We report the outcome at a minimum of 10 years follow-up for 80 polished tapered stems performed in 53 patients less than 35-years-old with a high risk profile for aseptic loosening. Forty-six prosthesis were inserted for inflammatory hip arthritis and 34 for avascular necrosis. The mean age at surgery was 28 years in the inflammatory arthritis (17–35) and 27 years in the avascular necrosis (15–35) patients. At a mean follow-up of 14.5 years in the inflammatory arthritis group and 14 years in the avascular necrosis group respectively, survivorship of the 80 stems with revision of the femoral component for any reason as an endpoint was 100 % (95 % CI). Re-operation was because of failure of four metal-backed cups, 3 all polyethylene cups and one cementless cup. None of the stems were radiographically loose. All but two femoral components subsided within the cement mantle to a mean of 1.2 mm (0 tot 2.5) at final follow-up. Periarticular osteolysis was noted in 4 femurs in zone 7. This finding was associated with polyethylene wear and was only seen in those hips that needed revision for a metal backed cup loosening. Our findings show that the polished tapered stem has excellent medium-term results when implanted in young patients with high risk factors for aseptic loosening.