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We report the results of total hip arthroplasty with use of a proximally hydroxyapatite-coated femoral component after a minimum follow-up of ten years in a group of patients who were less than fifty years old at the time of the primary procedure. In the five years since the original publication of our study, two additional stems have undergone revision. Thus, a total of six stems have been revised. A small amount of erosive scalloping of the proximal part of the femur was seen in nearly one-half of the hips; however, all unrevised stems were radiographically stable and no hip had intramedullary osteolysis. The revision rate because of aseptic loosening of the stem was 0.9%, which compares favorably with that for other stems and other fixation methods in young patients at this point in time. This stem is currently being paired with a highly cross-linked polyethylene liner because of cup failures and the need for reoperation secondary to excessive polyethylene wear and proximal femoral osteolysis.Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.