Following chemotherapy for acute lymphocytic leukemia (ALL) in a young woman, the articular surfaces of both femoral heads and the right knee lateral femoral condyle collapsed, resulting in significant pain and disability. Using a novel technique, the articular surface of the knee was reconstructed using fresh bulk osteochondral autograft harvested from the ipsilateral femoral head during a simultaneous total hip arthroplasty. Fresh osteochondral autografting enabled rapid osseous integration and articular surface reconstruction using living host cartilage, resulting in an excellent clinical outcome. Although uncommon, concurrent avascular necrosis of multiple large joints is occasionally encountered and management options are particularly limited in young patients. We recommend that this innovative technique be considered in those patients who satisfy the criteria for bulk osteochondral grafting procedures where total hip replacement is also required.