Fracture of the neck of the femur is highly prevalent among elderly individuals and represents a significant public health concern. Globally, there were roughly 14.2 million hip fractures in 2019, nearly doubling from 1990 .1,2 These injuries carry a steep toll: one-year mortality ranges between 20% to 24%, with many survivors experiencing profound functional decline—40% lose independent ambulation, and up to one-third either become fully dependent or require nursing care within a year.3,4 Against this backdrop, bipolar hemiarthroplasty has emerged as a standard surgical option in elderly patients (aged >65 years) with displaced femoral neck fractures.4 Its goals are early mobilization, pain alleviation, and restoration of function.5 Yet, the optimal fixation method—cemented versus uncemented—remains debated. AIM OF THE STUDY This research aims to compare functional outcomes of cemented versus uncemented bipolar hemiarthroplasty in patients aged above 65 years with fractures of the neck of the femur.

Study Design and Setting: After IEC approval, This was a prospective comparative study conducted in the Department of Orthopaedics at tertiary care Hospital, over a period of 3 years. Study Population: Patients aged above 65 years presenting with displaced fracture neck of femur were included in the study. Inclusion Criteria: • Age > 65 years. • Radiologically confirmed displaced fracture neck of femur. • Patients fit for spinal or general anesthesia. • Patients willing to provide informed consent. Exclusion Criteria: • Pathological fractures (other than osteoporosis). • Polytrauma patients or those with associated fractures in the same limb. • Patients with pre-existing hip deformities or previous hip surgery. • Medically unfit patients. Sample Size and Grouping: A total of 26 patients were recruited and randomly allocated into two groups: Group A (Cemented Bipolar Hemiarthroplasty): 13 patients underwent cemented fixation. Group B (Uncemented Bipolar Hemiarthroplasty): 13 patients underwent uncemented fixation. Surgical Procedure: All surgeries were performed under spinal or general anesthesia by experienced orthopaedic surgeons. Standard posterior or lateral approaches to the hip joint were used. In Group A, cemented fixation was achieved using polymethylmethacrylate (PMMA) bone cement, while in Group B, press-fit uncemented prostheses were used.6 Postoperative protocols including antibiotics, analgesics, and thromboprophylaxis were standardized for both groups. 7-13 Patients were mobilized as early as possible, typically within 48 hours post-surgery, with physiotherapy guidance. Weight-bearing was encouraged depending on the stability and patient tolerance. Follow up at was done at 4 weeks, 6 weeks, 3 months, and 6 months postoperatively Outcome Assessment: Functional outcomes were assessed using the Modified Harris Hip Score (HHS) at discharge 6 weeks, 3 months, and 6 months postoperatively. Pain, mobility, activities of daily living, and complications (intraoperative and postoperative) were recorded.14 Components of Modified HHS: Pain (0–44 points); Function (0–47 points) ;Activities of daily living (walking, stairs, sitting, etc.); The maximum score is 100 points, where: 90–100 = Excellent outcome; 80–89 = Good; 70–79 = Fair; <70 = Poor Statistical Analysis: Data were analyzed using SPSS version 21.00. Continuous variables were expressed as mean ± standard deviation and compared using the Student’s t-test. Categorical variables were expressed as percentages and compared using the Chi-square test. A p-value <0.05 was considered statistically significant.

Out of 26 patients 13 cases of cemented & 13 cases of uncemented bipolar prosthesis fixation done, whose mean age was 69.83 ± 3.2 years , 69.6 ± 4.1 years in group A and Group B respectively. The Modified Harris Hip Score at discharge was 90.2 ± 1.32 in cemented bipolar hemiarthroplasty group and 87.9 ± 1.24 in uncemented bipolar hemiarthroplasty group. Our study shows more blood loss in the cemented bipolar hemiarthroplasty group while more implant-related complications in an uncemented bipolar hemiarthroplasty group. Table 1: Distribution of age in years Age in years Group A (n=13) Group B (n=13) 65-70 years 8 10 71-75 years 3 1 >75 years 2 2 In Group A, the majority of patients (61.5%) were aged 65–70 years, 23.1% were 71–75 years, and 15.4% were above 75 years. In Group B, most patients (76.9%) were in the 65–70 years age group, 7.7% were between 71–75 years, and 15.4% were above 75 years as shown in Table 1. p > 0.05, indicating no statistically significant difference in age distribution between the groups. Table 2: comparison between groups Group A (n=13) Group B (n=13) Mean Age 69.83 ±3.2 69.6 ±4.1 Male : Female 6 : 7 5 : 8 With co-morbidities 10 (76.9%) 11 (84.6%) Without co-morbidities 3 (23.1%) 2 (15.4%) Hemiarthroplasty – Right side 8 (61.5%) 10 (76.9%) Hemiarthroplasty – Left side 5 (38.5%) 3 (23.1%) Both groups had a nearly balanced gender distribution, with slightly more females in both groups. Co-morbidities were present in the majority of patients (76.9% in Group A vs. 84.6% in Group B). Most patients underwent right-sided hemiarthroplasty in both groups as shown in table 2. Statistical comparison (Chi-square and t-test as applicable) shows no significant differences, confirming that both groups were comparable at baseline. Table 3: Modified Harris Hip score Group A (n=13) Group B (n=13) P Value 3 Months 76 ± 5.34 75 ± 4.28 0.027 6 Months 82 ± 2.34 81 ± 87 0.875 12 Months 91 ± 1.11 90 ± 2.12 0.981 At 3 months, both groups had similar functional recovery. At 6 months, scores were highest, again comparable between groups. By 12 months, the scores declined in both groups but remained almost equal. Statistical testing with Friedman (Group A: χ² = 21.38, Group B: χ² = 15.85) confirm significant difference over time within each group and between groups as in Figure 1.

