Dr. Andrea Fontana born in Palermo l’01.11.1959
Receives in Milan and Como
Surgeries: CMP Via Frova 34 Cinisello Balsamo (Milan North), Italy
For appointment telephone the numbers: Cinisella Balsamo +39 02/66012960 / Como +39 031 262136
Secretary and emergencies: +39 3358294892
VAT No. 02268200967
Degree in Medicine and Surgery at Palermo University in 1986
Specialized in Orthopaedics and Traumatology in Milan University in 1991
International scholarship as “clinical research fellow (hip and knee Unit) at the “BUPA Cambridge Lea Hospital” and “Addenbrookes Hospital” in Cambridge UK in 1995
Managerial Training Certificate for Managers of Complex Structure at the School of Health Management of the Lombardy Region in 2003.
Consultant for “hip arthroscopy” with the relationship of “teacher” at Bologna University’s Orthopaedics Clinic at the Rizzoli Orthopaedic Institute since 2009
Consultant in “hip arthroscopy” at Turin University’s Orthopaedic Clinic
Currently Manager of Operational Unit 1 and Director of the C.A.R.A. (Chirurgia Artroscopica e Rigenerativa dell’Anca, Arthroscopic and Regenerative Surgery of the Hip) Centre at the COF Lanzo Hospital in Lanzo D’Intelvi (CO), Italy.
Practices as a professional and in convention with the main insurance groups at Milan’s San Camillo Clinic and at the La Betulle Clinic at Appiano Gentile (VA), Italy.
He Perfected his skills in hip surgery through training courses attended at the following Universities:
BUPA Cambridge Lea Hospital – Cambridge UK
Addembrookes Hospital – Cambridge UK
Massachusetts General Hospital – Boston USA
Harvard University – Boston USA
Registered in the Como Register of Surgeons
I am registered with the UK “General Medical Council”
Member of the following scientific associations:
ISHA (International Society for Hip Arthroscopy)
ESSKA (European Society of Knee and Arthroscopy)
EFORT (European Society of National Associations of Orthopaedics and Trauma)
ICRS (International Cartilage Repair Society)
EHS (European Hip Society)
SIA (Società Italiana di Artroscopia, Italian Society of Arthroscopy)
SIOT (Società Italiana di Ortopedia e Traumatologia, Italian Society of Orthopaedics and Traumatology)
ASHA (Austrian Society for Hip Arthroscopy) Honorary Member
Hip arthrosis or primary coxarthrosis is a chronic and degenerative disease. This involves the femoral head and the acetabulum and determines a change of the joint’s surfaces. These are normally covered with cartilage which is a very delicate tissue that allows harmonious sliding of the two surfaces of the joint. The process of arthrosis alters and damages these surfaces, making hem deformed and irregular. As a consequence of this alteration the joint’s surfaces no longer slide harmoniously during movement and the joint becomes rigid and painful.
The classic clinical sign of this arthrosis is pain that can also be present at rest but increases considerably during activity, often limiting movement and causes limping. The patient has difficulty in moving correctly and carrying our daily activities such as climbing stairs, tying shoe laces or ever taking care of himself or herself.
Hip dysplasia is a genetic hereditary degenerative disease that consists of an alteration in the development of the acetabulum in the hip part of the pelvis. Due to this alteration, that already manifests itself in paediatric age, the acetabulum does not develop normally and does not cover the femoral head sufficiently. It follows that the femoral head does not tend to rise and does not articulate correctly with the pelvis. This causes serious arthrosic degeneration with the same symptoms of primary coxarthrosis but they manifest at a younger age (30-30 years).
•Avascular necrosis of the femoral head
This disease is caused by a loss of blood supply to the femoral head. The bone tissue is no longer moistened and fed by the blood dies (necrosis) and therefore a process begins that causes the “collapse” of said bone which no longer supports the cartilaginous coating. The joint is deformed and joint damage that causes secondary arthrosis follows.
More frequently the necrosis of the femoral head manifests in Patients who suffer a fracture of the femoral neck or are subject to treatment with steroids, chemotherapy or radiation therapy to cure neoplasm. At times this disease manifests in association with hypercholesterolaemia or, more rarely, in Patients who for sport or for work undertake activities under water.
