The lastest biomechanical studies have shown that the load in the proximal femur is transferred not only medially but also laterally. Following these new philosophies, an original ultra-short stem with extensive proximal load transfer was developed. The main features of this implant are: an almost complete absence of the diaphyseal portion of the stem; a well defined lateral flare with load transfer also on the lateral column of the femur; and a high femoral neck cut which allows the preservation of most of the anterior, posterior and medial wall of the femoral neck (giving a complete proximal circumferencial bone in-growth). The implant, which we began to use in 1995 as a custom made prosthesis based on pre-operative CT data (140 cases), and later as a standard prosthesis (Proxima Hip 347 cases) was, in the first years, recommended only for young and active patients before being extended with very large indications also to elderly ones. Purpose of this paper is to present clinical and radiological results of 487 implants with an 7 yrs average follow-up. (14 yrs to 3 months). Harris Hip Score (HHS) formed the basis of the clinical assessment. Serial post-operative AP and lateral radiographs were taken for all patients.

Excellent results were reported: patients were followed-up for up to 14 years in all the series there were no revisions for aseptic loosening and only one case was revised for a deep infection. The mean HHS increased from 44.8 pre-operatively to 98.6 post-operatively at the latest follow-up. Tight pain was recorded only in one case. Other complications included 3 dislocations and 2 superficial wound infections. Radiographically good periprosthetic bone remodelling with increase of the bone stock around the implant. No radiolucent lines, subsidence or loosening have been observed.

In conclusion after a 14 year experience we can assert that neck preservation combined with a proximal lateral flare support guarantees a more natural loading of the femur and large indications. The absence of the stem makes this implant ideal not only for conventional surgical approach but also for MIS.

Introduction: One of the problems of total hip arthroplasty (THA) is blood loss frequently leading to one or more postoperative blood transfusions. The use of fibrin sealants (Quixil) has already proved to be extremely effective in general surgery. Previous reports have shown remarkable benefits in liver resections, soft tissue tumor resections, adenoidectomy and tonsillectomy. The use of these sealants has been recently extended to total hip and total knee replacement surgey. We present our experience with Quixil in our orthopaedic practice.

Materials and Methods:Seventy-eight patients operated for primary THA between June 2006 and July 2008 were included in this study. Subjects with operative or transfusional risk increased by concomitant cardiovascular, autoimmune and/or metabolic pathologies were excluded from the study. All patients were operated by the same surgeon and received the same implant. Patients were randomly allocated in two groups: in the control group A (n=43) only conventional careful haemostasis was performed at the end of the procedure, whilst in the treatment group B (n=35) Quixil application was added. Postoperative haemoglobin (Hb) levels were measured at 12, 24 and 48 hours. Postoperative transfusions of autologous and/or heterologous blood were required when Hb was lower than 8.2 g/dl. The occurrence of haematomas or other complications was also evaluated.

Results: The use of Quixil in THA was associated with reduced postoperative blood loss, lower incidence of haematomas in the operated region, less pain and faster functional rehabilitation. The decrease of Hb levels measured at 12, 24 and 48 hours after the operation was higher in group A (10.3, 9.4, and 8.6 g/dL respectively) than in group B (10.6, 10.0, and 9.3 g/dL). Group A patients also showed a significant increase of blood loss in the drainages and a higher incidence of haematoma in the operated region. A cost benefit assessment of the use of Quixil in THA was also performed.

Conclusions: This is the first randomized study comparing in THA the results of patients treated with fibrin spray with patients treated with conventional haemostasis. A statistically significant reduction of blood loss was observed following the use of fibrin sealant, as well as a decreased requirement of auto/heterologous transfusions. The same treatment group also showed lower incidence of hematomas, less pain and faster rehabilitation. Based on these results, the possibility to perform THA without the requirement of autologous or heterologous transfusions can be predicted in patients with normal preoperative Hb levels and no concomitant pathologies.