In this prospective study, we compared the functional outcomes of cemented and uncemented bipolar hemiarthroplasty in elderly patients (>65 years) with fracture neck of femur. The mean age of participants was comparable between groups, with a predominance of female patients, consistent with the well-documented higher incidence of osteoporotic hip fractures among elderly women (Cooper et al., 2011). 15 Both groups had similar distribution of comorbidities, and the side of surgery was not significantly different, suggesting that the study groups were well-matched at baseline. Functional outcomes measured at 3, 6, and 12 months demonstrated comparable recovery in both groups. At 3 months, patients in both cemented and uncemented groups showed satisfactory early recovery. By 6 months, peak functional improvement was observed in both cohorts. At 12 months, however, a decline in functional scores was noted, though differences between groups remained statistically insignificant. This decline could be attributed to age-related functional deterioration and progression of comorbidities rather than implant type, as suggested in earlier studies (Parker & Gurusamy, 2006; Bhandari et al., 2003).16,17 The functional parity observed between cemented and uncemented hemiarthroplasty in our study aligns with findings reported by other authors. Parker et al. (2010), in a Cochrane review, concluded that cemented hemiarthroplasty provides slightly better early postoperative function but at the cost of increased operative time and risk of cement-related complications.18 In contrast, uncemented prostheses reduce the risk of cement implantation syndrome, which is of particular concern in frail elderly patients with multiple comorbidities (Donaldson et al., 2009). Nonetheless, long-term functional outcomes appear to be equivalent, as demonstrated in our series.19 Some studies suggest cemented stems are associated with lower rates of postoperative thigh pain and implant-related complications compared to uncemented stems (Yuan et al., 2019). However, uncemented implants may be preferable in patients with poor cardiopulmonary reserve to minimize intraoperative risks. In our cohort, the absence of significant functional differences between the groups indicates that the choice of implant can be individualized based on patient comorbidity profile, bone quality, and surgeon preference. STRENGTHS AND LIMITATIONS: The strengths of this study include its prospective design and uniform assessment using the Modified HHS. However, limitations include the relatively small sample size, short follow-up duration, and single-center setting, which may restrict generalizability. Further multicenter randomized controlled trials with longer follow-up are needed to provide more definitive evidence regarding implant choice.

This study was able to shows that both uncemented & cemented bipolar hemiarthroplasty had a good functional outcome with minimal variations

1. Schmidt AH, Swiontkowaski MF. 2002 “Femoral neck fractures”. Orthop Clin North Am; 33(1):97-111. 2. Lu-Yao Gl, Keller RB, Littenberg B, Wennberg JE. 1994 “Outcomes after fractures of the femoral neck” : A meta analysis of one hundred and six published reports. J.Bone Joint Surg; 76(A):15-25. 3. Kenzora JE, et al. 1998 “Outcome after hemiarthroplasty for femoral neck fractures in the elderly”. Clin Orthop:51-58. 4. Harkess JW. “Arthroplasty of hip.” Chapter -7 in: Campbell's operative orthopaedics, 11th edn, : Mosby 2008:312-481. 5. Bochner RM, Pellicci PM, Lyden JP. 1988 “Bipolar hemiarthroplasty for fracture of the femoral neck”. J Bone Joint Surg ;70A:1001-1010 6. Carpenter JE, et al. 1992 “Functional outcome following femoral neck factures in elderly”. Orthop Trans ;16:750. 7. Malhotra R, Arya R, Bhan S. 1995 “Bipolar hemiarthroplasty in femoral neck fractures”. Arch Orthrop Trauma Surg; 114:79-82. 8. Maricevic A, Erceg M, Gekic K. 1998 “Treatment of femoral neck fractures with bipolar hemiarthroplasty”. Lijec-Vjesn; 120(5):121-124. 9. Ioro R, et al. 2001 “Displaced femoral fractures in the elderly “:Outcomes and cost effectiveness. Clin Orthop; 383:292-242. 10. Haidukewych GJ, Israel TA, Berry DJ. 2002 “Long term survivorship of cemented bipolar hemiarthroplasty for fracture of the femoral neck”. Clin Orthop; 403: 118-126. 11. Maini PS, et al. 2006 “Results of cemented bipolar hemiarthroplasty for fracture of femoral neck, 10 yrs study”:Indian Journal of Orthopeadics;40,3:154-156. 12. Muller CA, et al. 2008 “Implantation of bipolar prosthesis for treatment of medial femoral neck fracture in elderly” – Zentralbl Chir; 133(6):580-6. 13. Marya SKS, Thukral R, Chandeep Singh. 2008 “Prosthetic replacement in femoral neck fracture in elderly”; Results and Review of the Literature;42;1:61-67 14. Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. J Bone Joint Surg Am. 2003;85(9):1673–1681. 15. Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 2011;2(6):285–289. 16. Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102(1):12–22. 17. Parker MJ, Gurusamy K. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2006;2006(3):CD001706. 18. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev. 2010;(6):CD001706. 19. Yuan BJ, Abdel MP, Cross WW, et al. Cemented versus uncemented hemiarthroplasty for femoral neck fracture in elderly patients: A meta-analysis. J Orthop Surg Res. 2019;14(1):229.