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  • Fusion (Ankylosis) can occur spontaneously following childhood sepsis, following ORIF of acetabular fractures (secondary to heterotopic bone) and in ankylosing spondylitis

  • Unpopular as leads to increased stress on other hip and ipsilateral knee

  • Oxygen consumption 32% greater than normal

  • Average walking speed 84% of normal


  • Young patient with unilateral hip disease (usually post-traumatic)

  • Contra-lateral hip, both knees and spine must all be normal


The goals of surgical treatment are to achieve bone apposition at the fusion site, rigid internal fixation, and early mobilization.

  • Anterior or posterior approach inorder to dislocate the hip and to remove the joint surfaces

  • AO Cobra Plate: stable but disrupts abductorscobra-plate

  • Trans-articular sliding hip screw

  • lag screw is inserted across the joint and just superior to the dome of the acetabulum

  • disadvantage of this technique includes poor fixation (due to large lever arm and the resulting torque on the lever arm) and need for postoperative hip spica casting

  • Some authors advocate supra-acetabular osteotomy or subtrochanteric osteotomy for improved positioning


Optimal position

  • 25o flexion
  • Neutral – 5o external rotation
  • Neutral or slight adduction
  • Avoid abduction and internal rotation


  •  Hip arthrodesis achieves lasting pain relief and satisfactory clinical results in most patients.
  •  The survivorship of arthrodesis can be limited by symptomatic degenerative disease of the neighboring joints:

    •  The lumbar spine
    • ipsilateral knee, or
    • contralateral hip can demonstrate joint degeneration.
  • Low back pain and instability and osteoarthritis of the ipsilateral knee are the most common problems.
  • Occasionally, hip fusion conversion to total hip replacement is needed.
  • Conversion of a hip arthrodesis to total hip arthroplasty provides good clinical results in most patients.
  • Trochanteric osteotomy is frequently necessary for surgical exposure.trochanteric-osteotomy
  • Rehabilitation is prolonged because of profound hip abductor weakness and the associated limp.


  • Non-union
  • Malunion
  • OA of hip, spine, knee 
  • Instability of ipsilateral knee


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