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Background/Objectives: Single-taper conical tapered stems (STCTSs) are possible options for femoral reconstruction in THA performed for primary osteoarthritis, but outcomes are poorly ascertained. A specific STCTS in THA performed for primary osteoarthritis was investigated and compared to a control group including all the other cementless stems, aiming to assess the following: (1) the survival rates of the two cohorts and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failures for stem failure, stem aseptic loosening, and periprosthetic fracture. Methods: A regional arthroplasty registry study evaluating a specific STCTS in THA performed for primary osteoarthritis was designed. A control group including all the other cementless stems was considered. Results: In total, 1773 STCTSs were compared to 37,944 cementless stems. The cumulative survivorship of the STCTS cohort was 95.6% at 10 years and 92.7% at 15 years, which was not different to the control group (p = 0.252). After age stratification, the hazard ratio for STCTS failure was not different to the control group. With stem revision as the endpoint, the STCTS cohort outperformed the control group (at 10 years, 98% versus 96.8%; p < 0.001). The STCTSs achieved better survival rates in females <65 years (p = 0.023). With stem aseptic loosening as the endpoint, the survival rates did not differ between the two cohorts (p = 0.085), as well as the adjusted hazard ratios (p = 0.264). With periprosthetic fracture as the endpoint, the survival rates were better for the STCTSs (p < 0.001). Conclusions: STCTSs in THA for primary osteoarthritis provided dependable long-term outcomes, not inferior to all the other cementless stems with various designs. Full article