Osseointegration is a term that refers to the formation of a direct interface between an implant and bone without intervening soft tissue. Cementless femoral fixation in total hip arthroplasty is dependent on mechanical and biological factors that affect implant stability and long-term outcome. Osteoporosis leads to morphological and biological alterations in the proximal femur that adversely affect both mechanical stability of implant and biological response of bone, making it more challenging to achieve a valid osseointegration.