We report the outcome of 58 consecutive polished tapered stems in 47 patients younger than 50 years, with a minimum of 10 years of follow-up. No stems were revised for aseptic loosening or osteolysis. The Harris hip scores were good or excellent in 76% of the patients. There was excellent preservation of proximal bone. Despite higher patient weight and frequent previous surgery, the outcome of polished tapered stems in patients younger than 50 years is comparable to the general population undergoing total hip arthroplasty and superior to other non–polished tapered stem designs in young patients. Cup wear and cup failure were significantly worse in this group, with a higher incidence of periarticular osteolysis. Polished tapered stem designs are the benchmark for comparison to other arthroplasty options in young patients.