Purpose <p>To compare primary (implant survival and periprosthetic fracture rates, PPF) and secondary (patient reported outcome measures, PROMs) outcomes of cemented and hybrid primary total hip arthroplasty (THA) for osteoarthritis.</p> Methods <p>Four databases (PubMed^®, EBSCO, ScienceDirect^®, and Scopus^®) were searched (1 October 2023 and 15 November 2024) for original studies comparing cemented and hybrid primary THA for osteoarthritis. survival, PPF rates, and PROMs. Included studies were assessed for risk of bias using the Quality in Prognostic Studies or RoB 2.0 tool, critically appraised for strength of evidence using GRADE, and underwent a narrative synthesis. PROSPERO registration number CRD42023462884.</p> Results <p>Eight studies met criteria for review (<i>n</i> = 357,748). Risk of bias was high for two, moderate for three, and low for three studies. Quality of evidence was very low for both primary and secondary outcomes. Five studies met the criteria for the primary outcome (survival) (<i>n</i> = 257,756), two PPF rates (<i>n</i> = 29,581), and three PROMs (<i>n</i> = 382). Three of five studies reported hybrid survival as not significantly different to cemented, and two identified cemented as superior. The three PROMs studies reported no difference between cemented and hybrid THA. A lack of studies and comparative data made it unfeasible to determine PPF outcomes.</p> Conclusion <p>Few high-quality studies and methodological heterogeneity led to moderate to high bias and very low overall evidence certainty. Eligible studies indicated no difference in short to medium term PROMs or 10-year survival between the two fixations. Long-term studies indicated superior cemented survival outcomes. A substantial gap in long-term PROMs and PPF rates is noted.</p>