[Objective] To investigate the effect of femoral head bone autograft to reconstruct the acetabular “up and in” defect in primary total hip arthroplasty (THA). [Methods] Between July 2010 to June 2016, THA combined with autogenous femoral head bone grafting was used to treat 14 patients with hip arthritis with acetabular “up and in” defect. There were 11 males and 3 females. The age ranged from 44 to 69 years, with an average age of (56.7 ± 15.4) years. The duration of disease was 7 to 30 years, with an average of (11.5 ± 9.8) years. The preoperative diagnosis included 5 cases of hip arthritis secondary to trauma and 9 cases of hip arthritis secondary to hip infection. The center of the femoral head was moved up (compared with the center of rotation of the femoral head on the contralateral side) by 3-10 mm, with an average of (5.6 ± 2.3) mm. Difference in length of both lower limbs was 10-40 mm, with an average of (24.2 ± 11.7) mm. The range of movement of hip is limited. Harris hip score was 30-65, with an average of (55.4 ± 17.6) points. [Results] The incision primarily healed in all patients. All of 14 patients were followed up for 3 to 9 years, with an average of (5.8 ± 2.9) years. X-ray films showed that the position of the prosthesis was good, and the center of the femoral head was moved 0 to 5 mm, with an average of 2.6 (2.6 ± 1.2) mm. At the last follow-up, all patients had no hip pain. The central position of the femoral head, the difference in length of both lower limbs, the range of movement of hip, and the Harris hip score were significantly better than those before surgery (P<0.05). No patient had complications such as loosening of the prosthesis, collapse of bone graft absorption, osteolysis, displacement of the acetabular cup, and sinking of the femoral stem. [Conclusion] THA combined with autogenous femoral head bone grafting was used to treat hip arthritis with acetabular “up and in” defect, can achieve satisfactory results and low of complications.