Aims: The aim of this study was to measure implant migration and bone remodelling of the proximal femur two years after insertion of a customized or a standard femoral stem. Materials and methods: In a prospective, randomized study 26 hips (26 patients) have been examined postoperatively and after 3, 6, 12 and 24 months using radiostereometry (RSA) and DEXA. Thirteen hips received a customized femoral stem (Unique, SCP as) and 13 hips received a standard uncemented femoral stem (ABG¨, Stryker-Howmedica). An uncemented acetabular cup (Duraloc¨, DePuy) was used in all hips. The mean age of the patients was 55 (24–67) years. Results: The median displacement of the custom/ standard femoral stems was 0.04/0.01 mm along the - medial-lateral axis, 0.08/0.02 mm along the proximal-distal axis and 0.03/0.08 mm along the anterior-posterior axis, respectively. Statistically, there was no difference between the two groups. One custom stem subsided 5.2 mm at one year, but showed no further migration at two years. The mean decrease in bone mineral density (BMD) in all Gruen zones was 6% in the Custom-group and 7% in the ABG-group. The most pronounced bone loss was seen in Zone 7 and was 21% and 25% for the two groups, respectively. Discussion: We found no statistically signiþcant difference in short-term stem migration comparing a customized and a standard, uncemented femoral stem. Furthermore, the changes in bone mineral density were almost equal in femurs with either type of prosthesis.