Metal-on-metal resurfacing of the hip is a bone sparing arthroplasty that may be an option when a head-sparing nonarthroplasty option fails. We present the first published report of 5 cases of failed free vascularized fibular graft treated with modern hip resurfacing arthroplasty. This selected group of patients had avascular necrosis with less than 20% head involvement and cysts less than 1 cm in diameter. Follow-up ranging from 2 to 5 years (mean, 38 months) showed improvement in hip function without evidence of prosthesis loosening. There were no femoral neck fractures or revisions. A vascularized fibular bone graft does not prevent good early results with hip resurfacing but may add technical complexity owing to its position within the femoral head and neck.