388 patients (423 hips) undergoing total hip arthroplasty were randomized to receive a cementless femoral stem with a flat, tapered wedge design either made with cobalt-chrome or titanium. The purpose of this study was to demonstrate the efficacy of flat cementless femoral stem, while comparing two different implant materials. Both flat stem femoral implants produced a significant reduction in pain scores and an increase in hip function when compared to pre-operative measures. The long term follow-up results indicated that patients with titanium stems reported less thigh pain and required fewer secondary operations.