DOCTOR ANDREA FONTANA, SPECIALIST IN HIP SURGERY

ADVANCED SOLUTIONS FOR THE CURE OF DISEASES OF THE HIP

Doctor Andrea Fontana operates in Como and since the beginning of his career has favoured the branch of hip surgery, the area of orthopaedics to which he has been dedicated himself up to achieving the specialties of orthopaedics and traumatology.

Over his years of training Dr. Fontana was a student of illustrious luminaries such as Dr, R. N. Villar of Cambridge, one of the major experts in hip arthroscopy, and of Professor Harris of Boston, one of the most authoritative experts in prosthetic surgery.

HIs experience in close contact with these world famous surgeons has brought Dr. Fontana to a growing interest in hip surgery that today lets him evaluate the diseases in a complete manner by adopting a mini-invasive approach whenever possible.

“Mini-invasiveness” represents one of the great innovations in the field of orthopaedic surgery and consists in treating the interested pathologies of this articulation by respecting the anatomy of the patient.

Since 2001, Dr. Fontana, who is also an expert in regenerative surgery, has developed this interest in a peculiar manner by contributing to developing the most innovative surgical techniques in the use of advanced biotechnology in orthopaedic surgery
  • dottor fontana como
  • chirurgo anca como
  • chirurgia protesica como

THE TREATMENTS BY DOCTOR ANDREA FONTANA

Thanks to his excellent training and years of experience, Dr. Fontana is able to evaluate quickly and completely the diseases tied to the hip, a sector that in recent years has undergone great innovation, especially in terms of invasiveness.

It is exactly in this new trend that Dr. Fontana always tries to always opt in a mini-invasive manner on the patient by carrying out treatments for the complete resolution of his or her problems.

Some of the services provided by the doctor are:

  • hip arthroscopy
  • hip prosthetics
  • regenerative surgery
  • infiltrative therapy


The Doctor receives on appointment in his surgery in Cinisello Balsamo, in Via Frova 34 and telephone number +39 02-66012960, and in Como, in Viale Varese 79 and number +39 031-262136.

USE OF BIOTECHNOLOGY


Thanks to the development of biotechnology and biological treatments serious damage suffered by the hip’s cartilage can be treated.

TREATMENT OF THE FEMOROACETABULAR IMPINGEMENT

Femoroacetabular impingement represents one of the initial forms of arthrosis of the hip. The arthroscopic treatment allows improvement of the symptoms and prevents arthritis. 

DOCTOR ANDREA FONTANA’S CURRICULUM VITAE

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
Email: dr.andreafonta@libero.it
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

DR. ANDREA FONTANA’S SCIENTIFIC ACTIVITIES. THE CONGRESSES AND THE MEDICAL AND SCIENTIFIC EVENTS

  • Director of Visiting Center “Hip Arthroscopy” – COF Lanzo Hospital
  • Director of Visiting Center“AMIC Hip Arthroscopy” – COF Lanzo Hospital
  • Director of "CHAIR" (Center for Hip Arthroscopy Italian Research)

Participation at congresses:
  • 1999
SECOT - 5-8/10 1999 – Valencia - Spain

  • 2002
EHS – 5-8/6 2002 – Baveno - Italia

  • 2003
EFORT – 6-10/6 2003 – Helsinki - Finland

  • 2004
Latest Advances e Controversies in Hip Surgery Meeting – 25/3 2004 – Stratford upon Avon – UK
EHS – 23-26/6 2004 – Innsbruck - Austria

  • 2005
AAOS – 23-27/3 2005 – Washington DC – USA
EFORT – 4-7/6 2005 – Lisbon - Portugal
Congresso Basileiro De Quadril – 7-10/9 2005 – Giania – Brasil
Arthroscopic Autologous Chondrocyte Transplantation of Hip Chondral Defects – Oral Presentation
Arthroscopically.guided Multiple Femoral Head Perforations in Avascular Necrosis – Oral Presentation

  • 2006
ICRS – 8-11/1 2006 - San Diego - CA – USA
Advances in Hip Arthroscopy – 22-23/5 2006 – Paris – France
Sports Hip Surgery – 30-31/10 2006 – Warwick – UK

