A prospective randomized trial comparing hydroxyapatite (HA)-coated and non-HA-coated femoral total hip arthroplasty components was conducted. Sixty-one consecutive patients undergoing primary hip arthroplasty were randomized to receive an identical femoral component with or without HA. Forty-eight hips were available for review at an average of 13 years and 5 months after surgery. The only femoral stem revised was secondary to femoral fracture after mitral valve area. All femoral stems were well fixed on x-ray with no evidence of loosening. There was no statistically significant difference in the revision rates or in the Harris hip score between the HA vs non-HA-coated groups. This study suggests there is no clinical advantage to the use of a hydroxyapatite coating on the femoral component of this design for primary total hip arthroplasty.