Uncemented hemiarthroplasty(UHA) for displaced femoral neck fracture (FNF) is favoured by some surgeons due to reduced perioperative mortality and shorter operative times. However, recent evidence from the WHITE5 trial has suggested an increased mortality and intra-operative fracture rates in UHA. This study aimed to compare day-0,2,30 and one-year mortality, as well as intraoperative and postoperative periprosthetic fracture(PPF) between UHA and cemented hemiarthroplasty (CHA) for displaced FNFs. This was a single centre retrospective observational study analysing 1430 UHAs and 313 CHAs in patients with displaced FNF. Primary outcomes included intraoperative and postoperative periprosthetic fracture rates. Secondary outcomes included day 0, 2, 30 and 1-year mortality rates. Radiographic analyses assessed femoral geometry, stem alignment, fit and subsidence to assess whether these factors were associated with preiprosthetic fracture in UHA. Among 1430 UHAs and 313 CHAs, Day 2 mortality was statistically significantly higher in the CHA group(p=0.002); no other significant mortality differences were observed. No differences in intraoperative or postoperative PPFs between groups were found(p=0.396, p=0.807). Intraoperative fractures were not associated with increased mortality (p=0.34), postoperative PPF (p=0.67), or all-cause revision in UHA (p=0.73). Higher all revision rates were seen in the CHA group (p=0.03). Subsidence was associated with early fractures in the UHA cohort (p=0.007), with poorer stem fit linked to early fractures (p < 0 .05). This is the largest series reviewing post-operative outcomes of UHA for FNF reported in the literature to date. UHA demonstrated advantages over CHA including lower early perioperative mortality, similar intraoperative fracture rates, and reduced reoperation rate for late periprosthetic fracture, making it a potentially preferable option for elderly patients with multiple comorbidities and displaced intracapsular neck of femur fractures. Subsidence and poor stem fit were key predictors of early fractures, underscoring the importance of initial implant stability.
Sheridan et al. (Wed,) studied this question.