Seventy-five patients with osteonecrosis of the femoral head (ONFH) scheduled for a total hip arthroplasty (THA) were randomized to receive a short femoral stem or a conventional femoral stem. Outcomes of interest included the Harris Hip Score (HHS), Oswestry Disability Index (ODI), incidence of adverse events, and radiological outcomes (e.g. femoral stem position, offset analysis, heterotrophic ossification, and stress shielding). Results revealed no significantly favourable stress shielding in the short femoral stem group compared to the conventional stem group. Neck cutting level was significantly greater in the short stem group. Otherwise, no significant differences were observed between the groups.