Osteolysis is the greatest threat to the viability of modern acetabular implants. The etiology and natural history of osteolysis remain unknown. Patients with cementless implants who have osteolysis are challenging to treat. There are no standards for follow-up methods or frequency, and there is little evidence to support timing of the decision to begin treatment in these patients. The natural history of proposed treatment options is also unknown. Reconstruction of the acetabulum in the presence of bone loss is difficult. Classifications have been developed to guide management. Multiple options exist for revision acetabular surgery, and it is important to understand the rationale and data in support of these options. A review of the literature was undertaken and algorithms were developed to help address acetabular bone loss in patients undergoing revision surgery.