We evaluated the significance of the stem alignment in 98 consecutive primary total hip arthroplasties with a cementless CLS component (Zimmer, Winterthur, Switzerland) after a mean follow-up period of 7.7 years (range, 5-11 years) The patients were divided into 3 groups on the basis of stem alignment: neutral, 62 hips (63%); valgus, 20 hips (21%); and varus, 16 hips (16%). Clinical and radiographic results for the groups were compared. No significant clinical or radiographic differences were found between groups. There was no difference in the Harris hip scores and in the incidence of thigh pain between groups. For all hips, radiographs showed stable osseous fixation of the stem and the cup. A similar pattern of adaptive bone remodeling occurred in all 3 groups. Stem alignment of a tapered-wedge cementless femoral component does not compromise the clinical and radiographic results of total hip arthroplasty at a mean end point of 7.7 years.