Hip Fusion Research Articles

Long-term outcomes of converting fused hips to total hip arthroplasty are satisfactory: a systematic review and meta-analysis

Background: Although conversion arthroplasty of fused hips can relieve pain and provide patient satisfaction, long-term outcomes of total hip arthroplasty (THA) after hip fusion remain a subject of debate. This meta-analysis aimed to assess the effectiveness of THA for fused hips over a long period with concerns over potential complications. Methods: A systematic search of five databases from 2000 until 2023 identified English studies evaluating THA for fused hips with at least 100 months of follow-up. Meta-analyses were conducted using random-effect models via the comprehensive meta-analysis software. Sensitivity analysis, in-depth meta-regression, Egger's test, and the trim-and-fill method were performed appropriately Results: The meta-analysis assessed 790 patients and 889 hips with a mean follow-up of 11 years. At the final follow-up, the mean Harris Hip Score (HHS) and leg length discrepancy (LLD) improved by 34.755 and 2.3 cm from the baseline, respectively. Regarding survival of hip fusion conversion to THA, most studies (88.8%) reported a 5-year implant survival rate of at least 90%, and the 15-year and 20-year implant survival rates, ranged between 80–90% and 70–90%, respectively. Subjective dissatisfaction with the conversion of hip fusion to THA was only 5.3%. Composite rates of revision, instability, and aseptic loosening were 13.6%, 3.8%, and 8.8%, respectively. Conclusions: Conversion of fused hips to THA results in favourable long-term outcomes regarding HHS, LLD, survival rates, and subjective satisfaction, leading to improved quality of life in properly selected patients. However, the presence of complications should be considered when evaluating the overall success of the procedure.

Treatment of hip fusion combined with equal degree knee osteoarthritis with total knee arthroplasty:a case report

Treatment of hip fusion combined with equal degree knee osteoarthritis with total knee arthroplasty:a case report

Fused hip conversion to total hip arthroplasty with the direct anterior approach: surgical technique on a regular surgical table under fluoroscopic guidance.

Conversion of a fused hip to a total hip arthroplasty (THA) is technically challenging due to the loss of anatomical references. Here, a reproducible technique using the direct anterior approach (DAA) with a regular surgical table under fluoroscopic guidance is described, which has several advantages over traditional such as lateral or posterior approaches. There were reported 11 cases of ankylosis hip that were converted to THA using the same surgical technique protocol. Clinical and radiographic outcomes were recorded at 3.2years of follow-up. A detailed preoperative evaluation was performed, including a pelvis radiological evaluation and magnetic resonance image (MRI) to assess the integrity of the periarticular soft tissue and flexor muscles. The DAA has considerable advantages, such as allowing more precise targeting during surgery, avoiding the risk of pseudoarthrosis due to the absence of a trochanteric osteotomy, preserving the abductors, and allowing an easier-to-use of intraoperative fluoroscopy due to the supine position. Besides, the use of a standard table reduces surgical time and allows assessment of limb length, hip stability, and impingement in all planes in an intraoperative dynamic range, which decreases postoperative complications. Conversion from hip fusion to THA is a rare and complex procedure. The use of DAA with a standard table and fluoroscopy helps to avoid high complications since it allows a dynamic intra-operative examination of the range of motion to rule out impingements, reduces the risk of dislocation, and allows leg lengthening verification.

Total Knee Arthroplasty in a Patient with Bilateral Fused Hip due to Seronegative Arthritis: A Case Report

Degenerative changes in other joints secondary to hip fusion occur due to changes in the relative biomechanical forces acting on those joints. At present, there are no standard protocols to aid the decision-making process of joint replacement surgery in patients with hip fusion due to secondary arthritis causes. Each patient requires tailored management planned by the surgeon to optimise treatment plan and achieve the highest degree of functional improvement. Total Knee Arthroplasty (TKA) is a welldocumented, common, and cost-effective procedure in the management of morbidities associated with joint degeneration due to wear and tear of the cartilage. TKA in patients with hip fusion is relatively rare, and there are few case reports and studies indicating a standardised approach and treatment protocols for the same. In this case report, TKA due to symptomatic knee arthritis in a patient with a 15-year history of spontaneous bilateral hip fusion due to seronegative arthritis is discussed. Postoperatively, the patient’s condition was stable, with good Range Of Motion (ROM) at the knee and without aseptic features as determined by recent radiologic investigations.

