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 Apr;99-B(4):421-431. doi: 10.1302/0301-620X.99B4.BJJ-2016-0758.R1.


Aims: Our aim was to prepare a systematic review and meta-analysis to compare the outcomes of cemented and cementless hemiarthroplasty of the hip, in elderly patients with a fracture of the femoral neck, to investigate the mortality, complications, length of stay in hospital, blood loss, operating time and functional results.

Materials and methods: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on randomised controlled trials (RCTs), studying current generation designs of stem only. The synthesis of results was done of pooled data, with a fixed effects or random effects model, based on heterogeneity.

Results: A total of five RCTs including 950 patients (950 hips) were included. Cementless stems were found to be associated with more complications compared with cemented stems (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.12 to 2.31, p = 0.01), especially implant-related complications (OR 3.15, 95% CI 1.55 to 6.41, p = 0.002). The operating time was shorter for cementless stems (weighted mean difference -9.96 mins, 95%CI -12.93 to -6.98, p < 0.001). The data on functional outcomes could not be pooled. There was no statistically significant difference for any other outcome between the two methods of fixation.

Conclusion: In hemiarthroplasty of the hip using current generation stems, cemented stems result in fewer implant-related complications and similar mortality compared with cementless stems. Cite this article: Bone Joint J 2017;99-B:421-31.

Keywords: Cemented hemiarthroplasty; Cementless hemiarthroplasty; Displaced femoral neck fractures; Fixation; Hip.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Hip / methods*
  • Blood Loss, Surgical
  • Bone Cements
  • Cementation / methods*
  • Femoral Neck Fractures / surgery*
  • Hemiarthroplasty / adverse effects
  • Hemiarthroplasty / methods*
  • Hip Prosthesis*
  • Humans
  • Length of Stay / statistics & numerical data
  • Prosthesis Design
  • Randomized Controlled Trials as Topic
  • Reoperation / statistics & numerical data


  • Bone Cements