In this era of prosthetic arthroplasty, one is apt to forget the important role that hip fusion plays in osteoarthritis. Prostheses yield their best results when used as a substitute for fractured necks of femurs when the articular acetabular cartilage is essentially normal. Almost as brilliant results can be obtained in traumatic arthritis from early aseptic necrosis following healed fractures or following dislocated hips or in fractured acetabula. However, the brilliant results diminish steadily as one uses the prosthesis in osteoarthritis due to congenital subluxation or dislocation, to malum coxae senilis, or to the degenerative hereditary type of osteoarthritis.

In the treatment of a painful osteoarthritic hip, hip fusion is still the procedure of choice if one requires a stable, painless hip which will allow a worker to return to long hours of duty. It is the operation of choice in a unilateral congenitally dislocated hip with severe pain. It needs to be considered strongly in bilateral painful hips where an arthroplasty is contemplated in one hip, but a stable, permanently nonpainful hip is required on the other side. Its great role is as an end-point salvage procedure, where previous operations have been attempted on a hip and have resulted in a painful failure, such as those following cup arthroplasties and prostheses and following infection in the hip.

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