In non rare cases however, the necrosis manifests without any cause and is therefore defined as “idiopathic”. There are various stages of severity of this disease. In the gravest and more advanced stages the arthrosic degeneration is so serious as to make total hip replacement necessary,
This is a disease that occurs at paediatric age and is characterized by widespread necrosis of the femoral head. Not rarely it manifests in both hips.
Its development is especially unfavourable in that the femoral head is seriously deformed by the necrosis and arthrosis process.
In these cases it is often necessary to carry out total prosthesis surgery, even in very young patients.
•Epiphysiolysis of the femoral head
This disease also occurs at paediatric age and is characterized by a sliding of the femoral head that therefore is not positioned correctly on the femoral neck.
This lesion represents the antechamber for hip arthrosis and often these cases need to be treated with prosthesis surgery at a very young age.
•Post traumatic Coxarthrosis
Fractures of the femoral neck are especially frequent in aged Patients due to senile osteoporosis. Despite this, even younger Patients can have a fracture of the femoral head or neck or a fracture of the acetabulum as a consequence of accidents in cars, at work or sport. Often the consequence, even after some time, is the arthritic degeneration of the hip and for this reason they are called post traumatic arthrosis.
Rheumatoid arthritis is a systemic disease that therefore affects all the body and its inflammatory nature involves the joints in particular. The hip can thus be affected by the arthritis that therefore causes deterioration of the joint with irreversible damage to the cartilaginous surfaces. Also in these cases the pain the limitation of functionality are prevalent symptoms.
Despite pharmaceutical therapies, this disease often requires prosthesis surgery as this is the only way that can restore full articulation without pain.
Psoriasis that notoriously manifests on the skin can also affect the joints. This pathology is similar to rheumatoid arthritis. Also in this case, the treatment of the joint damage to the hip requires resolutive prosthetic surgery.
Total hip replacement or arthroplasty begins with placing the patient on the operating table. The Patient is placed on his or her side so that the side to be operated is turned up and the pelvis is blocked with appropriate supports. We then proceed with the preparation and disinfecting of the operating field and subsequently, once all the instruments are position we proceed with the surgical incision. This can be more or less wide depending on the size and weight of the Patient. The joint capsule is incised and the bone and joint surfaces are exposed. These surfaces are treated with the appropriate tools that remove the arthritic part and allow the positioning of the elements of the prosthesis. Once the prosthesis is in position its stability and the movement of the joint are evaluated. If necessary, we proceed with the correction of any differences in the length of the lower limb. At the end of the surgery the surgeon will continue with the suturing of the various parts of the anatomy dissected and a small silicon tube is placed that protrudes from the skin. This is the drainage tube from which the blood and the clots from the operation will drain out. This drainage will be removed during the first medication of the wound, the day after surgery.
The Patient is then be moved to the hospital bed, examined by the anaesthetist and subsequently sent to the ward.
Cartilage is the tissue that covers the bone surface of our joints.
Thanks to the cartilage we can move, walk and jump. Therefore the cartilage allows us to carry out our daily actions that are part of our lives every day.
It is an elastic tissue that at the same time is resistant and is constituted of about 80% water and the rest of molecules of collagen and chondroitin which are the products of the cartilaginous cells, the chondrocytes. The chondrocytes are very solitary cells, they are not very many and they love to keep a due distance between themselves by surrounding themselves with molecules so they have no direct contact. Their peculiar nature makes the cartilaginous tissue extremely delicate and this is the reason for which any damage to the cartilage does not easily repair itself spontaneously. It can therefore be said that damage to the cartilage is irreversible.
In general arthrosis is a degenerative disease that affects both the bone and the cartilage. This is the reason for which treating arthrosis also needs to stimulate this tissue and its cells.
Medicine and regenerative surgery deal precisely with damage to the cartilage with the substances and gadgets that stimulate the chondrocytes to regenerate themselves and to regenerate the cartilage
Infiltrative hip therapy consists of injecting into the joint medications or medical substances that mainly serve to control the symptoms of disease such as pain and functional limitation. This is not a complete surgical treatment as it does not allow correction of the structural alterations of the joint resulting from the arthrosis. Therefore it does not allow the correction of deformation of the bone, cartilage or the labrum and the other endoarticular structures.
Therefore it is especially applied in two cases: