Objective A three dimensional finite element model after total hip replacement was established to analytically study the stress distribution of the artificial stem, bone cement and human femur. Methods The influence of the hollow shape and surface treatment of the stem on stress distribution of the prostheses and femur after total hip replacement was calculated and analyzed using 3-D reconstruction software, Pro/ Engineer software and ABAQUS finite element software. Results (1) The stress value of the cemented stem with a upside-down tapered hollow is lowest, and the proximal cement stress is lower. (2) Using the stem with the cement coat in the upper stem can reduce the stress of the proximal cement, the interface shear stress and relative slippage between the stem and cement. (3) The stress area in the human femur transfers down with the tiny-hole coating range in the uncemented stem increasing, so the proximal human femur stress descend. Conclusions (1) The use of upside-down tapered hollow stems to reduce proximal femur stress shielding could be profitable. (2) Using the stem with the cement coating in the upper stem can increase the adhesive strength at the interfaces with the stem and the cement, which is helpful to reduce prosthesis loosening of hip replacements. (3) The effects of the tiny-hole coating range of uncemented stems on the human femur stress are obvious, and the large tiny-hole coating range is disadvantageous tomaintaining suitable human femur stress and the stem fixation.