Controversy exists regarding the use of cementless femoral fixation for hip arthroplasties in elderly patients. This study reviews the clinical and radiographic outcomes of cementless bipolar hemiarthroplasties in patients older than 65 years of age. From 1998 to 2000, 256 cementless bipolar hemiarthroplasties were performed in 248 patients with displaced femoral neck fractures who had a mean age of 77 years. The mean final follow-up was 3.5 years and Harris hip scores averaged 82 points. Two loose femoral stems were revised and the rest of the implants were radiographically stable and demonstrated evidence of bone ingrowth. Six patients had debilitating groin pain necessitating conversion to total hip arthroplasty. Cementless bipolar hemiarthroplasty can be safely performed in elderly patients and can provide predictable clinical and radiographic results.