Total hip replacement is one of the advanced treatment modalities of adult hip joint disease. Reconstructive surgical procedure is very difficult in acetabular defects complicated from infectious disease of hip joint such as tuberculosis and pyogenic arthritis, especially if it is associated with proximal migration of hip joint, a shortening of the limb length and a joint contracture. It has been reported that acetabular defects in revision total hip replacements are managed with a large size ace tabular cup, a bulky mass of bone cement, and the banked homobone or autogenous bone graft. But primary total hip replacement in acetabular defects associated with infectious hip joint diseases is not well documented. We analysed 17 total hip replacements in 15 patients in acetabular defect managed with autogenous bone graft who were followed over 1 year, operated at Department of Orthopedic Surgery, St. Vincent Hospital for 5 years from 1984 to 1988. The results were as follows:1. There were 7 males, 8 females and the age distribution was from 32 to 63. 2. Among 15 patients, 10 cases were tuberculous arthritis, 4 were pyogenic arthritis, 3 were unknown etiology. 3. There were 9 cases of superior lateral wall defect, 1 protrusio acetabuli, 2 medial wall deficiency without protrusio, 2 posterior and inferior wall defect and 3 severe enlargement of the acetabulum. 4. Bone grafts were performed with resected femoral head and neck in 6 cases and additional iliac bone graft were needed in 11 cases. Graft bones were fixed with various types of screws. In 16 cases, we got a solid bony union of grafted bone without bone resorption at 1 year after surgery. 5. According to d'Aubigne and Postel criteria, the clinical results were good in 10 patients (67 %), fair in 3 (20%), poor in 2 (13%). 6. Nonunion of greater trochanter was developed in 3 among 10 osteotomized greater trochanter. Reactivation of tuberculosis was developed in 2 patients and one hip dislocation was complicated.