Total Knee Arthroplasty in Patients with Ipsilateral Hip Fusion: Technical Notes and Literature Review.

Numerous studies report the success and outcomes of the total knee arthroplasty (TKA); however, few papers present patients with knee osteoarthritis and ipsilateral hip fusion. One controversy when treating patients requiring a TKA with prior ipsilateral hip fusion is whether to first perform a total hip arthroplasty (THA) of the fused hip, followed by the ipsilateral TKA, or to proceed with the TKA without replacing the hip; studies suggest that the position of the fused hip is a key factor when making this therapeutical decision. In addition, performing a TKA in patients with an ipsilateral fused hip may require modifications to the surgical technique generated by the lack of joint mobility in the hip. We identified 12 studies encompassing 30 patients with hip fusion and ipsilateral TKA in current orthopedic literature, but only six offered insights on patient positioning on the operating table during surgery. This study aims to review the current literature on patients with knee osteoarthritis and prior ipsilateral hip fusion and to present some technical considerations when performing a TKA on a 75-year-old patient with hip ankylosis who underwent a total ipsilateral knee arthroplasty in our clinic.

Single-stage bilateral conversion arthroplasty for hip fusion via direct anterior approach in a patient with severe ankylosing spondylitis and kyphoscoliosis: a case report

BackgroundSevere ankylosing spondylitis (AS) frequently involves hip joints and, occasionally, presents with concurrent spinal deformities, such as kyphoscoliosis, creating complex challenges for surgical management.Case presentationWe present a 26-year-old Persian male with a history of AS and severe kyphoscoliosis, leading to bilateral hip fusion and immobility. Following spinal deformity correction, a one-stage bilateral conversion to total hip arthroplasty (THA) was conducted through the direct anterior approach.ConclusionPrimary correction of spinal deformities allows for extended surgical procedures under general anesthesia. Single stage bilateral hip conversion arthroplasty via the direct anterior approach enhances postoperative mobilization, reduce the risk of re-ankylosis, and improve the overall quality of life for AS patients with this unique presentation.

Clinical Outcomes and Complications Following Hip Fusion Conversion to Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundEfficacy, clinical outcomes, and complications following hip fusion conversion to total hip arthroplasty (THA) surgery have been explored in several studies with controversial findings and no consensus. MethodsComprehensive search of online databases was performed through December 2022 for prepost clinical trials using MeSH keywords. Harris hip score (HHS), leg length discrepancy (LLD), pain score, and range of motion (ROM) were considered as clinical outcomes along with implant survival and complications. The retrieved studies were assessed for methodologic quality. Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated using random effects meta-analysis taking into account for heterogeneity. Subgroup meta-analysis as well as sensitivity analysis were performed. ResultsFindings of meta-analysis on 34 trials showed that HHS increase after THA (WMD: 42.3; 95% confidence interval (CI): 38 to 47). Subgroup analyses indicated that cementless prosthesis, length of arthrodesis <12 years, age <45 years, and studies with good quality have more HHS improvement. The LLD decreased 21 mm (95% CI: 19 to 24 mm) based on 21 trials. The range of motion (ROM) reached to 89 (95% CI: 84 to 95) for flexion, 32 (95% CI: 27 to 37) for abduction, 25 (95% CI: 21 to 29) for adduction, 29 (95% CI: 25 to 33) for external rotation, and 25 (95% CI: 20 to 31) for internal rotation after surgery. The most common complication was heterotopic ossification (14%). ConclusionConversion of an ankylosed hip to THA leads to improved hip function and leg discrepancy with relatively notable rate of complications. Our findings could provide a framework to guide surgeons and decision makers.

Robotic-assisted revision total joint arthroplasty: a state-of-the-art scoping review.

