Recent premature failures of metal total hip replacements have raised concerns about their load bearing capacity, safety, reliability, and survival rates. Specifically, femoral stem fracture is one of the most acute complications of total hip replacement (THR) and results in greater morbidity and higher cost of revision hip surgery. Femoral stem fracture incidence varies from 0.23% to 10.7% depending on geometric design and prosthetic materials. This study reports an unusual case of late fatigue failure of a cobalt-chromium alloy cementless femoral stem which functioned well for 24 years. The failure occurred at the stem/neck transition radius remote from any modular interface. The crack initiated at the top tensile side at the implant surface following a minor traumatic event. It then propagated transgranularly up to about half of the neck cross-section before final fracture occurred, which illustrates the high toughness of the implant. Fractography analysis found no intrinsic defects in the failed component. Scanning electron microscopy-energy- dispersive X-ray spectroscopy analysis revealed a chemical composition in agreement with the wrought CoCrMo alloy ASTM F1537 used in such implants. A grain size of between 6 and 70 µm was measured, which is also in agreement with the standard. Precipitates were found at grain boundaries, consistent with M26C6 and M7C3, which are often reported in cobalt-chromium alloys used in bone replacement applications. This late failure illustrates the importance of proper long-term testing of implants in regards to cyclic loading, as patients undergoing total joint replacement are increasingly younger and more active, putting implants at greater risk of long-term fatigue failure.