Cementless total hip replacement techniques are increasingly used in revision arthroplasty. A major challenge is to achieve implant stability in a femur distorted by a failed arthroplasty. Five patients with aseptic loosening of cemented primary or revision total hip replacements complicated by significant proximal femoral disease, four with marked angular deformity of the femur and one with a subtrochanteric nonunion, were treated successfully with cementless revision arthroplasty combined with proximal femoral osteotomy. At follow-up examination, all femoral and trochanteric osteotomies had healed and D'Aubigne and Postel scores for pain, function, and range of motion had improved. All porous prostheses demonstrated radiographic features consistent with bone ingrowth fixation. No progressive stress shielding has been observed. Concomitant femoral osteotomy to correct anatomic deformity, in association with cementless total hip arthroplasty, results in union of the osteotomy and restoration of hip function.