During the past decades, robotic-assisted technology has experienced an incredible advancement in the field of total joint arthroplasty (TJA), which demonstrated promise in improving the accuracy and precision of implantation and alignment in both primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, revision TJA remains a technically challenging procedure with issues of large-scale bone defects and damage to nearby anatomical structures. Thus, surgeons are trying to harness the abilities of robotic-assisted technology for revision TJA surgery. PubMed, Embase, Cochrane Library, and Google Scholar were comprehensively searched to identify relevant publications that reported the application of robotic-assisted technology in revision TJA. Overall, ten studies reported the use of the robotic system in revision TJA, including active (ROBODOC) and semi-active (MAKO and NAVIO) systems. One clinical case reported conversion from hip fusion to THA, and three studies reported revision from primary THA to revision THA. Moreover, four studies reported that robotic-assisted technology is helpful in revising unicompartmental knee arthroplasty (UKA) to TKA, and two case reports converted primary TKA to revision TKA. In this study, we present the latest evolvements, applications, and technical obstacles of robotic-assisted technology in the revision of TJA and the current state-of-the-art. Current available evidence suggests that robotic-assisted technology may help surgeons to reproducibly perform preoperative plans and accurately achieve operative targets during revision TJA. However, concerns remain regarding preoperative metal artifacts, registration techniques, closed software platforms, further bone loss after implant removal, and whether robotic-assisted surgery will improve implant positioning and long-term survivorship.

Conversion of a Fused or Ankylosed Hip to Total Hip Arthroplasty: Is the Direct Anterior Approach in the Lateral Decubitus Position an Ideal Solution?

BackgroundTotal hip arthroplasty (THA) using the direct anterior approach (DAA) is becoming increasingly popular due to its potential benefits over the posterolateral approach (PLA). However, few studies have compared the efficacies of these two surgical approaches in hip fusion treatment. This study compared early clinical direct anterior and posterolateral THA outcomes in hip fusion treatment.MethodsHere, 127 hips (65 DAA, 62 PLA) were retrospectively evaluated. Early postoperative functional outcomes of DAA and PLA groups were assessed using Harris score and Oxford Hip Score (OHS) and standard anteroposterior hip radiographs. Surgical characteristics, perioperative results, and complications within 6 months postoperatively were recorded.ResultsThough baseline values were similar, Harris and OHS scores were better in the DAA group than in the PLA group at 1 and 3 months postoperatively. The average cup anteversion angle was significantly greater in the DAA group than in the PLA group (12.7° vs. 11.1°). More hips undergoing DAA were successfully orientated in both inclination and anteversion angles (46 vs. 32). Early postoperative hip function predictors were preoperative fused hip position, surgical approach, and range of motion. DAA was associated with reduced postoperative blood loss and shorter hospital stays. Furthermore, 14 vs. 8 complications occurred in the DAA vs. PLA group. Lateral femoral cutaneous nerve injuries were observed in eight hips (12.3%) of the DAA group.ConclusionFor fused or ankylosed hips, THA using DAA in the lateral decubitus position may result in excellent prosthesis positioning and faster postoperative recovery throughout early follow-up vs. PLA.

Total Knee Arthroplasty in Patients With Prior Ipsilateral Hip Fusion: A Surgical Technique.

In patients with severe osteoarthritis of the knee with prior ipsilateral hip fusion who require total knee arthroplasty (TKA), a controversial issue is whether to first convert the hip fusion to a total hip arthroplasty (THA) or to perform TKA without reconstruction of the hip. Also, immobility of the ipsilateral, fused hip adds significant technical challenge because the usual positioning of the leg requires modification in order to gain access needed for the TKA. In such cases, we position the patient with the knee suspended, similar to how we perform knee arthroscopy. In our experience, the ipsilateral knee has significant deformity and is best addressed with a constrained, hinged TKA. In 3 patients with severe knee osteoarthritis with prior ipsilateral hip fusion-a 72-year-old man and a 79-year-old woman with hip arthrodesis due to posttraumatic arthritis and an 81-year-old woman with hip arthrodesis due to congenital dislocation of the hip-rotating-hinge knee prostheses were implanted due to severe knee instability. All 3 patients had satisfactory results, without complications, after follow-up of 1 to 5 years. We obtained satisfactory results in the short and medium term without previously converting the hip arthrodesis to THA by positioning patients with the knee suspended, in a way similar to when knee arthroscopy is performed, and implanting rotating hinge TKAs due to severe preoperative knee instability.

