Hip Arthrodesis

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  • End stage hip disease in a patient not a candidate for hip arthroplasty
  • A reconstructive option following tumor resection when there is insufficient bone remaining to support a prosthetic joint replacement
  • A reconstructive option following failure of joint replacment
  • A modification of lower extremity amputation for limb salvage for tumor resection, a hip rotation plasty


  • Exposure
  • Bone preparation
  • Positioning
  • Fixation
  • Managment of the abductor mechanism
  • Planning for the future

Primary Arthrodesis for Arthritis with no Deformity

  • Lateral decubitus position
  • Position patient in ideal positon of fusion using bean bags
    • Hip flexion 30 degrees
    • 10 degrees of adduction
    • 15 degrees of external rotation
  • Form bean bags around pelvis and lower limbs in this position
  • Check an Xray

Surgical Approach
  • Use a straight lateral incision
  • Classic trochanteric osteotomy, carefully preserving the abductors
  • Anterior hip capsulectomy
  • Expose the acetabulum and carefully ream the acetabulum
  • Use corresponding femoral head resurfacing reamer to create a pencil in cup fit femur to acetabuluum
  • Reduce the hip
  • Contour a Cobra plate and fix to the supraacetabular bone

  • Use an outrigger compression device to compress the femur to the acetabulum
  • Complete the fixation to the ffemur using compression screws.
  • Check an X-Ray
  • Reattach the trochanter to near anatomical position to facilitate future take down if necessary.

Postoperative Care

Include immediate postoperative care and rehabilitation


  • Pseudarthrosis rate 0 - 10%
  • Femoral fractures develop in 5 - 15%
  • Back pain in ~ 60% (long term, usually ~ 25 years post op)
  • Pain in the knee 50 - 55% (usually after ~ 24 years)
  • Fusion in adduction caus hes less back and knee pain than those fused in abduction
  • Hip fused in adduction also has lower incidence of degenerative changes in ipsilateral knee and better gait pattern


  • Later conversion to THR is associated with limp, due to abductor weakness and positive Trendelenburg test. Conversion to THR however, will improve sitting comfort, may improve level of function, reduce back pain and knee pain.


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