Management of the failed acetabulum following cemented total hip replacement is a challenging problem. With the advent of cementless technology it is possible to reconstitute the bony architecture about the acetabulum and create a biologic environment conducive to cementless fixation. The technical demands of this particular process of reconstructive hip surgery require an appreciation of both the various types of bony defects as well as the selection of the appropriate prosthetic devices, which not only maintain fixation but also support adjunct biologic bone grafting techniques. Sophisticated instrumentation and a prosthetic inventory that will address the issues of fixation and prosthetic stability are required.Rehabilitation and patient management are essential in order to create the appropriate environment for an ultimately biologic steady state. These issues of hip surgery are presented with an emphasis on prosthetic selection, technical considerations, and rehabilitation.