Proxima Hip replacement – Less is More Dr.A.K.Venkatachalam MS, DNB, FRCS, MCh Orth Consultant Orthopaedic surgeon

Proxima- What does it mean Proxima - refers to the anatomy in the proximal portion of the “Femur’ or thigh bone. It is shaped by the inner contours of the proximal femur

Conventional Total Hip replacements Introduced in 1960’s by Dr.John Charnley, an English Orthopedic surgeon. Upper end of the femur is resected consisting of the head and neck portion. Socket of the pelvic bone is deepened Prosthesis is implanted with bone cement. Metal articulates with High density polyetheylene. Risk of dislocation results in poor function Recovery takes upto three months

Surface hip replacements Developed in late nineties in UK by Dr.Derek Mcminn Head of femur is sculpted and not chopped off to receive a cap or resurfaced. Socket is deepened and a new socket banged in Could survive for long term as bearings are made of metal on metal – Unknown at present Recovery is faster. Function is better.

Proxima is a bone preserving hip replacement Neck portion of femur is preserved Only head is removed. The shaft of the femur is not entered or reamed, once again preserving bone.

Design features of Proxima hip. Designer- Italian surgeon Dr. F.Santori Ten year follow up of a similar implant. Implant is fixed in the spongy upper part of the thigh bone. Large diameter head – less chance of dislocation Metal on metal possible longer survivor ship Can be implanted by a small incision as less bone is resected ( Minimally invasive surgery)

Advantages of Proxima Less soft tissue dissection Less bony resection Large diameter Head- less chance of dislocation Fluid film lubrication – leads to less wear of the implant Metal on metal bearings- less wear Hence less is More

Intelligent Hip surgery Maximising survivorship Optimising function Accelerating recovery

Indications for Proxima Hip Any patient with Hip arthritis for whom a total hip replacement is the permanent solution but Proxima will preserve more bone than a total hip replacement. Bone stock should be intact. Those patients with disease in the head which is more extensive making “ Resurfacing” unsuitable. For eg- Avascular necrosis

Minimally invasive Hip & Knee surgery - What is it? Skin incisions are smaller than conventional surgery It is not Key hole or arthroscopic surgery Inside soft tissue dissection is less. More Bone, tendons, soft tissues are preserved

Benefits of Minimally invasive surgery Less Blood loss Less Post op pain Less requirement for narcotic analgesia Shorter hospitalization Early functional recovery Cosmesis

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