Objective To compare the effect and safety between cemented and uncemented long-stem hip arthroplasty for treatment of unstable intertrochanteric fracture in the elderly.Methods A retrospective review was made on 70 cases (70-87 years old) undergone artificial long-stem hip arthroplasty of unstable intertrochanteric fracture between June 2012 and June 2014.According to the material of prostheses,the cases were assigned to cemented group (n =36) and uncemented group (n =34).Operation-related index,postoperative complications,ambulation time,Harris hip score and prosthesis stability and excellent results were compared between the two groups.Results There were no significant differences in operation time,bleeding volume and ambulation time between the two groups (P ＞ 0.05).Postoperative drainage volume and blood transfusion volume in cemented group [(277.4 ± 22.0) ml and (245.1 ± 17.8) ml] were lower than these in uncemented group[(294.2 ± 33.7) ml and (262.8 ± 30.9)ml] (P ＜0.05).Harris scores in cemented group were higher than these in uncemented group 1 and 3 months after operation(P ＜0.05),and there were no significant differences 6 and 12 months after operation(P ＞ 0.05).Complication rate had no significant difference between the two groups (P ＞ 0.05).Two cases were died of cement poisoning,one case of subsequent acute myocardial infarction,and two cases of subsequent acute cerebral infarction.Sixty-five cases were followed up for 12-36 months,which showed no complications such as prosthesis loosening,displacement or infection.Prosthesis stability and treatment excellent rate between the two groups were not significantly different (P ＞ 0.05).Conclusions Clinical efficacy of the two treatments is comparable,including good function recovery and early off-bed activity.Cemented long-stem hip arthroplasty reduces blood requirements,but the risk of cement poisoning exists.