The Impact of Fixation Method and Surgical Approach on Outcomes Following Hip Hemiarthroplasty for Femoral Neck
Brian D Rust1, Mitchel R Obey1, Jenna-Leigh Wilson1
1Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Introduction:
Hip hemiarthroplasty is commonly performed for displaced femoral neck fractures in older adults, with implants placed either cemented or uncemented. While cemented fixation offers immediate stability, uncemented fixation reduces operative time and pulmonary complications. Large single-center analyses comparing these techniques remain limited, and this study aims to assess this.
Methods:
We conducted a retrospective case-control study of 634 adult patients undergoing hip hemiarthroplasty at a single Level 1 trauma center from 2019 to 2025. Patients were classified by cemented (n=403) or uncemented (n=231) fixation and further stratified by surgical approach (anterolateral vs posterior). Outcomes included length of stay, postoperative complications, return to baseline mobility (Koval score), discharge destination, and postoperative mortality within 1 year. Statistical analyses were conducted to evaluate predictive factors with independent-samples t-tests, Mann-Whitney U tests, Chi-square tests, and logistic regression utilized where appropriate.
Results:
Baseline demographics and preoperative mobility were similar between cohorts. Cemented hips with anterolateral approaches had the lowest rates of dislocation (1.3%, p=0.036) and revision surgery (1.7%, p=0.024), but this did not remain significant after statistical correction (p=0.228, p=156). Functional recovery was comparable across groups. Cemented fixation independently predicted discharge home (OR 2.17, p=0.002). There were no significant differences in length of stay, postoperative pain, periprosthetic fracture, infection, readmission, or mortality within 1 year.
Conclusions:
In this large single-center cohort, cemented hip hemiarthroplasty, particularly with an anterolateral approach, was associated with reduced dislocation and revision rates and increased likelihood of discharge home. These findings support consideration of cemented fixation with an anterolateral approach in appropriately selected patients to optimize postoperative outcomes and quality of life. Further multicenter prospective studies are warranted to confirm these results and refine surgical decision-making for femoral neck fractures.
