Cemented Versus Cementless Femoral Fixation for Total Hip Arthroplasty Following Femoral Neck Fracture in Patients Aged 65 and Older

Introduction Femoral neck fractures are prevalent in individuals aged 65 and above, requiring prompt mobilization for optimal outcomes. The best method for femoral component fixation after such fractures is debated. Most recent data indicates over 93% of primary THAs in the U.S. use cementless techniques. However, cemented fixation might lead to fewer revisions, reduced periprosthetic fractures, less thigh pain, and improved long-term implant survival in those over 65. This study compares the two fixation techniques in THA by examining postoperative complications at various intervals in patients aged 65 and older. Methods Utilizing a national database, we identified patients aged 65 and above who underwent primary THA, either cementless (n=2,842) or cemented (n=1,124) for femoral neck fractures between 2016 and 2021. We then conducted a 1:1 propensity-matched analysis, balancing factors such as age, sex, and specific comorbidities, resulting in two cohorts of n=1,124. Outcomes assessed included infection, venous thromboembolism (VTE), wound issues, dislocation, periprosthetic fracture, and more at 90 days, 1 and 2 years. A P-value <0.05 was deemed statistically significant. Results Initially, the cemented group was generally older, had more females, and higher incidences of several comorbidities. Both cohorts had comparable rates of infection, wound complications, and aseptic loosening. However, the cemented group showed lower periprosthetic fracture rates (2.5 vs. 4.4%, P=0.02) and elevated VTE rates (2.9 vs. 1.2%, P=0.01) at 90 days. In 1 and 2-year intervals, the cementless group had increased aseptic revision rates. Conclusion A large, nationally representative database of propensity-matched cohorts showed that cemented femoral component fixation for THA was associated with lower rates of periprosthetic fracture and aseptic revision, but higher rates of VTE. While the decision regarding type of fixation is multifactorial, including age, sex, comorbidities, bone quality, and surgical expertise, this data may provide additional information to guide surgeons in the decision-making process.