Cemented vs. Uncemented Hemiarthroplasty for Displaced Femoral NeckFractures: A Prospective Comparative Analysis of Clinical and FunctionalOutcomes

Background: Hemiarthroplasty is a widely performed surgical intervention for displaced femoral neck fractures,particularly in elderly patients with osteoporosis and functional limitations. The choice between cemented anduncemented prostheses remains a subject of debate, as both approaches have unique advantages and risks.Cemented hemiarthroplasty provides superior initial fixation, better pain relief, and lower implant subsidence,while uncemented implants reduce operative time and avoid cement-related complications such as bone cementimplantation syndrome (BCIS). This study compares the clinical, functional, and radiological outcomes ofcemented versus uncemented hemiarthroplasty in elderly patients with displaced femoral neck fractures.Objectives: To compare functional outcomes, intraoperative and postoperative complications, and implantstability between cemented and uncemented hemiarthroplasty in elderly patients with displaced femoral neckfractures. Secondary objectives include evaluating surgical time, intraoperative blood loss, early postoperativemobility, and long-term prosthesis survivorship.Methods: This prospective comparative study was conducted at the Department of Orthopaedics, K S HegdeMedical Academy, Nitte University, Mangalore, India. A total of 120 patients (≥60 years) with displaced femoralneck fractures were enrolled, with 60 patients undergoing cemented hemiarthroplasty and 60 receivinguncemented hemiarthroplasty. Clinical outcomes were assessed over a 12-month follow-up period using the HarrisHip Score (HHS) and Visual Analog Scale (VAS) for pain at 6 weeks, 3 months, 6 months, and 12 months.Radiological evaluations assessed implant positioning, periprosthetic fractures, and aseptic loosening. Surgicalparameters, including operative time, intraoperative blood loss, hospital stay duration, and postoperativecomplications, were documented.Results: The cemented hemiarthroplasty group exhibited better early functional recovery, with higher HHS scoresat 6 weeks (82.5 ± 4.3 vs. 75.8 ± 5.1, p = 0.002) and 3 months (85.7 ± 3.8 vs. 79.1 ± 4.5, p = 0.001). The VASpain scores were also lower in the cemented group at 6 weeks (3.2 ± 1.1 vs. 4.7 ± 1.3, p = 0.004). However, thecemented group had a longer operative time (74.6 ± 10.3 min vs. 62.1 ± 9.8 min, p = 0.001) and higherintraoperative blood loss (325.4 ± 58.2 mL vs. 210.3 ± 49.5 mL, p = 0.002) compared to the uncemented group.The uncemented hemiarthroplasty group showed higher rates of early periprosthetic fractures (10% vs. 3.3%, p =0.03) and initial postoperative instability (15% vs. 6.7%, p = 0.04). In contrast, the cemented group had a slightlyincreased incidence of thromboembolic events (8.3% vs. 3.3%, p = 0.08, not statistically significant). Long-termimplant survival and complication rates at 12 months were comparable, with no significant difference in asepticloosening (cemented: 3.3% vs. uncemented: 5%, p = 0.62).Conclusion: Cemented hemiarthroplasty provides better early functional outcomes, superior pain relief, andenhanced implant stability, making it the preferred option in elderly patients with osteoporotic bone. However, itis associated with longer operative time and increased intraoperative blood loss. Uncemented hemiarthroplasty,while reducing cement-related complications and operative time, carries a higher risk of periprosthetic fracturesand early postoperative instability, especially in patients with poor bone quality. The decision between cementedand uncemented prostheses should be individualized, considering bone quality, patient comorbidities,rehabilitation potential, and surgeon expertise, to optimize functional outcomes and minimize complications