Despite increasing confidence in the intermediate and long-term results of total hip replacement, considerable and justifiable concern remains about its use in young, active adults. Hip arthrodesis is a valuable, although unpopular, option in this group of patients. The authors describe, step by step, the standardized technique of arthrodesis that they first used in 1981, and they review the results of their experience. The importance of precise positioning of the fusion is emphasized: 20 degrees of flexion, 5 degrees of external rotation and neutral abduction-adduction. Intraoperative radiography to check the positioning is strongly advised. Because total hip arthroplasty will likely be necessary at a later date, every effort should be made to preserve the abductors, and the greater trochanter should be fixed in place at its normal level. If these precautions are taken and if the patient is carefully selected and properly educated preoperatively, a high success rate can be expected for hip arthrodesis.