Balancing Safety and Efficacy: Uncemented Versus Cemented Total Hip Arthroplasty in the Elderly

The increasing use of total hip arthroplasty (THA) in elderly patients has led to debate regarding optimal femoral fixation. Although press-fit (noncemented) fixation remains common, there is concern regarding its association with increased periprosthetic fracture risk in elderly populations with compromised bone quality. We evaluated the outcomes and complications of cemented versus press-fit fixation in a well-matched, elderly cohort.

This was a retrospective study of 1449 patients who, between January 2020 and December 2023, underwent a primary, elective, unilateral THA. Patients were subdivided by decade (70 to 79, 80 to 99-year-old groups). Demographics, clinical factors, surgical parameters, and postoperative patient outcomes, including fracture within the first 90 days, were evaluated. Predictive modeling was used to evaluate risk factors for cementation.

Eleven periprosthetic fractures occurred exclusively in the noncemented group (P = 0.186). The calculated number needed to treat indicated that in patients aged 70 to 99 years, 168 cemented procedures would prevent one periprosthetic fracture; this number decreased to 60 in the 80 to 99 year subgroup. Older age, lower body mass index, female sex, anterior approach, and low preoperative Hip Disability and Osteoarthritis Outcomes Score all increased cementation risk.

Although noncemented THA remains generally safe for elderly patients, it does carry an increased risk of periprosthetic fracture, a serious complication with notable morbidity. Orthopaedic surgeons should thoroughly counsel elderly patients regarding fracture risks associated with noncemented femoral fixation. Our large, well-matched cohort adds robust evidence supporting careful patient selection and discussion of cemented fixation benefits in this population.