A prospective study was completed on 106 consecutive cementless arthroplasties (94 patients) to determine the clinical and radiographic outcome. Ninety-two hips (81 patients) had complete follow-up data. The average age was 46 years, and the average follow-up period was 41 months (24–63 months). Clinically 94% had no or slight pain. Two patients had activity-limiting thigh pain. Most patients bad no or slight limp and walked without support. Patients had similar outcomes regardless of their bone type. Ninety-three percent of hips were radiographically stable. Six were loose; three of those had major intraoperative fractures. Stable stems were characterized by middle and distal zone endosteal condensation and cortical hypertrophy; these occurred primarily in the distal zones for unstable implants. Calcar resorption was noted in 38% of hips with collars and in 68% without collars (p = 0.015). Endosteal erosions were seen in six hips (6.5%) and were related only to the patient's activity level (p = 0.021). Seven hips were revised, two for delayed sepsis, one for loosening after trauma, one for intraoperative fracture, and three for aseptic loosening. The Omniflex implant system provides acceptable but not outstanding results in a wide array of femoral geometries. The early difficulty with femoral fractures has been significantly reduced by using a prophylactic cerclage cable.