Introduction: Intraoperative femoral fractures occurring in cementless total hip replacement are not frequent. In a series of in 350 consecutive hip replacements 15 cases of fractures were recognized and included for this study.

Materials and Methods: The fractures mainly occured during the femoral preparation rather than during the definitive stem impaction. Accurate reduction and stable internal fixation were considered necessary intraoperatively. Nevertheless in 4 cases the fixation of the stem was converted into a conventional cemented one. Postoperatively the patients were allowed to have an immediat full weight bearing on the operated side in 5 cases.

The remainders (10 patients) had a delayed reloading on the lower limb.

In this study the clinical and radiological results of the fracture group were compared to those of a control group of 15 patients.

Results: One year after surgery the Harris Hip score was no significantly different between the groups.

Postoperative complication rate (deep venous thrombosis, infection, dislocation) were not different between the groups.

There was a significant increase of duration of the stay of the patient in the rehabilitation center (p=0.007) in the fracture group and the patient spend more time with the physiotherapist (p=0.001)as they left the center.

The fracture rate was lower when the patients were operated by a senior surgeon (p=0.021).

Discussion: These results are comparable to those of the literature. Nevertheless intraoperative fractures of the proximal femur occurring in cementless total hip replacement do not jeopardize the clinical final outcome. This study emphasizes the importance of the learning–curve in cementless THR. Additional studies could assess the real costs for the medical care of such fractures.

Introduction: The choice of a procedure for the treatment of hallux rigidus depends on the severity of the disease, patient activity level, and expectations about the surgery. For patients who have severe hallux rigidus, arthrodesis has shown good results. On the opposite the results of joint-preserving procedures are less frequently presented.

Material et Methods: The following study concerns 113 cases of hallux rigidus with a mean age of 58 years. Seventy seven percent of the patients underwent arthrodesis of the first metatarsophalangeal joint, 23 % of them had a joint preserving procedure : phalangeal osteotomy and cheilectomy and were reviewed at an average 69 months postoperatively.

Results: The patients were assessed according to the AOFAS score. In the group, which had an arthrodesis, the results were satisfactory in 85 % of the cases. In the joint preserving technique group, 80% of patients were completely satisfied, 15% were satisfied with reservation, and 5% were dissatisfied. One patient suffered continued metatarsophalangeal joint pain that led to an arthrodesis after 10 years.

Discussion: First metatarsal decompression osteotomy are known for increasing joint range of motion but the risk of complication and patient dissatisfaction is less after phalangeal osteotomy.The clinical results are frequently not correlated with the radiological data.

Conclusion: Cheilectomy is classically proposed with predictable success to treat Grade-1 and 2 and selected Grade-3 cases. Nevertheless, in our experience we proposed as an alternative to a joint preserving procedure always an arthrodesis which functional results seemed more reliable. These results encourage us in being less restrictive in the indication for a joint preserving procedure.