Hip Surgery

Istituto Ortopedico Galeazzi

key figures 

CLINICAL SERVICES:

  • Primary Total Hip Arthroplasty (THA)
    • Special focus on complex cases and innovative minimally invasive, high wear resistant materials for young patients
  • Revision Total Hip Arthroplasty (THA)
    • Including bone stock restoration, treatment of septic cases and special implants
  • Developmental Dysplasia of the Hip in adult and adolescent patients
  • Knee Surgery - Knee Arthroplasty 
    • Unicompartmental and total, primary and revision
  • Knee Surgery - Arthroscopic surgery 

PROCEDURES PERFORMED PER YEAR: 600

Clinical activity focuses on the field of orthopaedics and traumatology with particular clinical and scientific interest in hip diseases. The Department is a centre of excellence for hip arthroplasty specialised in tissue sparing and anatomical-biomechanical reconstruction techniques, the use of highly wear-resistant materials (ceramic, titanium). The Unit has particular experience in complex cases (outcomes of dysplasia and congenital dislocation or other diseases of the young age, outcomes of traumas or previous surgeries and inflammatory or neurological diseases), in young high demanding patients and in old fragile patients, with a wide range of high quality implants used with the focus on minimally invasive prosthesis and on preventing any possible complication (pain, infection, dislocation, periprosthetic fractures, wear and osteolysis).

The Unit is also a reference centre in Italy for revision surgeries of failed prostheses, with patients coming from all over the country, due to wear of materials, metal on metal related issues, loosening, dislocation, heterotopic ossifications, infection or fracture, developing techniques that include biological reconstruction of bone loss with bone grafts and impaction grafting and restoration of stability, limb length and joint function using the most modern and updated techniques available in the orthopaedic field worldwide.

It also provides hip (non-prosthetic) conservative surgery for younger patients including treatments of femoroacetabular impingement (FAI) with mini-open and arthroscopic techniques, congenital dysplasia of the hip in adolescent and adult patients with osteotomies of the femur and of the pelvis, childhood pathologies such as Perthes disease and slipped capital femoral epiphysis (SCFE) and their outcomes in adulthood.

Total and unicompartmental knee arthroplasty is also part of the clinical activity that, in addition, includes knee revision and treatment of failure of previous knee surgeries.

 

treatmentS

Hip Surgery 

Total hip arthroplasty is considered the operation of the 20th century for its high clinical success. More than one million patients are implanted worldwide each year. Both, the acetabular side and femoral side, are replaced by means of the artificial joint that can be fixed to the bone of the pelvis and of the femur, with or without cement according to the age of the patient, to the bone morphology and the bone quality (osteoporosis). The two parts move one on the other re-establishing the physiological movement of the hip joint that can be severely limited and painful in case of arthritis. Arthritis of the hip is a degenerative disease of the cartilage that can lead to severe functional limitation, pain and limp, with great discomfort. Reasons for this degenerative process are sometimes unknown or secondary to childhood diseases, trauma, necrosis of the femoral head, inflammatory diseases. The material of the moving ball of the prosthesis is also very important as a material with high wear resistance and biocompatibility such as ceramic can further improve the longevity of the implant. Different approaches and techniques are defined as each single case is different to the other and requests dedicated preparation and planning to choose the targeted implant.

The patients, immediately after the recovery from the anaesthesia, can move their lower limbs and start walking the same day or the day after surgery. Only a couple of weeks later, patients are already able to resume their normal life activity.

In case of old implants or complications including problems of related to the material, such as in case of metal on metal prosthesis, a revision of the implant can be necessary. This type of surgery is usually heavier and more complex and mainly performed in selected Departments.

In selected cases of deformity of the hip joint or impingement in young patients without degenerative arthritis, a “conservative” non-prosthetic and sometime arthroscopic surgery can be performed.

Main Pathologies Treated: 

  • Primary arthritis of the hip
  • Arthritis post childhood diseases (DDH, SCFE, Perthes)
  • Post traumatic hip arthritis and sequelae of trauma
  • Avascular necrosis of the femoral head
  • Failed primary hip replacement including wear, loosening, osteolysis, metal on metal failures, dislocation, infection and periprosthetic fractures
  • Failed hip revision surgery including loosening, infection and dislocation
  • Treatment of femoral and acetabular bone loss in revision
  • Treatment of failures related to the material of THA (metal, polyethylene, ceramics)
  • Femoro-acetabular Impingement (FAI)
  • Developmental dysplasia of the hip

Top Procedures: 

  • Hip arthroplasty primary (including complex cases)
  • Hip arthroplasty revision (including special implants and bone stock restoration)

Knee Surgery 

Knee arthroplasty can be total (when all the surface of the distal femur and of the proximal tibia are replaced) or unicompartmental (partial knee replacement when only half of the surface is replaced, that is performed when only half of the joint is damaged). The prothesis is usually fixed with bone cement, while in our country the patella is usually preserved in most of the cases. Following a knee replacement, the patient can immediately start moving the joint and is able to walk on crutches. After only a few weeks it is possible for the patient to resume their normal life activity pain-free.

During sport or other trauma injuries including minor accidents, the ligaments and/or the meniscus can be damaged. In this case an arthroscopic surgery with reconstruction of the anterior cruciate ligament and/or repair/removal of the meniscal damage is indicated.

In case of deviation of the axis of the lower limb in younger patients without advanced arthritis, correction osteotomies around the knee can lead to very good results.

Main Pathologies Treated: 

  • Knee meniscal and chondral lesions
  • Knee ligament lesions
  • Patellofemoral instability
  • Osteoarthritis
  • Failed knee arthroplasty
  • Failed primary knee replacement
  • Failed knee surgery revision

Top procedures: 

  • Knee arthroscopy: meniscal and cartilage restoration
  • Knee ligament reconstruction
  • Knee osteotomies
  • Medial patellofemoral ligament reconstruction
  • Uni and total knee arthroplasty
  • TKA revision 

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

Complete set of instrumentation and implants able to cover all the most difficult and complex cases, to evaluate intra-operatively the leg length and lower limb off-set. 

  • Special implants for high risk patients: 
    • dual mobility cups in case of instability in patients at risk 
    • high porosity materials to improve bone fixation and osseointegration 
    • modular implants for severe cases of primary and revision THA 
    • ceramic and titanium in order to avoid any metal related issue 
  • Ceramic on ceramic bearing and short cement-less stems in young active patients, implants for older patients including excellent knowledge and experience with cemented implants for cases of poor bone quality. 
  • Availability of bone grafts from the bone bank in order to improve bone stock in case or bone loss. 
  • Antibacterial coatings on implants to avoid reinfection in case of complications. 
  • All the main types of cement-less and cemented prosthesis from the major Italian, European, and US companies are available for a joint reconstruction targeted to each patient, bone morphology and tissues quality. 
  • All the patients are screened out by the means of calibrated X-rays and CT scan and the hip reconstruction is planned by the means of a dedicated hospital software for each patient. 
  • Routine rapid functional recovery with early rehabilitation under the guidance of skilled physiotherapist and machines when necessary. 
  • Epidural anaesthesia for long lasting and effective pain control, advanced program of multimodal pain control in the post-operative phase, drugs for blood loss preservation with very low risk of blood transfusion (no drains, no catheters) and rapid discharge for healthy patients able to immediately walk autonomously.