Abstract Between 1984 and 1989, 188 consecutive femoral revision surgeries were performed. Eighteen patients died or were lost to follow-up, and the remaining 170 patients were followed for 11 to 16 years (mean, 14.2 years). Radiographic evidence of a bone ingrown stem was present in 82% of the hips, stable fibrous fixation was present in 14% of the hips, and 4% of the hips were unstable. Six stems were revised to a larger, fully coated cementless implant. Proximal femoral osteolysis was seen in 23% of femora but was limited to Gruen zones 1 and 7. No diaphyseal osteolysis was seen. The overall mechanical failure rate in this series was 4.1%. Failure of fixation correlated highly with extent of bone loss present at the time of surgery. On the basis of the radiographic and clinical results at a mean follow-up of 14.2 years, we recommend the use of extensively coated femoral stems in revision hip arthroplasty. Copyright 2002, Elsevier Science (USA). All rights reserved.