Objective The methods for designing and manufacturing custom hip stems based on standard X-ray films was researched. Methods developing the software that includes X-ray scanning, femoral canal obtaining, implant designing, fit evaluation, and drawing a 2-D map. CAM technique also was used to manufacture hip stems. Results The paper introduce a manufacturing method of processing a hip stem, on general machine tools as possible as it can. Clinical results reflected that hip implants matched the femoral cavities very well. Conclusions The clinical result and analyse indicates that the method of designing and manufacturing hip implants is practicable.