  • 2007
SIA – 7-11/3 2007 – Modena – Italy
Oral Presentation
ISAKOS – 28-31/5 2007 – Florence  -Italy 
AMIC: First Experience in the Hip – Oral presentation
Faculty Member – Arthroscopic Hip Tecniques International Course – 9/66 2007 Barcellona – Spain
Why I do prefer the lateral position – Oral Presentation
How to avoid complications – Oral Presentation
ICRS – 29/09 02/10 2007 – Warsaw - Poland
AMIC: First Experience in the Hip – Oral Presentation
Arthrex Hip Arthroscopy Course – 15/11 2007 – Saltzburg – Austria
Oral Presentation

  • 2008
Faculty Member -Richard Villar School of Arthroscopy – 22/2 2008 – London – UK
Hip Arthroscopy Master Class (Wet Lab Training)
Faculty Mamber - Hip University – 2008 – Univ. Of Milan – Monza Italy 
Arthroscopic Anatomy of the Hip– Lecture
Arthroscopic Treatment of Condropathy - Lecture
The Round Ligament: Pathologies and Treatment – Lecture
SIOT – 23-27/11 2008 – Rome – Italy
Oral Presentation

  • 2009
KLEOS – European Sports Medicine e Hip Arthroscopy Meeting – 13-17/5 2009 – Rome – Italy
Oral Presentation.
Faculty Member - Hip University – 2009 – Univ. of Milan – Monza - Itay
Treatment of aseptic necrosis of the femoral head – Lecture
Arthroscopic Anatomy of the Hip – Lecture
The Treatment of Cartilaginous Lesions – Lecture
ICRS – 23-26/9 2009 – Miami – USA
Chondrocyte Transplantation: ACT OR AMIC – Oral Presentation
Faculty Member - SIA – Instructional Course on Hip Artheoscopy - 1-3/10 2009 – Rome – Italy
1.Indications and limits of hip arthroscopy LA COXARTROSI – Oral presentation
Faculty Member – ISHA – 9-10/10 2009 – New York – USA
IS ARTHROSCOPIC HIP DEBRIDEMENT WORTHWHILE? – Oral Presentation
Faculty Member – Cadaver Lab on Hip Arthroscopy – 24/10 2009 – Arezzo – Italy
SIOT – 7-11/11 2009 – Milan – Italy
Oral Presentation

  • 2010
KLEOS – Mediterranean Hip Meeting – 15/17/4 2010 – Athens – Greece
Contemporary Solutions in Total Hip Arthroplasty – Oral Presentation
ICRS – 26-29/9 2010 – Sitges/Barcelona – Spain
Limitations of Cartilage Repair in the Hip Joint – Oral Presentation
Faculty Member – ISHA - 8-9/10 2010– Cancun – Mexico
Cartilage Flap. Membrane with Chondrocytes – Oral Presentation
Faculty Member – Sports Hip Surgery 2010 – 14-15/ 2010 - University of Warwick – Warwick – UK
Chondrocyte Grafting – Oral Presentation
Practical Techniques in Hip Arthroscopy – Teacher at Workshop
OTODI – 6/11 2010 – Bologna – Italia
La Chirurgia conservative dell’anca – Oral Presentation

  • 2011
Faculty Member - Webinar 2011
The Management of Articular Cartilage Lesions. Internet conference – Oral presentation
SIA – 2011
Acetabular chondral defect – Oral Presentation
AGA 2011
AMIC – HIP Arthroscopic Surgical Technique and Clinical Results - Oral Presentation
AMIC vs ACT in the HIP – Oral Presentation
Faculty Member – Santander Hip Meeting – 10-11/3 2011 – Santander – Spain.
Localización de las lesiones cartilaginosas e implante de condrocitos – Oral Presentation
Faculty Member – ASHA – 6-7/5 2011 – Bad Ausee – Austria.
Hip Chondral lesions. Oral Presentation
SICOT – 6-9/9 2011 – Prague – Czech Republic
Arthroscopic Management of Articular Cartilage Lesions in the Hip – Oral Presentation
Faculty Member – ISHA – 14-15/10 2011 – Paris - France
MACI – Oral Presentation
Faculty Member – European Expert Meeting – 24/9 2011 – Rosensburg – Germany
Arthroscopic Surgical Approaches for AMIC with Chondro-Gide – Oral Presentation
Faculty Member - International Hip Arthroscopy Course – 25-26/11 2011 – Ypres – Belgium
Treatment options & results of scaffolds - Oral Presentation

