The exact role of proximal femoral replacement (megaprosthesis) in revision hip surgery is unclear. During the past decade remarkable advances in the field of revision hip reconstruction have been made including the availability of allograft cancellous and cortical bone. With the increased use of cortical strut grafts to augment host bone, the indications for the use of megaprostheses have narrowed. Currently, we reserve the use of megaprostheses for elderly or sedentary patients with massive proximal femoral bone loss that cannot be reconstructed by other reconstructive procedures. This may include failed total hip arthroplasty (THA), nonunion of the proximal femur with multiple failed attempts at osteosynthesis, and hip salvage after a failed resection arthroplasty.