Cemented hip stems reduce mortality and periprosthetic fractures in elderly femoral neck fracture patientsCemented Fixation Reduces Mortality for Femoral Neck Fractures

Injury Published August 3, 2026 Study authors: Malki Abdalmalik T, Babtain Hamed W, Alharbi Deemah M, Shahhatalsayed Awwab A, Alshaban Raneem M, Al… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider cemented fixation for displaced femoral neck fractures to lower periprosthetic fracture risk and modestly reduce mortality.

This meta-analysis pooled data from randomized controlled trials involving elderly patients undergoing hemiarthroplasty or total hip arthroplasty for displaced femoral neck fractures. The analysis compared cemented femoral stem fixation with uncemented fixation, focusing on mortality as the primary outcome, along with secondary outcomes including periprosthetic fracture, dislocation, and wound infection.

The authors observed a statistically significant reduction in overall mortality with cemented fixation compared to uncemented fixation, though the effect was described as modest. More notably, the risk of periprosthetic fracture was substantially lower with cemented stems. However, there were no significant differences between the two fixation methods for dislocation or wound infection.

The authors did not report specific limitations, but as with any meta-analysis, the findings are dependent on the quality and heterogeneity of the included trials. The analysis is based on randomized controlled trials, which supports the association, but the modest mortality benefit should be interpreted cautiously.

For clinical practice, cemented fixation appears to offer advantages in reducing periprosthetic fractures and possibly mortality, without increasing the risk of dislocation or infection. However, individual patient factors and surgical expertise should guide the choice of fixation method.

Researchers analyzed data from 3,776 elderly patients who underwent surgery for displaced femoral neck fractures. The study compared two types of hip replacements: cemented femoral stem fixation and uncemented femoral stem fixation. This type of analysis combines results from multiple studies to identify broader trends in patient outcomes.

The findings showed that patients who received cemented fixation had a statistically significant reduction in overall mortality compared to those with uncemented fixations. Additionally, the study found a substantially lower risk of periprosthetic fractures for patients with cemented stems. These results suggest that cemented fixation may offer specific safety benefits for this patient group.

However, there were no significant differences between the two methods regarding wound infections or hip dislocations. Because this is a meta-analysis of existing data, it shows an association rather than a direct cause. Patients and doctors should consider these findings as one part of the overall clinical picture when choosing the best surgical approach for hip fractures.

What this means for you:

Cemented hip implants may lower mortality and fracture risks in elderly patients with femoral neck fractures.

Common questions

Is it safer to use cemented or uncemented hip implants?

The study found that cemented fixation was associated with a statistically significant reduction in overall mortality compared to uncemented fixation. It also showed a substantially lower risk of periprosthetic fractures for those with cemented stems. There were no significant differences between the two methods regarding wound infections or dislocations.

Does cement increase the risk of infection?

No, the data did not show a significant difference in wound infection rates between patients who received cemented fixation and those who received uncemented fixation. The odds ratio for infection was 0.89, which was not statistically significant.

Does cement affect how often the hip joint dislocates?

The study found no significant differences in dislocation rates between cemented and uncemented fixation methods. The results showed an odds ratio of 0.96, indicating that both types of fixations performed similarly regarding the risk of a dislocated hip.

Study Details

Study typeMeta analysis

Sample sizen = 3,776

EvidenceLevel 1

PublishedAug 2026

PMID42259040

View Original Abstract ↓

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Cemented hip stems reduce mortality and periprosthetic fractures in elderly femoral neck fracture patientsCemented Fixation Reduces Mortality for Femoral Neck Fractures

Common questions

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Cemented hip stems reduce mortality and periprosthetic fractures in elderly femoral neck fracture patientsCemented Fixation Reduces Mortality for Femoral Neck Fractures

Common questions

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Study Details

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Clinical research that matters. Delivered to your inbox.

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