This video shows single-stage bilateral total hip arthroplasty for fused hips via the direct anterior approach in a 36-year-old man with a stiff spine. Preoperative imaging studies revealed bilateral protrusio with bilateral hip flexion and a windswept deformity. This video demonstrates the steps for acetabular preparation for management of bony ankylosis in a patient in whom the femoral head cannot be removed and an in situ neck cut is made and serial reaming is performed. Trimming of the greater trochanter also is performed to remove extra bone in preparation of the femur.