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Failure of the femoral component due to severe loss of femoral bone is an important long-term complication of total hip arthroplasty. We treated four patients with a type IV femoral defect (Paprosky classification) because of aseptic and septic loosening. To enhance bone stock and create a stable prosthetic reconstruction we used femoral allografts as inlay strut grafts alone or combined with onlay strut grafts and impaction grafting. At a mean follow-up of 11 years all four patients presented good or excellent results with Harris Hip Score between 86 and 95 points. Radiologically, no migration of the stems were found and the struts showed signs of incorporation. Inlay strut grafts are a reliable method for bone reconstruction of deficient femoral bone stock in failed total hip replacement. [ABSTRACT FROM AUTHOR]