Objective To investigate the medium- and long-term effectiveness of total hip arthroplasty (THA) in total hip arthroplasty with Cementless Spotorno (CLS) stem prosthesis. Methods The clinical data of 78 patients who underwent total hip arthroplasty with CLS femoral stem prosthesis in our department from May 2013 to August 2015 were analyzed retrospectively, including 45 males (48 hips) and 33 females (38 hips), aged from 43 to 81 years (mean 61.3 years). Preoperative diagnosis included aseptic necrosis of the femoral head in 39 cases (39 hips), hip dysplasia in 28 cases (36 hips), femoral neck fracture in 7 cases (7 hips) and rheumatoid arthritis in 4 cases (4 hips). The preoperative Harris score was 52.10±3.35. Regular clinical follow-up and pelvic X-ray examination were performed to evaluate the related complications such as subsidence, loosening and displacement of the prosthesis. Moreover, the comparison of Harris score of hip pre-operation and the final follow-up was also performed. Results All the operations were successfully completed. Among them, during the operation, there were 3 patients with split fracture of femur, and there was no prosthesis loosening after steel cable encircling. Two cases had poor wound healing after operation, and the wound healed in the first stage type I after dressing change. All cases were followed up with an average period of 6.4 years (5-7 years). The Harris score of the last follow-up was 92.39±6.61, which was significantly different from that before operation (P＜0.05). During the follow-up period, 2 patients had mild thigh pain, 1 patient had periprosthetic fracture, no patient had complications such as aseptic loosening, neurovascular injury and dislocation, and 2 patients (2 hips) had chronic low toxic prosthesis infection and two-stage revision hip arthroplasty. The long-term survival rate of CLS was 97.7%. Conclusion When the CLS femoral stem prosthesis is used in the primary THA, a good initial stability of the prosthesis can be obtained. The medium-and long-term effect of CLS femoral stem prosthesis is satisfactory.