Active patients with displaced femoral neck fractures are often treated with total hip arthroplasty (THA). However, optimal femoral fixation in these patients is controversial. The purpose of this study was to compare early complication and readmission rates in hip fracture patients treated with THA receiving cemented versus cementless femoral fixation.

The National Readmissions Database was queried to identify patients undergoing primary THA for femoral neck fracture from 2016-2017. Postoperative complications and unplanned readmissions at 30, 90, and 180-days were compared between cemented and cementless THA patients. Univariate and multivariate analyses were performed to compare differences between groups and account for confounding variables.

Of 17,491 patients identified, 4,427 (25.3%) received cemented femoral fixation and 13,064 (74.7%) cementless. The cemented group was significantly older (77.2 vs. 71.1, p<0.001), had more comorbidities (CCI: 4.44 vs. 3.92, p<0.001), and had a greater proportion of females (70.5% vs. 65.2%, p<0.001) compared to the cementless group. On multivariate analysis, cemented fixation was associated with reduced rates of periprosthetic fracture (OR 0.052, 95%-CI 0.003-0.247, p=0.004) at 30 days but similar readmission rates at 30-, 90-, and 180-days (OR range: 1.012-1.114, p>0.05) postoperatively compared to cementless fixation. Cemented fixation was associated with greater odds of medical complications at 180-days postoperatively (OR: 1.393, 95%-CI 1.042-1.862, p=0.025).

Cemented femoral fixation was associated with a lower short-term incidence of periprosthetic fractures, higher incidence of medical complications, and equivalent unplanned readmission rates within 180-days postoperatively compared to cementless fixation in patients undergoing THA for femoral neck fracture.