Comparative risk of periprosthetic fractures with cemented and uncemented femoral stems in hip arthroplasty: A multi-center retrospective analysis

Objective The decision between cemented and uncemented femoral stem fixation remains controversial despite the general success of both techniques. Conflicting evidence surrounding fixation techniques and their impact on postoperative fracture rates remains prevalent. The purpose of this study was to examine the incidence of periprosthetic fractures in a multi-center cohort of arthroplasty patients using cemented and uncemented femoral stems. Methods A multi-center retrospective study was conducted within the Virtua Health Department of Orthopedics in South Jersey. Adults >18 years that underwent THA or HA between 2020 and 2023 with a minimum of two years follow-up were included. Patients treated with open reduction internal fixation or intramedullary nailing were excluded. Periprosthetic Fracture risk was assessed. Outcomes were measured using two-sided Fisher exact tests with calculation of odds ratio, ratio risk, and absolute risk with 95% confidence intervals. Results A total of 353 patients (cemented, n=93; uncemented, n=260) were analyzed. Patients that received cemented stems were older (mean age 81.8±10.1 years), predominantly female (80.6%), and had lower BMIs (24.5±3.9 kg/m 2 ) than uncemented patients (70.0±1.5 years; 61.9% female; 30. 3±5.7 kg/m 2 ). Postoperative periprosthetic fractures occurred in 2/93 and 3/260 of cemented and uncemented cases, respectively (p=0.61; OR=1.88, 95% CI, 0.31–11.45). Adverse outcomes were rare across cemented and uncemented femoral stems. Conclusion The rates of periprosthetic fractures were low and statistically similar for both fixation methods. These findings support the safety and reliability of either fixation strategy.