Introduction and purpose: The purpose of the study is to look at the progress of fixed implants with osteolysis and bone defects treated and to set ground rules for treatment guidelines.

Materials and methods: We reviewed 204 hips between March 1996 and March 2003, in 40 of which femoral osteolysis was treated with fixed prostheses.

The reasons for the revisions were 20 aseptic cup loosenings and 20 cases of worn polyethylene, with presence of femoral osteolysis. Thirty of the stems were biological, nine mini-madreporic and one cemented.

The mean follow-up was 5 years and 2 months.

We used morsellised impacted bone graft held in place with cement, metal laminas or bone stock.

Results: Clinically the outcome was excellent or good in 92.5% of the cases, with no migration or revision of the stem.

All the grafts took. There was very limited partial resorption in 20% of the cases and radiolucent lines in 20.6%.

Among the complications were two new cases of wear with osteolysis and a fractured femur caused by a fall, with no infection or dislocation.

Conclusions: Femoral osteolysis must be watched and treated surgically if it progresses, even though the implant is fixed.

Impacted morsellised bone grafts in the femoral canal with a fixed stem, even with extensive, unchecked osteolysis, held in place with metal cages are a reliable means of recovering bone stock and holding the femoral component firmly in place for the long term, with good clinical and radiological outcome, minimal risk and shorter surgery.