Revisiting Cemented Femoral Fixation in Hip Arthroplasty

The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation.Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients.Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation.The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality.We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.