Other than the results of the Charnley group, using a transtrochanteric approach, there is little in the literature regarding the techniques and results of total hip arthroplasty following hip fusion. Thirteen cases carried out via an anterior Smith-Peterson approach have been performed by the senior author over the last few years. These cases have been studied to determine pitfalls and outcomes using this method. At one year, seventy-five percent of the cases became Trendelenberg negative. The average range of flexion at one year was 88 degrees and the Harris Hip Score was 2 poor, 2 fair, and 9 good or excellent. Retrospectively, one patient would rather not have had surgery. Nerve and vessel damage was not a problem and neither was myositis ossificans. Where possible, existing hardware was removed six months prior to arthroplasty. However, three femoral shaft splits occurred where noncemented femoral components were used. While it is a technically demanding exercise, the results of total hip replacement following hip fusion are acceptable.