  • 2012
Faculty Member – Harvard 2012
Reconstruction with Cartilage Impregnated Flexible Scaffold – Oral Presentation
Faculty Member - ASHA 2012
Hip Arthroscopical Cartilage Treatment – Oral Presentation
ESSKA – 2-5/5 2012 – Geneva - Switzerland
Arthroscopic Autologous Membrane Induced Chondrogenesis for the treatment of FAI in the hip – Oral Presentation – Vincitore del Porto Award
ICRS – 12-15/5 2012 – Montreal - Canada
AMIC or ACI for arthroscopic repair of delaminated acetabular cartilage in femoroacetabular impingement – Oral Presentation
Microfracture or AMIC for arthroscopic repair of acetabular cartilage defects in femoroacetabular impingement – Oral Presentation
Faculty Member - Barcellona Hip Arthroscopy – 20-21/9 2012 – Barcelona - Spain
AMIC Hip – Surgical approach and 5 year clinical outcome – Oral Presentation
Arthroscopy and Rehabilitation Course – 22/9 2012 – Rozzano (MI) - Italy
Clinical and Strumetal Diagnostic Pathway– Oral Presentation
Clinical / Diagnostic - Integration. When I decide for an Arthroscopic Osteochondroplasty – Oral Presentation
The causes of failure– Oral Presentation
Faculty Member - ISHA 27-29/9 2012 – Boston - USA
AMIC or ACI for arthroscopic repair of grade IV acetabular cartilage defects in femoroacetabular impingement – Oral Presentation
Microfracture or AMIC for arthroscopic repair of acetabular cartilage defects in femoroacetabular impingement. – Oral Presentation
SIGASCOT - 10-12/10 2012 – Napoli - Italy
Hip Arthroscopy case report: Very Bad! – Oral Presentation
Difetto condrale acetabolare – Oral Presentation
GAMOT – 27/10 2012 – Sulmona - Italy
FAI – Arthroscopic treatment – Oral Presentation
SIOT - 10-14/11 2012 – Rome - Italy
Comparative AMIC or ACI technique in the Arthroscopic Treatment of Cartilaginous Lesions – Oral Presentation
Microfratture ed AMIC a Confronto nel Arthroscopic Treatment of Cartilaginous Lesions Acetabular Consequent to FAI – Oral Presentation
Faculty Member – International Hip Arthroscopy Meeting – 16-17/11 2012 – Munich - Germany
AMIC (Autologous Matrix Induced Chondrogenesis) Oral Presentation
Hip Preserving Case – Oral Presentation
Faculty Member – Corso Propedeutico di Artroscopia d’Anca – 30/11 2012 – Bologna - Italy
The Treatment of Cartilaginous Lesions  – Oral Presentation
Hip Arthroscopy Portals – Oral Presentation
Hip to snap – Oral Presentation
SICOP 2012
Impingement - Arthroscopic treatment – Oral Presentation

