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Abstract

Introduction:
Periprosthetic femur fractures (PPFx) are a major cause of early revision after total hip arthroplasty (THA), accounting for nearly 20% of early failures. Cementless fixation, though widely used, has been associated with an increased risk of early PPFx, particularly in elderly or osteoporotic patients. Cemented femoral fixation may reduce this risk in high-risk populations.

Case Presentation:
We performed a retrospective review of 430 consecutive primary THAs conducted between July 2022 and July 2025 at a single institution. Cementless fixation was used in 390 patients and cemented fixation in 40 high-risk patients (mean age 81.7 vs. 65.9 years; BMI 24.5 vs. 30.3). The primary outcome was early PPFx within 90 days postoperatively; secondary outcomes included femoral loosening, prosthetic joint infection (PJI), reoperation, and medical readmission. All cemented cases used fourth-generation cementation techniques and were graded radiographically for cement mantle quality.

Discussion:
No periprosthetic fractures, femoral loosening, PJIs, or reoperations occurred in the cemented cohort. Five patients (12.5%) were readmitted for medical reasons unrelated to surgery. All cemented stems achieved Barrack A or B mantle quality. In contrast, the cementless group included cases of early postoperative PPFx. Despite being older and lower BMI, patients in the cemented group had superior short-term outcomes, consistent with literature demonstrating fracture risk reduction with cemented fixation.

Conclusion:
Cemented femoral fixation eliminated early PPFx in this high-risk cohort. Selective use of cemented stems in elderly or osteoporotic patients remains an effective strategy to prevent early periprosthetic complications and improve short-term outcomes following THA.

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