Introduction Severe bone loss is not uncommon in hip revision surgery and bone grafts or subistitutes are often required. Although the literature report excellent results, there are few clinical trials on the outcome of bone substitutes with long follow up. The aim of our study was to evaluate the clinical and radiographic outcome of bone substitutes implanted from 2010 to the present. Materials and methods We evaluated 18 patients (14 F, 4 M) treated for revisions in aseptic loosening of hip arthroplasty that required the use of bone substitutes. All patients were studied retrospectively by clinical and radiographic examination (RX-TC) with a mean F-UP of 18 months (min 1 - max: 24 months). We analyzed the following parameters: radiographic bone healing and its timing, bone \material resorption\replacement, adverse effects. Results We implanted 23 substitutes / bone grafts. The materials used were HA / TCP (3) and homologous bone grafts (18). At the end of the F-UP, we observed the following results: 14 bone healing (77.7%) at 5.9 months F-Up; 44.4% of bone/substitutes resorption / bone replacement, good-excellent clinical result in 88.8% of cases (excellent / good range of motion, absence of pain), and poor in 18.2% of cases (moderate pain and / or limited joint movement); adverse effects or complications were observerved in 16.6% of cases (pain, infection, osteonecrosis). Discussion The analysis of the results shows that the homologous bone grafts provide satisfactory results. Among the synthetic substitutes calcium sulphate, did not demonstrated to be osteoconductive and showed an excessively rapid resorption for bone replacement. The TCP based substitutes, while presenting poor resorption, are a good alternative and their association with the DBM increases bone healing. Conclusions Bone loss in hip replacement surgery can be treated with good and safe results and with few complications by bone grafting. The synthetic bone substitutes can be a valid alternative in spite of high costs and minor demonstration of clinical efficacy.