We have reviewed, at a mean follow-up of 63.7 months, 36 total hip replacements performed with bulk acetabular autograft. Before surgery all the hips had acetabular insufficiency. Improvement of acetabular coverage was achieved in all cases with the patient's femoral head screwed to the ilium. Only one massive graft resorption was observed, simultaneous to loosening of the socket. Partial graft resorption was observed in 6 cases, and was not correlated with loosening of the socket. In all cases we observed radiographic features consistent with graft incorporation. Periprosthetic ossifications were noted in 13 cases. At follow-up, four sockets were loose, among which were included three Weill threaded rings. The mean functional improvement scores evaluated with the Merle d'Aubigné hip rating were: 4 points for pain, 2.7 points for mobility, and 2.4 points for walking. The authors concluded that femoral head, used as a massive autograft during total hip replacement, was a safe procedure for bone stock reconstruction in case of severe acetabular insufficiency.