Orthopaedics and Traumatology

Istituto Ortopedico Galeazzi

key figures 

CLINICAL SERVICES:

  • Hip arthroplasty
  • Revision surgery
  • Regenerative medicine
  • Foot and ankle surgery
    • Ankle replacement
    • Ankle arthroplasty 
    • Ankle arthrodesis
    • Ankle arthroscopy
    • Supramalleolar osteotomy
    • Forefoot surgery
  • Upper limb surgery
    • Anatomic and reverse shoulder replacement
    • Elbow and hand surgery
    • Cartilage repair
  • Sports medicine
    • Knee arthroplasty
    • Knee arthroscopy
    • Shoulder arthroscopy
    • Shoulder arthroplasty

PROCEDURES PERFORMED PER YEAR: 

  • 1.450 prosthetic surgeries:
    • 700 knee total replacement
    • 150 unicompartmental knee replacements
    • 500 hip replacements
    • 50 knee replacement revision surgeries
    • 70 hip replacement revision surgeries

Team C.A.S.C.O operates at the Galeazzi Research Hospital in Milan and was founded in 2010 by an initiative of Dr. Nicola Ursino. To date it consists of 12 specialists. Every year it performs on average 1450 prosthetic interventions and 1550 minor orthopaedic interventions such as arthroscopy, ligaments and more, for a total of about 3000 interventions per year. The Unit helps people with degenerative or traumatic articular disability to recover mobility and return to having an excellent quality of life. The C.A.S.C.O. Unit today is a specialised division in the prosthetic reconstruction of the lower limb and has widened its field of interest to the upper limb, the foot and to the ankle prosthetics. Ongoing studies include the evaluation of: 

  • Anti-allergic prosthesis (Bioloy) and bacterial biofilm: the first study in Europe to analyse its relationship in terms of reduction of infectious risk. 
  • Hypoallergenic prostheses (Vital-xe): polyethylene is also enriched with Vitamin-E which gives it anti-oxidant power and therefore a longer life over the years. 

These materials represent the latest evolution of engineering applied to prosthetic surgery. 

 

treatmentS

Knee Surgery

A total knee replacement is a surgical procedure performed to replace a diseased knee with artificial material. During surgery, both the femur and the end of the lower leg bone (tibia) are cut and replaced with a metal shell with an interposition of channelled plastic piece. If also the patella has a huge degeneration, a patellar arthroplasty is used, adding a resurfacing of polyethylene. 

Beyond the individual prosthetic designs of the various companies, what the patient needs to know is that if they will be implanted for total knee replacement surgery, the posterior cruciate ligament is either retained, sacrificed, or substituted by a polyethylene post. Total knee replacement surgery should be considered for patients whose knee joints have been damaged by either progressive arthritis, trauma, or other rare destructive diseases of the joint that represent pain and functional limitation which compromises the normal activities of daily life.

In unicompartmental knee replacement (also called "partial" knee replacement) only a portion of the knee is replaced. This procedure is an alternative to total knee replacement for patients suffering from osteoarthritis in a single compartment of the knee. 

Due to the smaller incision and lesser invasiveness of the soft tissues, usually patients have a faster recovery and are able to return to normal activities sooner than the total knee replacement patients. Also, because the bone, cartilage, and ligaments in the healthy parts of the knee are kept, many patients report that a unicompartmental knee replacement feels more natural than a total knee replacement. A unicompartmental knee may also bend better. 

Main Pathologies Treated: 

  • Knee joint pathologies 

Top Procedures: 

  • Total knee replacement 
    • Posterior cruciate or posterior stabilised 
  • Unicompartmental knee arthroplasty for isolated medial or lateral osteoarthritis
  • Knee arthroscopy for anterior and posterior cruciate and anterolateral ligaments

Hip surgery

Hip replacement, also called total hip arthroplasty, is a surgical procedure to replace a worn out or damaged hip joint with a prosthesis. This surgery may be an option after a hip fracture or for severe pain due to arthritis. Hip arthroplasties are also performed, using a mini-invasive posterolateral access, and patients are able to walk the day after surgery. The Unit treats all various types of arthritis may affect the hip joint such as osteoarthritis, rheumatoid arthritis, and traumatic arthritis. The goal of hip replacement surgery is to replace the parts of the hip joint that have been damaged and to relieve hip pain that can’t be controlled by other treatments.

Main Pathologies Treated: 

  • Hip trauma 
  • Acquired hip joint pathology

Top Procedures: 

  • Total hip arthroplasty
    • Traditional surgery 
    • Minimally invasive technique 

Foot and Ankle Surgery

Total ankle arthroplasty, also known as total ankle replacement, is a surgical procedure that foot and ankle orthopaedic surgeons use to treat ankle osteoarthritis. Arthrosis of the ankle is a degenerative and progressive pathology that induces lameness, swelling and deformity. It arises following a trauma or a systemic inflammatory disease. Historically the only surgical solution has been for years the arthrodesis, today there are modern prostheses that allow to preserve the movement even in young patients. The Unit has the largest case studies in Italy and one of the largest in Europe on this subject.

Main Pathologies Treated: 

  • Ankle osteoarthritis 
  • Arthrosis 

Top Procedures: 

  • Ankle arthroplasty 

Shoulder Arthroplasty

The Unit’s team is at the forefront in upper limb surgery, in fact, shoulder arthroscopy for instability or rotator cuff repair are performed on a daily basis along with shoulder and elbow replacement. For initial degeneration or joint osteoarthritis, the Unit also offers regenerative treatment such as Platelet Rich Plasma or adipose-derived stem cells infiltration. Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain. 

Main Pathologies Treated: 

  • Upper limb pathologies and degeneration 
  • Joint osteoarthritis 

Top Procedures: 

  • Shoulder arthroscopy
  • Stemmed or resurfacing hemiarthroplasty 
  • Shoulder replacement and reverse shoulder replacement 
  • Elbow replacement 

Regenerative medicine

Regenerative medicine aims to stimulate the body's natural resources to regenerate tissues damaged by trauma or disease. In orthopaedics, the goal is to develop new therapies to promote bone and soft tissue repair of the musculoskeletal system (cartilage, tendons, ligaments, meniscus, muscles) and also the more ambitious goal is to reconstruct the structures in the laboratory, repair it, and re-implant them in a second surgery. This area of medicine is becoming increasingly important due to the insufficient availability of donor organs and tissues as well as the risk of rejection.

Although many of these therapies are only at the initial stage of their potential development, the results obtained so far indicate that regenerative medicine will be complementary to traditional pharmacological and surgical treatments and, in some cases, will replace them.

Top Procedures: 

  • Stem cell therapy 
  • Platelet-rich plasma therapy 
  • Gene transfer 
  • Tissue engineering 

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • Adipose-derived stem cells                                                                
  • Anti-allergic knee and hip replacement added with vitamin E
  • Metal-on-metal hip revision
  • Ankle replacement with trans fibular osteotomy