Review of complications, functional outcome, and long-term survival following conversion of hip fusion to total hip arthroplasty.

Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed. At mean 12.2 years (2 to 24) follow-up, HHS improved from mean 34.2 (20.8 to 60.5) to 75 (53.6 to 94.0; p < 0.001). Mean postoperative ROM was flexion 77° (50° to 95°), abduction 30° (10° to 40°), adduction 20° (5° to 25°), internal rotation 18° (2° to 30°), and external rotation 17° (5° to 30°). LLD improved from mean -3.36 cm (0 to 8) to postoperative mean -1.14 cm (0 to 4; p < 0.001). Postoperatively, 26 patients (68.4%) required the use of a walking aid. Complications included one (2.5%) dislocation, two (5.1%) partial sciatic nerve injuries, one (2.5%) deep periprosthetic joint infection, two instances of (5.1%) acetabular component aseptic loosening, two (5.1%) periprosthetic fractures, and ten instances of HO (40%), of which three (7.7%) were functionally limiting and required excision. Kaplan-Meier Survival was 97.1% (95% confidence interval (CI) 91.4% to 100%) at ten years and 88.2% (95% CI 70.96 to 100) at 15 years with implant revision for aseptic loosening as endpoint and 81.7% (95% CI 70.9% to 98.0%) at ten years and 74.2% (95% CI 55.6 to 92.8) at 15 years follow-up with implant revision for all cause failure as endpoint. The use of an optimal and consistent surgical technique and cementless implants can result in significant functional improvement, low complication rates, long-term implant survival, and high patient satisfaction following conversion of hip fusion to THA. The possibility of requiring a walking aid should be discussed with the patient before surgery. Cite this article: Bone Joint J2021;103-B(7 Supple B):129-134.

Conversion of Hip Arthrodesis Using Robotic Arm Technology

Recent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.

The short-term outcomes of hip arthrodesis in children and adolescents with end-stage hip disease

ABSTRACT BACKGROUND: The management of end-stage hip disease in children and adolescents is a challenging clinical problem. While total hip replacement (THR) offers the benefit of improved mobility, this is offset by the risk of multiple revisions. Hip arthrodesis remains a salvage option to relieve pain and restore function at the cost of hip movement. This study aimed to determine the short- to medium-term outcome of hip arthrodesis in paediatric and adolescent patients in a developing world setting. METHODS: All children and adolescents under the age of 18 years who underwent hip arthrodesis between 2010 and 2014 were included in the study. Measurements included diagnosis, preoperative deformity, fusion position, fusion rate and functional outcomes. Our surgery involved transarticular compression screw fixation and subtrochanteric osteotomy. Postoperative skeletal traction maintained optimal limb position for two weeks, after which spica cast immobilisation was used. RESULTS: Nineteen patients (11 female) had hip fusions at a mean age of 12 years (range 5-18). The mean follow-up period was 5 years (range 1-8). Most cases were due to end-stage TB arthritis (12/19; 63%). Other causes were septic arthritis (3/19; 16%); neglected slipped capital femoral epiphysis (1/19; 5%); post-traumatic avascular necrosis (1/19; 5%); and idiopathic chondrolysis (2/19; 11%). Primary fusion was achieved in 68% (13/19) of cases. Six patients developed complications. Complications included adduction drift (3/19), failed fusion (3/19), screw malpositioning (1/19) and screw breakage (1/19). Eight reoperations were required in six patients. In two of these patients, one additional surgery had to be performed to achieve fusion or correct limb position. The mean fusion position was 31° (range 20 to 50) flexion, 2° (range 10 to -10) abduction, and 1° (range 10 to -10) external rotation. Mean leg length discrepancy was 1.8 cm (range 0 to 4.5) of shortening. All except one patient reported relief of hip pain and satisfaction with the procedure. CONCLUSION: While hip arthrodesis is a technically challenging procedure, high fusion rates and reliable pain relief may be expected in these patients. However, complications should be anticipated, and reoperation may be required to achieve fusion and an optimal limb position Level of evidence: Level 4 Keywords: end-stage hip arthritis, TB hip, hip arthrodesis, hip fusion, subtrochanteric osteotomy

