We reviewed 62 revision total hip arthroplasties performed using a fluted and tapered modular distal fixation stem after a mean follow-up of 4.2 years. An extended trochanteric osteotomy (ETO) was used in 32 of the 62 hips (52%), whereas no osteotomy was used in the remaining 30 hips. The mean postoperative Harris hip score among the patients was 87.3 points. The mean stem subsidence was 1.1 mm. With the exception of one reoperation for a deep infection, no femoral revision was performed because of mechanical failure. Complications included intraoperative diaphyseal split fractures (6%), cortical perforations (6%), and dislocations (5%). Postoperative Harris hip scores, femoral component stability, and overall complication rates did not differ between the group treated with an ETO and that treated without it. However, the rates of cortical perforation and marked stem subsidence (>5 mm) were significantly higher in the group treated without an ETO than those in the group treated with an ETO, but these were not significantly different when stratified by femoral bone defect. The potential advantages of this implant design could be highlighted in a clinical setting when inserted using an ETO.