Abstract
➤: The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation. ➤: Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients. ➤: Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation. ➤: The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality. ➤: We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.