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Hip Arthrodesis
Hip arthrodesis was widely used to treat end-stage hip osteoarthritis before the development of THA. However, arthrodesis was largely abandoned in the 1930s in favor of motion-sparing procedures such as cup arthroplasty, and its popularity further eroded in the 1970s as THA gained acceptance. Despite the high success rate of THA, concerns remain about its long-term durability in patients younger than 40 years of age. Revision rates as high as 45% have been reported in younger patients, but may be considerably less with uncemented implants and alternative bearing surfaces. Hip arthrodesis should be considered in selected symptomatic adolescents or adults younger than 40 years of age with monoarticular end-stage hip osteoarthritis and resultant pain. The ideal candidate is a manual laborer who wants to return to work. Patients should be free of low back pain, ipsilateral knee pain, and contralateral hip pain or pathology. Radiographs of these areas should be normal. Patients undergoing arthrodesis for osteonecrosis also should have MRI of the contralateral hip to rule out silent disease. Patients who do not meet all the indications for hip arthrodesis should be considered for alternative procedures such as resurfacing or THA. This chapter reviews the indications, contraindications, results, and surgical techniques for hip arthrodesis. Tips for avoiding pitfalls and complications in hip arthrodesis are also discussed.