A 39-year-old woman underwent bilateral total hip arthroplasty with conventional, ethylene oxide-sterilised liners when she was a subject in a radiostereometric analysis study. Within 2 years she had rapid polyethylene wear with aggressive, asymptomatic, and periprosthetic osteolysis on both sides. Oral alendronate therapy halted the progression of osteolysis over a year and revision to cross-linked polyethylene liners was then undertaken while one stem was curettaged and the other revised. Radiostereometric analysis revealed a 96% reduction in wear rate over 2 years with the cross-linked liners. On stopping alendronate treatment, aggressive osteolysis recurred on the curretaged but not on the revised femur.