Background Cemented hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. Therefore, this study aimed to compare cemented vs uncemented outcomes. Methods A literature review using Pubmed, EMBASE, Cochrane Library, and Science Citation Index databases was conducted. Studies comparing outcomes of cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to March 2020 were included. Dichotomous outcomes were pooled and reported as relative risk (RR) or odds ratio (ORs), while continuous outcomes were pooled and reported as the mean difference (MD) or standardized mean difference (SMD). Results The analysis included 39 studies with a total of 112 576 patients. Pooled analysis revealed that compared with cemented, patients with uncemented intervention had better outcomes for intraoperative blood loss (OR 0.19; 95% CI 0.01-0.37), systolic blood pressure (OR 2.83; 95% CI 1.51-5.28), surgery duration (SMD, 0.51; 95% CI 0.2-0.81), length of anesthesia (OR 0.28; 95% CI 0.11-0.45), 6-month mortality (OR 1.11; 95% CI 1.03-1.2), cardiovascular accidents (OR 2.14; 95% CI 1.07-4.28), respiratory failure (OR 8.26; 95% CI 1.38-49.4), fat embolisms (OR 1.58; 95% CI 1.29-1.93), and heterotrophic ossification (OR 2.3; 95% CI 1.3-4.06), but more intraoperative accidents (OR 0.34; 95% CI 0.26-0.45), postoperative fractures (OR 0.27; 95% CI 0.21-0.34), reoperations (OR 0.59; 95% CI 0.53-0.65), and revisions (OR 0.62; 95% CI 0.44-0.88). Conclusions Meta-analysis of hemiarthroplasty outcomes shows that elderly patients who underwent uncemented vs cemented procedures had better results for several factors that are important for not only improved recovery in elderly populations, but also more intraoperative and postoperative risks.