We previously reported the seven-to-ten-year results of the use of a porous-coated acetabular metal shell in a consecutive series of 204 primary total hip arthroplasties. In the present study, we evaluated the longer-term outcomes of these arthroplasties, at fifteen to eighteen years. One hundred and thirty-six (96%) of the 142 hips available for study retained the original acetabular metal shell. Three of the 142 metal shells failed secondary to aseptic loosening. Ten hips (7%) required a change of the modular acetabular liner because of excessive wear or for the treatment of osteolysis. The fifteen-year rate of survival of the metal shell, with failure defined as revision because of loosening or radiographic evidence of loosening, was 99%. The rate of survival of cementless acetabular reconstructions was excellent at fifteen years, although osteolysis and reoperations were noted to occur much more frequently as the duration of follow-up increased. The majority of the complications were related to wear of the polyethylene liner.