Pigmented villonodular synovitis (PVNS) is a rare benign but aggressive disease of the synovium. If the hip is involved early destruction of the joint is common due to the tight structure of the capsule and arthroplasty is unavoidable in these cases. We implanted a cemented total hip replacement in a 17-year-old female patient who had histologically confirmed PVNS. Because of massive bony destruction in the acetabulum a reconstruction with homologous bone (two femoral heads) from the bone bank was necessary. After 5 years the bone transplant had become integrated, there were no signs of recurrence and the patient was pain-free with a normal joint function. There were no signs of loosening.