Comparison of Cemented Versus Cementless Total Hip Arthroplasty in Elderly Patients: A Prospective Cohort Study

Introduction: Total hip arthroplasty (THA) is an effective intervention for advanced hip disorders in elderly patients; however, the optimal method of femoral fixation remains debated. This study compared clinical, intraoperative, and radiographic outcomes of cemented versus cementless THA in an elderly population. Material and Methods: This prospective cohort study included 120 patients aged 65 years or older who underwent primary unilateral THA. Patients were allocated to either a cemented (n = 60) or cementless (n = 60) femoral fixation group based on intraoperative assessment. Baseline characteristics were comparable between groups. Operative time, blood loss, complications, radiographic outcomes, and functional recovery using the Harris Hip score (HHS) were evaluated over a 12-month follow-up. Statistical analysis was performed with a significance threshold of P < 0.05. Results: Mean operative time and intraoperative blood loss were significantly higher in the cemented THA group compared with the cementless group (P < 0.01 and P = 0.002, respectively). Functional outcomes improved progressively in both cohorts. While early post-operative HHS did not differ significantly, cemented THA demonstrated superior functional scores at 6 months (P = 0.03) and 12 months (P = 0.002). The incidence of post-operative complications, including infection, dislocation, aseptic loosening, and mortality, was low and comparable between groups. Radiographic assessment revealed no significant differences in stem subsidence, radiolucent lines, or implant alignment at final follow-up. Conclusion: Both cemented and cementless THA provide favorable outcomes in elderly patients. Cemented fixation is associated with improved mid- and late-term functional outcomes without an increase in short-term complications, supporting its continued use in this population.