The authors present a long term review of thirty cases of massive homogenous bone grafts carried out at the Istituto Ortopedico Rizzoli between 1967 and 1971. Thirty one of these were either complete or partial diaphyseo- articular grafts. The lesions for which the operations were performed were: twelve giant cell tumours; one Ewing's tumour; two reticulosarcomas; eight osteosarcomas; six chondrosarcomas; one loss of bone substance from trauma, one echinococcosis of the femur and one aneurysmal bone cyst. In some of these cases amputation or disarticulation had been advised but refused by the patient. Follow up three and a half to five years after operation showed complete incorporation of the graft in eight cases, partial incorporation in live, and resorption in four. In the remaining fifteen cases the follow up was terminated by early death, recurrences, infection or intolerance with rejection. In conclusion, the authors recommend that massive osteoarticular homogenous grafts should be confined to the substitution of unicondylar lesions as these offer greater contact with the host bone and therefore a greater possibility of incorporation. The same indications exist in cases involving only diaphyseal substitution where osteogenetic invasion of the graft can occur from both ends. In all the other cases, they recommend either resection arthrodesis or prosthetic replacement.