Introduction: Modular metaphyseal-diaphyseal femoral stems are infrequent in primary total hip arthroplasty. We analyse the results of a proximally hydroxyapatite coated anatomic two-piece modular femoral stem over a minimum five years follow-up.

Material and Methods. 94 ESOP (Fournitures Hospitalieres, France) stems are analysed. The mean follow–up was 70.45 + 8.6 months. Patients’ mean age was 65.8 + 9.6 years. Proximal osteopenia and radiographic stem fixation are assessed according to Engh et al.

Results: There were 2 aseptic femoral stem loosenings. There were no cases with thigh pain. Three stems presented subsidence. Mean femoral canal filling was 89% and was related to stem subsidence (p< 0.05). Stable bone fixation was obtained in 83 hips and was related to fluted femora (p< 0.0001). The cumulative probability of not having radiographic loosening was 97.8% (94.8% to 100%). The cumulative probability of not having proximal femoral osteolysis was 86.0% (78.9% to 93.1%), cortical widening 88.1% (81.5% to 94.7%), and proximal osteopenia 94.5% (89.8% to 99.2%).

Conclusions: A cementless two-piece modular hydroxyapatite coated femoral stem provides good clinical results with an absence of pain and excellent radiographic results when there is good adaptation between the metaphyseal part of the stem and the femoral anatomy. This design is an option in femora with good bone quality and especially in tunnel-shaped cases. Femoral osteopenia and cortical widening were infrequent in this series. The modular metaphyseal-diaphyseal junction is not an in vivo problem, contrary to previous reports. A longer follow-up is needed to assess the results of this design.

In order to regain preinjury activities following an Achilles tendon rupture while reducing the potential complications of open surgery and non-operative treatment, we developed a new protocol that involved the use of a modified local anaesthetic technique, percutaneous repair and early function.

We prospectively treated 32 patients with acute Achilles tendon ruptures according to our protocol with a 12 month minimal follow-up. Surgery was performed on an outpatient basis and within 48 hours from rupture for all cases. Our local anaesthetic technique allowed us to have a comprehensive control over sural nerve location by the definition of a “safe area” (video will be shown) and has proved to be effective to avoid sural nerve damage during surgery. The 28 male and 4 female patients had a mean age of 35 years (range, 26 to 47 years). The percutaneous repair was performed with a #2 nonabsorbable monofilament. Patients began range-of-motion exercise at 48 hours, used a posterior splint for 2 weeks, and then began ambulation with crutches and a 2 cm heel wedge incorporated on sport shoes or alternatively country boots. At 5 weeks, the wedge shoe was discontinued, full weight-bearing was allowed, and progressive resistive exercises were initiated.

There were no reruptures, wound infections, sural nerve damage, recurrent pain, or skin necrosis in our group of patients. One patient (with an hemathological disorder) developed a deep venous thrombosis that resolved uneventfully.

Mean AOFAS score was 80 at 6 months and reached 98 at 12 months. High-demand patients (police officer, firemen, athletes, professional soccer player) returned to their activities by 5–6 months. Patients were very satisfied with the procedure and subjetive evaluation turned to be very good or excellent for all cases.

Achilles tendon management using our protocol is an efficacious method demonstrating a low morbidity rate together with a return to preinjury level by 6 months. In addition, this protocol is cost effective (saves on hospital admission, anaesthesia, complications) and athletes in our group were able to obtain their athletics goals with minimal or no deficits.