Robotic-Arm Assistance Simplifies Hip Arthrodesis Conversion to Total Hip Arthroplasty

Hip fusion takedown to total hip replacement is a challenging operation. Neck osteotomy and acetabular component placement are technically demanding and often require fluoroscopic guidance. Robotic arm–assisted total hip arthroplasty enhances accuracy of preoperative planning and provides navigated guidance for neck osteotomy and haptic guidance on acetabular reaming and cup implantation. Fluoroscopic guidance is replaced by real-time navigation and on-screen data. This article describes how robotic arm assistance can simplify this complex operation.

Total Knee Arthroplasty with Prior Ipsilateral Hip Arthrodesis

Total knee arthroplasty (TKA) in the setting of previous hip fusion is rare with a paucity of evidence in the orthopaedic literature. Traditionally, TKA is performed supine, with the aid of knee-positioning devices allowing for hip flexion and range of motion of the knee to facilitate ease of surgical intervention. However, TKA using traditional positioning would not be possible in the presence of ipsilateral hip arthrodesis preventing hip motion. This case report describes a TKA performed for a 72-year-old woman with end-stage osteoarthritis of the right knee, ipsilateral hip arthrodesis, and leg-length discrepancy as the sequelae of slipped capital femoral epiphysis. We describe novel surgical positioning to be used to facilitate TKA in the absence of ipsilateral hip motion with bed modifications and the use of an extremity positioning device.

Conversion of Hip Fusion to Total Hip Arthroplasty

Hip fusion provides adequate pain relief for various end-stage hip pathologies. However, this comes at the expense of motion, restricting most of daily-living activities. Conversion to a THA has been shown to restore range of motion, relieve pain, and decrease stress in adjacent joints. Furthermore, THA can enhance quality of life, improve function, and restore the ability to perform activities of daily living. This systematic review study to evaluate the indications, clinical outcome, complications, overall satisfaction and change in quality of life in patients underwent conversion of hip fusion to total hip arthroplasty. The electronic database search yielded 2154 studies; 1352 studies were duplicated so removed. After removal of 422 for language and sampling defects, 380 were screened according to inclusion and exclusion criteria. Only 11 studies were eligible, so included in qualitative synthesis in the current systematic review. Regarding the outcome assessment, 8 out of 11 studies used Harris hip score (HHS) for outcome evaluation, 2 out of 11 studies used Mayo score and only one study out of 11 studies used Merle d’Aubigne scale. The all included studies showed significant improvements of the scores postoperative and enhanced outcomes. Despite the lack of well deigned studies on the conversion to total hip arthroplasty, the present systematic review provides some evidence that total hip arthroplasty can aid to restore range of motion, relieve pain, and decrease stress in adjacent joints.

Limb lengthening in down syndrome

Introduction: The average life expectancy for Down syndrome patients has markedly improved. Musculoskeletal disorders occur in 20%–27% of patients with Down syndrome, with hip or knee instability among the most common presentations. Leg length discrepancy has rarely been reported in Down syndrome but can occur as the result of previous lower extremity surgery. This case report presents our experience with the first documented use of an intramedullary lengthening nail to correct a 4.5 cm iatrogenic leg length discrepancy in a skeletally mature Down syndrome patient. Materials and Methods: A single patient surgically treated for leg length discrepancy was followed over a 1-year period and retrospectively reviewed. Results: An 17-year-old male with Down syndrome presented with a 4.5 cm leg length discrepancy secondary to a previously attempted hip fusion. He had been treated with a shoe lift but had difficulty walking with the lift and resorted to toe walking whenever the lift was not being used. His mother, who was his full-time caregiver, was interested in surgical options for permanently correcting his discrepancy. After long discussions over multiple visits covering the risks and benefits of the various choices, the decision to proceed with lengthening of the short limb using a retrograde femoral intramedullary lengthening nail was made. Distraction osteogenesis of 4.5 cm with full consolidation was achieved in this patient without complications. He was able to return to full independent ambulation without a lift by 4 months. Conclusion: Limb lengthening requires a detailed postoperative protocol that may appear to be difficult for a Down syndrome patient with cognitive developmental delay to manage. However, this report documents that if the patient has a reliable caregiver and close postoperative monitoring is maintained, a successful outcome is possible. This represents the first published case of limb lengthening in a Down syndrome patient.

