Thirty-eight patients with primary osteoarthritis who had previously participated in a randomized controlled trial were followed for ten years to assess the long-term effects of a 3D porous titanium construct shell (PTC) versus a standard porous hydroxyapatite-coated titanium shell (PC) in total hip arthroplasty. Patients were randomized to receive either a PTC implant (n=18) or a PC implant (n=20). The primary outcome was the change in periacetabular bone mineral density (BMD) in four specific zones around the acetabular cup. Secondary outcomes included clinical scores (Harris Hip Score and EQ-5D) and the frequency of adverse events. BMD measurements were assessed at 2, 6, and 10 years postoperatively. Overall, the results showed that the PTC group had a significantly smaller reduction in BMD at 10 years compared to the PC group. Clinical outcomes and adverse event rates were similar between groups. These findings suggest that PTC implants may better preserve bone density, potentially improving long-term THA durability.