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Background: Excellent intermediate-term results with use of tapered femoral components in primary total hip arthroplasty have been reported. The purpose of this study was to update our previous report and to evaluate the outcome of total hip arthroplasty with use of the porous Taperloc femoral component in patients who had been followed for a minimum of eighteen years postoperatively.Methods: One hundred and forty-five consecutive uncemented total hip arthroplasties in 138 patients were performed between 1983 and 1985, by a single surgeon, with use of the Taperloc femoral component. The outcome of every femoral component with regard to stem fixation, retention, or revision was determined for all 145 total hip replacements. At a mean of twenty years (range, eighteen to 22.6 years) postoperatively, fifty-eight patients (sixty-five hips) were living. In fifty living patients (fifty-seven hips), the femoral component had not undergone revision surgery. Evaluation of the living patients included clinical and radiographic analysis and recording of complications.Results: Of the eighty patients (eighty hips) who had died, five hips had undergone revision of the femoral component. Only one stem had been revised for aseptic loosening, and no femoral component had been definitely loose by radiographic criteria. In the remaining sixty-five hips in the fifty-eight living patients, eight femoral components were revised. No femoral component underwent revision for aseptic loosening. Definite radiographic evidence of femoral component loosening occurred in one hip. In the fifty living patients (fifty-seven hips) who had not undergone femoral component revision, there was a significant improvement in the mean Harris hip score from 49.3 points preoperatively to 85.4 points at the time of latest follow-up (p = 0.001). Survivorship analysis of all 145 hips, with revision for any reason as the end point, estimated that the survival rate for the femoral component was 87% (95% confidence interval, 79% to 93%) at twenty-two years.Conclusions: Primary total hip arthroplasty with the Taperloc femoral component is associated with a low rate of aseptic loosening at a mean follow-up of twenty years.Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.