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.

Purpose of the study: The efficacy of metatarsophalangeal joint (MPJ) fusion for the treatment of hallux rigidus has been well defined in the literature. There is however still some debate about the efficacy of conservative treatment, especially concerning the respective role for each of several different techniques.

Material and methods: This study reports the analysis of 113 patients treated for hallux rigidus with minimum one year follow-up. Mean age of this predominantly female population was 58 years. Fusion of the MPJ of the great toe was performed for 77% of patients and conservative treatment for 23%: isolated osteophytectomy (n=5), dorsal cheilectomy and shortening osteotomy of P1 (5 cm on average) with or without dorsal flexion for the others. The clinical outcome was assessed with the Groulier criteria.

Results: Overall outcome was satisfactory in 85% of the patients treated by MPJ fusion; MPJ pain resolved in 92%. There was however late healing or nonunion in 13% with no apparent clinical impact. Conservative treatment successfully relieved pain in 80% of patients who were able to wear ordinary shoes and had improved dorsal flexion of the MPJ.

Conclusion: The results of this study are helpful in determining the appropriate indications for surgery as a function of the clinical and radiological presentation of hallux rigidus.