https://doi.org/10.1177/1120700018772291 HIP International 2019, Vol. 29(2) 177–183 © The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1120700018772291 journals.sagepub.com/home/hpi HIP HIP International Introduction Hip arthroplasty has become the standard of care for dis- placed femoral neck fractures in elderly patients. The per- centage of femoral neck fractures treated with arthroplasty has increased from 3% to 61% between 1998 and 2010. 1 The hip fracture population is unique in arthroplasty as the majority of these patients have very poor bone quality and an increased risk of falls, putting them at increased risk of periprosthetic fracture. 2–5 In most of these elderly or frail patients only the femoral side is replaced in a procedure known as hemiarthroplasty. This procedure allows for early weight-bearing with a relatively low risk of re-operation. Higher periprosthetic fracture rate associated with use of modern uncemented stems compared to cemented stems in femoral neck fractures Jin Soo A. Song, Daryl Dillman, Dave Wilson, Michael Dunbar and Glen Richardson Abstract Introduction: Hemiarthroplasty is the preferred treatment for displaced femoral neck fractures in elderly patients. Recently, short tapered-wedge cementless stems have increasingly been used in this population. However, historic data has consistently shown higher rates of periprosthetic fracture with uncemented stems in hip fracture patients. This study aims to evaluate the rate of periprosthetic fracture requiring re-operation and all-cause mortality between cemented and uncemented femoral stem designs including more recent short tapered-wedge cementless stems in hip fracture patients. Methods: A retrospective chart and radiographic review of patients received bipolar hemiarthroplasty for femoral neck fractures from 2010–2016. Patients biologically (age ≥ 65 years) or physiologically (American Society of Anesthesiologists (ASA) class ≥ 3) elderly were eligible. The uncemented group was subdivided into tapered-wedge stems (a broach only system) and reamed uncemented stems. The primary outcome was periprosthetic fracture requiring re-operation. Results: We included 657 patients in total, with 296 and 361 patients in the uncemented and cemented stem groups respectively. In the uncemented group there were 197 tapered-wedge and 99 reamed uncemented stems. There was a significantly higher rate of periprosthetic fracture requiring re-operation in the uncemented group (3.0% vs. 0.6%) (p ≤ 0.05). There were no significant differences in rates of all-cause mortality, infection or all-cause re-operation. Conclusions: Compared to modern uncemented femoral stem designs, cemented stems yield lower rates of periprosthetic fracture requiring re-operation, without increasing risk of all-cause mortality. Tapered-wedge stems had similar rates of re-operation due to periprosthetic fracture as reamed uncemented stems. Keywords Bipolar, femoral neck fracture, hemiarthroplasty, tapered-wedge stem Date received: 29 August 2017; accepted: 06 February 2018 Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada Corresponding author: Jin Soo A. Song, Division of Orthopaedic Surgery, Dalhousie Medical School, 5850 College St, Halifax, Nova Scotia, B3H 1X5, Canada. Email: jasong5963@gmail.com 772291HPI 0 0 10.1177/1120700018772291HIP InternationalSong et al. research-article 2018 Original research article