A randomized controlled trial of cemented versus cementless arthroplasty in patients with a displaced femoral neck fracture: a four-year follow-up

Bone Joint J. 2018 Aug;100-B(8):1087-1093. doi: 10.1302/0301-620X.100B8.BJJ-2017-1593.R1.


Aims: The aim of this study was to compare the functional and radiological outcomes in patients with a displaced fracture of the hip who were treated with a cemented or a cementless femoral stem.

Patients and methods: A four-year follow-up of a randomized controlled study included 141 patients who underwent surgery for a displaced femoral neck fracture. Patients were randomized to receive either a cemented (n = 67) or a cementless (n = 74) stem at hemiarthroplasty (HA; n = 83) or total hip arthroplasty (THA; n = 58).

Results: Early differences in functional outcome, assessed using the Harris Hip Score, the Short Musculoskeletal Functional Assessment score and EuroQol-5D, with better results in cemented group, deteriorated over time and there were no statistically significant differences at 48 months. Two (3%) patients in the cemented group and five (6.8%) in the cementless group underwent further surgery for a periprosthetic fracture. This difference was statistically significant (p = 0.4). No patient underwent further surgery for instability or infection between one and four years postoperatively. The mortality and the radiological outcomes were similar in both groups.

Conclusion: Patients with a displaced femoral neck fracture treated with an arthroplasty using a cemented or cementless stem had good function and few complications up to four years postoperatively. However, due to the poor short-term functional outcomes in the cementless group, the findings do not support their routine use in the treatment of these elderly patients. Cite this article: Bone Joint J 2018;100-B:1087-93.

Keywords: Cemented; Cementless; Femoral neck fracture; Hemiarthroplasty hip; Total hip arthroplasty.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Hip / methods*
  • Arthroplasty, Replacement, Hip / mortality
  • Bone Cements / therapeutic use*
  • Cementation / methods
  • Female
  • Femoral Neck Fractures / mortality
  • Femoral Neck Fractures / physiopathology
  • Femoral Neck Fractures / surgery*
  • Follow-Up Studies
  • Hemiarthroplasty / adverse effects
  • Hemiarthroplasty / methods*
  • Hemiarthroplasty / mortality
  • Humans
  • Male
  • Postoperative Care
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Quality of Life
  • Reoperation / statistics & numerical data
  • Treatment Outcome


  • Bone Cements