Records of 28 patients with pathologic lesions in the proximal femur treated by implantation of a femoral head and neck replacement prosthesis between 1984 and 1995 were reviewed. Mean clinical followup was 47.8 months in the eight living patients and 15.8 months in the 20 patients who had died. The underlying diagnosis was metastatic disease or myeloma in 22 patients. The most frequently occurring indication for implantation of this device was a pathologic fracture in 26 patients (18 displaced, eight impending), followed by resection and reconstruction in two patients. All femoral components were cemented: 23 were bipolar hemiarthroplasties and five were total hip arthroplasties. Implant survivorship was good (93%), with only two prostheses removed during the followup period, both for infection. However, radiographic analysis revealed increasing lucencies with time, particularly in the most proximal zones, resulting in radiographic failure in an additional case. Deep infection occurred in three cases, leading to resection arthroplasty in two patients. Periprosthetic fractures occurred in three cases, but only one occurred intraoperatively. Despite a high complication rate, the good implant survival during the shortened life span of these patients supports the continued use of femoral head and neck replacement prostheses in this population.