Hip arthroplasty in patients who have had previous biplanar femoral osteotomy (eg, Southwick) is a technical surgical problem. Distorted proximal femoral anatomy may make routine insertion of a femoral prosthesis impossible. The authors report the short-term results in three patients with hip arthroplasty after biplanar femoral osteotomy. The technique consists of a biplanar closing wedge osteotomy at the level of the lesser trochanter to correct the previous surgical deformity. The remaining proximal femur becomes a vascularized bone graft that is skewered by the femoral prosthesis, which also gains purchase in the medullary canal of the proximal femoral shaft. This technique allows restoration of anatomic femoral alignment and the use of standard prostheses with preservation of bone stock. The initial results have been very good. The appearance of the hip is very similar to that in primary hip arthroplasty.