Compensatory sagittal plane ankle gait mechanics: Are they present in patients with a weak or stiff hip?

IntroductionSimulations suggest that subjects with reduced hip range of motion (ROM) and/or weakness can achieve more normal walking mechanics through compensations at the ankle. The aims of this study were to assess whether subjects with reduced hip ROM (Stiff hip) or hip flexor weakness (Weak hip) exhibit ankle compensations during walking and investigate redistribution of power in the lower extremity joints. MethodsRetrospective gait data were reviewed (IRB-approved hip registry). Preoperative kinematic/kinetic walking data were collected in patients with: adolescent hip dysplasia (AHD), femoral acetabular impingement (FAI), and Legg-Calvé Perthes disease (Perthes). AHD patients with significantly weak hip flexors on their affected side were included (Weak hip group). The Gait Profile Score (GPS) was calculated on the affected side of the FAI and Perthes groups to identify patients who had a Stiff hip. Patients who had undergone a hip arthrodesis (Fusion) were also included (Stiff hip group). Ankle kinematics/kinetics were compared to healthy participants (Control). The total positive work of sagittal plane hip, knee and ankle power were compared along with the distribution of power. ResultsPatients in the Weak/Stiff hip groups did not walk with greater ankle plantarflexion, peak push-off power or positive ankle work on their affected sides compared to Control. Ankle work contribution (percentage of total positive work) on the affected or unaffected sides was greater in the Perthes and Hip Fusion patients compared to Control. Significant gait abnormalities on the unaffected side were observed. ConclusionsPatients with a weak or stiff hip did exhibit altered ankle mechanics during walking. Greater percent ankle work contribution appeared to correspond with hip stiffness. In patients with hip pathology the redistribution of power among the lower extremity joints can highlight the importance of preserving ankle function.

Survival of the native hip after spinopelvic fusion

Studies describe progression of adjacent joint arthritis after hip fusion but not vise versa. We investigated the relationship after spinopelvic fusion and total hip arthroplasty.383 patients undergoing spinopelvic were investigated. Perioperative demographics were recorded. A matched 2:1 cohort was used to detect risk factors for THA progression. 10 patients (2.6%) underwent THA after spinopelvic fusion. Average time from surgery to THA was 24.4 months.After spinopelvic fusion, patients progressed to THA 24.4 months on average. Due to small numbers, we couldn't find differences between the two groups regarding comorbidities nor risk factors for THA. Further studies are needed.

Long-term results of custom cementless-stem total hip arthroplasty performed in hip fusion.

Due to complex anatomical considerations, results of cementless-stem total hip arthroplasty (THA) in hip fusion remain controversial compared with conventional THA. We therefore aimed to analyse 3D anatomy of the fused hip based on pre-operative computed tomography (CT) scans, functional outcomes based on the Harris Hip Score (HHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS), modifications of hip anatomy based on post-operative standardised radiography, and determine complication rate and long-term survival based on Kaplan-Meier analysis. We retrospectively studied 23 hips that underwent conversion of a fused hip to THA using a 3D CT scan-based custom titanium (Ti alloy hypoxyapetite (HA)-coated stem. The mean follow-up was 15(9-22)years. Femur anteversion ranged from -29° to 80°. HHS improved from 59 to 89 points and average range of motion (ROM) was 88° for flexion. Back pain decreased in 62%, and knee pain decreased in 42%. The mean post-operative leg-length discrepancy was 7.8mm. No intra-operative complications occurred. One aseptic stem loosening for mechanical failure was observed. The Kaplan-Meier survivorship considering revision for any reasons as the end point was 95.6% [95% confidence interval (CI) 92.4-98.8] at 15years. Custom cementless stems may be an interesting solution to address the particular anatomical features of hip fusion at the time of THA, with an excellent survival rate at 15years.