Concerns exist with cementless total hip arthroplasty (THA) femoral fixation in the elderly patient population. This study reviews the outcomes of a tapered cementless femoral component in elderly patients 75 years of age and older. Forty-seven patients (49 hips) older than 74 years of age (average age, 79 years) underwent primary cementless THA with a double-tapered stem between 1996 and 2000. Radiographs and clinical data were reviewed. At a mean follow-up of 5 years, the mean postoperative Harris Hip Score was 84, with 87% having no or minimal pain; none had severe thigh pain. Two cases of stem subsidence and no progressive radiolucencies were seen. One well-fixed stem was revised for unexplained pain (2%). Survival with aseptic loosening as an end-point was 100%. Overall implant survival was 98% at an average of 5 years. No perioperative deaths or significant orthopedic complications were identified. Advanced age is not a contraindication for tapered cementless THA.