Comparison of Mortality and Revision Rates between Cemented and Cementless Fixation in Bipolar Hemiarthroplasty: A Nationwide Cohort Study

Why clinicians should know about it

• Picked for Orthopedics and Sports Medicine (paper of the day, 17 October 2026): Mortality and revision rates cemented vs cementless bipolar hemiarthroplasty

Abstract

BACKGROUD: The purpose of this study was to compare the mortality and the revision rates between patients undergoing cementless hemiarthroplasty (HA) and cemented HA using national claims data in South Korea. METHODS: We identified patients who received HA from January 2003 to December 2019 using procedural codes and categorized them into 2 groups according to the fixation method: with or without cement. Orthopedic complications including dislocations, periprosthetic fractures (PPFs), and periprosthetic joint infections were evaluated. The revision survivorship was calculated using the following endpoints: stem revision only, conversion to total hip arthroplasty (THA) (including stem revision), any stem revision, conversion to THA (cup only), and any revision. Short-term mortality and adverse cardiac events were also assessed. RESULTS: A total of 175,841 patients including 64,786 (36.8%) with cement and 111,055 (63.2%) without cement received HA. The cemented group (80.5 ± 8.1 years) was older than the cementless group (77.8 ± 10.3 years) (p < 0.001) and had fewer comorbidities. The PPFs were less common in the cemented group (adjusted hazard ratio [aHR], 0.64; 95% CI, 0.58-0.70). The risk of conversion to THA was higher (aHR, 1.66; 95% CI, 1.39-1.98); however, the risks of stem revision only (aHR, 0.61; 95% CI, 0.53-0.70), any stem revision (aHR, 0.88; 95% CI, 0.79-0.98), and any revision (aHR, 0.81; 95% CI, 0.76-0.87) were lower in the cemented group. The cemented group had a 5-fold higher mortality rate (10 / 64,786) on the day of surgery compared to the cementless group (2 / 111,055). The adjusted in-hospital mortality was higher in the cemented group (aHR, 1.53; 95% CI, 1.45-1.62). The cemented group had higher risks of myocardial infarction (aHR, 1.28; 95% CI, 1.09-1.51), stroke (aHR, 1.27; 95% CI, 1.18-1.36), and heart failure (aHR, 1.32; 95% CI, 1.22-1.43) compared to the cementless group. CONCLUSIONS: Cemented fixation had a higher risk of short-term mortality and adverse cardiac events after HA, while it had a lower risk of femoral stem revision and PPFs.

Abstract as published, via PubMed.