51 patients with osteoarthritis undergoing total hip arthroplasty were randomized to receive either an uncemented conventional tapered stem or an uncemented ultra-short stem. The purpose of this randomized controlled trial was to compare the different stems in terms of periprosthetic bone loss in the proximal femur, safety, and migration, at 2 years postoperatively. The results suggested that the decrease in periprosthetic bone mineral density (Gruen zone 1 and 1-7) was significantly lower in the ultra-short stem patients. During the first 6 postoperative weeks, the ultra-short stem group displayed greater implant migration, which remained significant at 2 years. Between groups, clinical outcomes were similarly improved at 2 years and adverse events were comparable.