Extensive loss of bone from the proximal part of the femur may occur as a result of trauma, infection or operative resection. Loss of the femoral head represents a particular reconstructive challenge. Treatment options have included allograft, prosthesis and hip disarticulation. We report a new technique to create an effective lower extremity weight-bearing stump through the use of an ipsilateral osteomusculocutaneous rotational flap, which allows the tibia and ankle joint to function as a femur. Four patients who had extensive segmental loss of femoral bone proximal to the distal femoral condyles, were reconstructed with a tibia-hindfoot osteomusculocutaneous rotationplasty after transtarsal (Chopart) amputation, with calcaneopelvic arthrodesis to create stable fixation of the extremity to the pelvis; this fixation allowed flexion, extension, abduction, and adduction of the hip by means of the retained tibiotalar and subtalar joints. Two patients had complete resection of the proximal part of the femur because of an infection following the insertion of custom femoral replacement and hip arthroplasty prosthesis. The remaining two patients required débridement of the femur from the subcapital line to the femoral condyles because of post-traumatic osteomyelitis after failure of a reconstruction with a massive allograft and a failed free fibular graft. Patient age averaged 41. Operative time averaged 6.5 hours. Average follow up was 4.5 years. Minor complications occurred in all patients and included skin flap revision in 3 patients, distal stump revision in one, and abscess drainage in another. Final hip motion averaged 30 degrees of hip abduction and 30 degrees of forward flexion. At the time of the latest follow-up all reconstructions were functional; three of the four patients were bearing full weight, without pain, with the use of a standard above-the knee-amputation prosthesis. We report this procedure as a useful alternative to disarticulation at the level of the hip in patients who have massive loss of femoral bone and destruction of the hip joint in association with scarred and previously infected soft tissues and are not considered to be candidates for other forms of limb-preservation reconstruction. The patient must be willing to accept the equivalent of a low above-the-knee amputation and recognize the potential value of a weight-bearing stump.