141 elderly patients scheduled for hip arthroplasty after having suffered a displaced femoral neck fracture were randomized to either cement or cementless fixation of the femoral stem with either hemiarthroplasty or total hip arthroplasty. Patients were followed up for clinical scores, radiographic assessment of stem subsidence, acetabular erosion, radiolucency, component loosening, and reoperation rate 4 years after surgery. The cemented group was significantly favoured with respect to results on total Harris Hip Score at 4 months, Short Musculoskeletal Function Assessment dysfunction score from 4 months to 1 year, and SMFA bother score from 1 year to 2 years. However, by 4 years, no significant differences in clinical scores, radiographic measures, or incidence of reoperation were observed between groups.