Background: Total hip arthroplasty (THA) is a common and effective procedure for treating hip osteoarthritis in elderly patients. However, debate persists regarding the optimal fixation method - cemented or cementless. This study aimed to compare outcomes between cemented and cementless THA in elderly patients over a 5-year period. Methods: This retrospective cohort study analyzed 121 THAs (93 cemented and 28 uncemented) performed on elderly patients (≥50 years) with advanced hip osteoarthritis from April 2018 to October 2023. Outcomes assessed included pain (Visual Analog Scale), functional mobility (WOMAC), postoperative complications, and quality of life (EQ-5D-5L). Statistical analysis included t-tests and chi-square tests to compare outcomes between groups. Results: Cementless THA demonstrated significantly better outcomes across all measures at an average follow-up of 36 months. Patients in the cementless group reported lower postoperative pain levels (p