We retrospectively reviewed 27 patients who underwent an uncemented total Moje ceramic arthroplasty of hallux rigidus.

Out of 33 patients who had the above procedure, 27 were available for review. Clinical and functional outcome were assessed using the American orthopaedic foot and ankle society (AOFAS) fore-foot score, and the SF-36 health assessment score. All patients had an anteroposterior and a lateral weight bearing radiograph

The primary pathology was oesteo-arthritis (Hallux Rigidus). All procedures were performed by the senior author or under his supervision.

All patients were female with an average age at surgery of 52.6 years (range 45.8–64.7). The average follow up was 39.5 months (range 14–46).

The average post-operative AOFAS forefoot score was 80/100 (range 40–100). The average subscore for pain was 29.39/40 (range 10–40). Twenty five patients 92.5% were satisfied with the outcome, and 22 (81%) were able to wear high heel foot wear.

The functional outcome as assessed using the SF-36 health score was compatible with an age matched population.

The alignments of component were measured in relation to the shaft of the metatarsal and to the proximal phalange. There was no statistical correlation between the alignment and the functional scores.

Although, arthrodesis remains the gold standard procedure, total ceramic first MTP joint arthroplasty has a place in the management of some cases of advanced but not end stage hallux rigidus. Careful patient selection is essential to achieve a favourite outcome.

Aim: To evaluate the effect of Warfarin, the prevalence of acceptable level of INR by the anaesthetist, leading to delay of surgery in patients with fracture neck of femur and the outcome of such treatment.

Material and Methods: We retrospectively reviewed all patients admitted with fracture neck of femur who were on Warfarin in the year 2002. In total 9 out of 135 pt were on Warfarin.

Their entire medical records were scrutinised.

A control group of similar age, sex and pre- morbid conditions was identified.

A telephone survey was then conducted

In warfarin group average delay in surgery was 4 days (1 to 7) , needed 76% more blood test, total morphine 40mg and Codeine 960mg, 60% longer stay and after all 78% had General anaesthesia.

The six hospital survey showed the estimated number of such patients averaged 2 (1 to 4) per year, delay in surgery of 2 to 5 days and acceptable INR between 1.5 to under 3.

Conclusion: We found that we under estimate the number of patients on Warfarin. These patient had a significant delay in surgery requiring more analgesic both oral and parental, no significant post- op complications but a much longer hospital stay causing significant increase in morbidity, bed block and expenditure. We were surprised that there is no consistently acceptable level of INR to perform the surgery and type of anaesthesia.