The basic concepts involved in using the Biologic Ingrowth Anatomic System (BIAS) as a substitute for cemented total hip arthroplasty are based on proximal press fit and load transfer and distal stability. Both requirements of an ingrowth prosthesis can be accomplished through anatomic design and the intramedullary rod stem. Essential features of the surgical technique used in BIAS hip insertion include careful preoperative sizing of the prosthesis in reference to the prosthesis’ long stem to fit the intramedullary canal; appropriate rasps to accomplish press fit proximally; intramedullary reaming 1 to 2 mm over the prosthesis size to accommodate the long curve stem; and an ingrowth acetabular component with three smooth pegs to allow transmission of compressive load to the ingrowth material on the acetabular cup while providing rotatory stability. The BIAS femoral component has a 12° anteverted head and neck. All patients were allowed full weight bearing as tolerated three to four days postoperatively.