Management of pseudotumours associated with MoM THA can be difficult and complications are frequent. The functional outcome of patients after revision surgery may be suboptimal. The objective of this study was to assess our experience with revisions of failed MoM THA due to pseudotumours.

78 hips were diagnosed with pseudotumours in 70 patients following metal-on-metal hip replacements. Of these, 68 MoM THA were revised in 62 patients. Pre operative symptoms, radiographic analysis, metal ion levels, MRI results, intra-operative findings, WOMAC scores, the satisfaction level and the complication rate were recorded.

Five patients had a resurfacing arthroplasty as their primary implants while the remaining 63 hips in 57 patients had MoM THA of different brands. The average time between the primary and revision surgery was 69 months (range 15–120). The average age at revision was 59 years (43–87). The mean follow-up was 24 months (range 2–73). 36 patients had minimal one year follow-up. Most lesions consisted of cystic changes and solid lesions were observed in 19 patients. In 57 hips, the pseudotumours were located posteriorly or postero-laterally around the greater trochanter. Intra operatively, muscle necrosis was observed in 15(22%) patients. Most THA cases demonstrated wear and corrosion at the head neck junction of the femoral implants. Thirty-five patients (44.9%) had greater than 50 degrees of cup abduction, including 10 patients (12.8%) with an abduction angle greater than 60 degrees. The average pre operative and postoperative Co ion levels were 27.46 ug/L (range 0.36–145.6) and 2.46 (range 0.4–12.48), respectively. Post revision, a total of 10 hips (14.7%) sustained a dislocation, with seven (10.3%) of them experiencing recurrent dislocations. In 8/10 hips, the femoral head size was 36mm or greater. Revision for dislocation occurred in seven(10.3%) patients. Three(4.4%) deep and one(1.47%) superficial infections occurred and deep infections were re-operated. One(1.47%) fracture of the greater trochanter and one (1.47%) psoas tendinitis did not need revision. Therefore, a total of 10 patients (14.7%) were reoperated. 6 revisions for instability were performed in the first 34 patients, while 1 were done in the last 34 patients. At one year post revision surgery, the mean WOMAC score was 19.68 (range 0–48). In comparison, the mean WOMAC score of the same patients one year after their primary surgery was 8.1 (0–63). Patient satisfaction level of patients one year post revision surgery was 7.61 (range 5–10) compared to 4.15 (range 0–7) pre-revision one.

The complication rate after revision of pseudotumours is high. Most re revisions occurred secondary to instability despite the use of larger femoral heads. The functional outcome at one year post revision seems to be lower than that seen after primary THA but similar to other revisions in the literature. Experience in the management of these patients may reduce the complication rate.

Objectives: To report the outcome and comparison of calcaneum fracture managements for intra-articular fractures.

Methods: A prospective study of the patients with intra-articular calcaneum fractures in the foot& ankle unit of a busy trauma hospital. All the patients were followed up with the calcaneal fracture score. We compared the outcome of surgical management Sanders type-2 and type-3 fractures with conservative treatment at 2 years and then, the medium term (> 5 years) outcomes of type-2 and type-3 surgical groups were assessed. Conservative group was a consecutive series of patients recruited to the study later than surgical groups, hence the smaller number in that group.

Results: 126 patients were included in our study. There were 70 in group type-2 and 38 in group type-3 with surgical management, while only 18 in the group with conservative management. The mean age for surgical type-2 = 46.2, type-3= 46.3 and conservative group = 51.7. Mean follow-ups for the groups were type-2=6y, type-3 =5.5y and conservative one =2.34y. Mean two-year scores for the surgical groups were type-2=68.13, type-3=63.78, while conservative one =51.36.

There was a statistically significant differences in their score between type-2 surgical and conservative groups (P=0.0006), and between type-3 surgical and conservative ones (P=0.04), but no significant difference between type-2 and type-3 surgical groups.

At medium-term follow-up, the scores for type-2 and type-3 surgical groups were 77.06 and 63.66 respectively, with significant increase in type-2 while type-3 remains similar comparing to two-year scores. There were 7 deep, 5 superficial infections and 32 metalwork removals in total.

Conclusion: On comparing the medium term outcome to the two-year one, surgical type-2 group of patients showed some improvement, while type-3 stayed the same.

In this series, contrary to published articles, there was a better outcome at two years with surgical treatment than conservative treatment.

Objectives: To report the outcome and comparison of calcaneum fracture managements for intra-articular fractures.

Methods: A prospective study of the patients with intra-articular calcaneum fractures in the foot& ankle unit of a busy trauma hospital. All the patients were followed up with the calcaneal fracture score.

We compared the outcome of surgical management Sanders type 2 (Group A) and type 3 (group B) fractures with conservative treatment (group C) at 2 years and assessed the medium term outcomes of groups A and B. Group C were a consecutive series of patients recruited to the study later than A and B, hence the smaller number in that group.

Results: 126 patients were included in our study. There were 70 in group A, 38 in group B, and 18 in group C. Mean follow-ups for the groups were A=6y, B=5.5y and C=2.34y. Mean two-year scores for the groups were A=68.13, B=63.78, and C=51.36, with statistically significant differences between groups A and C (P=0.0006), and between groups B and C (P=0.04), but no significant difference between groups A and B.

At medium-term follow-up (> 5 years), the scores for group A and B were 77.06 and 63.66 respectively.

There were 7 deep, 5 superficial infections and 32 metalwork removals in total.

Conclusion: On comparing the medium term outcome to the two-year one, group A showed some improvement and group B stayed the same.

In this series, there was a better outcome at two years with surgical treatment than conservative treatment.