/PubMed, ScienceDirect, and Scopus were searched from inception through July 2025 for randomized controlled trials comparing cemented and uncemented femoral stems in patients aged 60 years or older undergoing hemiarthroplasty or total hip arthroplasty for displaced femoral neck fractures. Outcomes included mortality, periprosthetic fracture, dislocation, and wound infection. Random-effects models generated pooled Odds Ratios (ORs) with 95% Confidence Intervals (CIs). Follow-up publications from the same randomized cohort were identified to prevent duplicate inclusion in overall analyses.
Results: Sixteen randomized controlled trials involving 3,776 participants were included: 1,901 received cemented fixation and 1,875 received uncemented fixation. Cemented stems were associated with lower overall mortality (OR 0.83, 95% CI 0.70–0.97) and a substantially lower risk of periprosthetic fracture (OR 0.22, 95% CI 0.12–0.41). There were no significant between-group differences in dislocation (OR 0.96, 95% CI 0.53–1.72) or wound infection (OR 0.89, 95% CI 0.58–1.35). Findings remained consistent across subgroup analyses by follow-up duration and arthroplasty type.
Conclusion: In elderly patients undergoing hip arthroplasty for displaced femoral neck fractures, cemented femoral stems reduce periprosthetic fractures and provide a modest mortality benefit without increasing dislocation or wound infection. These findings support cemented fixation as a reliable and safe strategy in this population.
