This secondary analysis of the HEALTH trial, a multicenter randomized controlled trial comparing total hip arthroplasty (THA) and hemiarthroplasty (HA) in patients with femoral neck fractures (FNFs), assessed 1,374 patients with FNFs receiving cemented (n=896) or cementless stems (n=478). This study examined the incidence of early and late periprosthetic femoral fractures (PFFs) for both groups, as well as the comparison of taper-slip vs. composite-beam designs within cemented stems, single-wedge vs. metaphyseal filling designs within cementless stems, and the impact of a collar on press-fit stems. Outcomes were assessed up to two years. Overall, the results of the study revealed that cemented stems had a significantly lower incidence of PFFs compared to cementless stems (2.6% vs. 10.3%, p<0.001). The type of cemented stem did not significantly affect the incidence of PFFs, nor did the type of cementless stem or the presence of a collar. These findings suggest that cemented fixation is the safer option for reducing PFF incidence in this population.