Vol. 9, Issue 4, Part A (2025)

Total hip arthroplasty is one of the most successful orthopaedic procedures for restoring mobility and relieving pain in elderly patients with degenerative hip disease or femoral neck fractures. The choice between cemented and cementless fixation remains a subject of ongoing clinical debate, particularly in older populations with variable bone quality and functional demands. Early functional recovery is a critical determinant of postoperative independence, complication risk, and overall quality of life in this age group. Cemented hip arthroplasty has traditionally been favored in elderly patients because it provides immediate implant stability, potentially allowing earlier weight-bearing and faster rehabilitation. In contrast, cementless hip arthroplasty relies on biological fixation through bone ingrowth, which may be influenced by age-related osteoporosis but offers theoretical advantages related to long-term implant survival and avoidance of cement-related complications.

This practical review synthesizes current evidence comparing early functional outcomes of cemented and cementless hip arthroplasty in elderly patients, focusing on parameters such as pain relief, mobility scores, gait recovery, weight-bearing capacity, and early complication profiles. Available studies suggest that cemented fixation often results in superior early postoperative function, particularly within the first three to six months, due to immediate mechanical stability and reduced micromotion. Cementless fixation, while demonstrating comparable outcomes over longer follow-up periods, may be associated with delayed functional gains and a higher risk of early periprosthetic fractures in osteoporotic bone.

The review highlights that patient-specific factors including age, bone density, fracture pattern, comorbidities, and preoperative functional status play a decisive role in fixation choice. Understanding the trade-offs between early function, surgical risk, and long-term performance is essential for optimizing outcomes in elderly patients undergoing hip arthroplasty. A tailored, evidence-based approach to fixation selection can enhance early recovery while maintaining implant durability and patient safety.