Background. We retrospectively compared the influence of surface finish with respect to the long-term durability of a cemented titanium alloy stem of the same design but different surface finish. Methods. From 1984 to 1994, the stem was made of a titanium-aluminum-vanadium alloy. A total of 201 patients with 220 smooth stems (mean follow-up 11years and 4months) out of 612 implanted between 1984 and 1987 and 319 patients with 343 rough stems (mean follow-up 5years and 10months) out of 812 implanted between 1991 and 1993 could be reviewed clinically and radiologically for comparison. The average age of the patients with the smooth stem was 58.1years and of the patients with the rough stem, 62.2years. In both groups, 35% of patients were male and 65% female. Results. The mean Merle dAubign hip score increased from 10.5 to 16.0 points in the smooth stem group and from 11.0 to 16.9 points in the rough stem group. The distribution of radiolucent lines, according to the zones of Gruen, was similar in both groups. The smooth stem required revision in 18 cases after a mean follow-up of 11years and 4months and the rough stem in 30 cases after a mean follow-up of 5years and 10months. The survival analysis (Kaplan-Meier) revealed 95.4% survival after 13years for the smooth femoral component and 76.7% survival after 8years for the rough femoral component. Conclusions. The implantation of titanium alloy stems with a rough surface finish cannot be recommended because of its high aseptic loosening rate.