  • 2013
Faculty Member – Brussels 2013
MACI: should we do it? - Oral Presentation
Hip Arthroscopy Today– 7/11 2013 – Florence- Italy
Chondral Lesions of the Hip – Oral Presentation
Faculty Member – Bone Serendipity – 19-20/4 2013 – Milan– Italy
Exam Objective Reasoned - Hip - Lecture
Coxalgia and Periarthritis FAI and role of Arthroscopy - Lecture
ISAKOS – 12-16/5 2013 – Toronto - Canada
Microfracture or AMIC for arthroscopic repair of acetabular cartilage defects in femoroacetabular impingement. – Oral Presentation
SIA – 2-4/10 2013 – Pesaro – Italy
AMIC technique (Autologous Membrane Induced Chondrogenesis) for the Treatment of Lesions Condrali of the Hip - Oral presentation
Faculty Member - ISHA – 10-12/10 2013 – Munich - Germany
Clinical Results of the AMIC Arthroscopic Hip Technique – Oral Presentation
MACI – AMIC Autologous Membrane Induced Chondrogenesis – Oral Presentation
Director - Cadaver Lab – Luzern 2013
AMIC – HIP Arthoscopic Tecnique – Oral Presentation
AMIC – HIP Clinical Results – Oral Presentation
SIA 2013 – Pesaro – Italy
Tecnique AMIC (Autologous Membrane Induced Chondrogenesis) for the treatment of chondral lesions of the hip – Oral Presentation
Effort 2013
Arthroscopic AMIC® for the treatment of FAI in the hip – Oral Presentation
Microfracture or AMIC for arthroscopic repair of acetabular cartilage defects in femoroacetabular impingement – Oral Presentation

  • 2014
Faculty Member – ASHA – 9-10/5 2014 – Vienna – Austria
Cartilage Therapy: MF, ACT, MACT, AMIC, MAC, Membranes and spheroids,… What’s best when? - Oral Presentation
Faculty Member – Hip Joint Preservation Course – 7-8/7 2014 – Sheffield – UK
Arthroscopic Chondral Repair AMIC/ACT – Oral Presentation
Sports injuries of the Hip – Oral Presentation
ISMuLT – 5-6/12 – 2014 – Rome – Italy
Hip Arthroscopy: Indications, surgical approasches and future perspectives – Oral Presenation
Faculty Member – Corso Propedeutico in Artroscopia D’Anca – 12/12 2014 – Bologna – Italy
Arthroscopic Treatment of Chondral Lesions of the Hip – Oral Presentation
Faculty Member – ISHA – 2014 – Rio de Janeiro - Brasil
Microfracture or AMIC for Arthroscopic Treatment of Acetabular Cartilage Defects In Femoroacetabular Impingement Five-Years Results – Oral Presentation
ACI / MACI/ Scaffoldos – Oral Presentation
Faculty Member – International Hip Arthroscopy Meeting – 21-22/11 2014 – Munich – Germany
Arthroscopic AMIC or MACI for the treatment of acetabular chondral defcts secondary to FAI. – Oral Presentation

  • 2015
ICRS – 8-11/5 2015 – Chicago – USA
Is Matrix Induced Chondrogenesis better? – Oral Presentation
Arthroscopic AMIC or MACI for the treatment of acetabular chondral defects secondary to FAI. – Oral Presentation
Treatment of Acetabular Chondral Defects In Femoral Acetabolar Impingement. AMIC Vs Microfractures. A 5-Year Follow-Up Study. – Poster presentation
ISAKOS – 7-11/6 2015 – Lyon – France
Treatment of Acetabular Chondral Defects in Femoral Acetabular Impingement. Autologous Matrix Induced Chondrogenesis Vs Microfracture. A 5 Year Follow-up Study – Oral presentation
Director – Cadaver Lab – Campus Lab Hip Arthroscopy – 8-9/7 2015 – Arezzo – Italy
ISHA – 24-26/9 2015 – Cambridge – UK
Unreasonable expectations - Lecture

HIP ARTHROSCOPY

OPERAZIONI NON INVASIVE PER TRATTARE LE PATOLOGIE DELL'ANCA

chirurgia non invasiva como
A true expert in the application of mini-invasiveness, Dr. Fontana offers his patients the following non-invasive techniques for the resolution of hip-related diseases:

  • HIP ARTHROSCOPY

Hip arthroscopy is a surgical intervention with minimal invasiveness. With this technique only 2 or 3 small incisions are practiced through which the arthroscope, a camera, is inserted and the surgical instruments that allow the manoeuvres and the procedures needed to treat the diseases of this joint. Thanks to this technique, large incisions to the skin are avoided and in any case maintain valid effectiveness of the surgical treatment. The operational risks are greatly reduced and the recovery from the intervention is considerably faster.


Indications for the treatment:

  • Femoroacetabular impingement
  • Coxarthrosis
  • Cartilaginous lesions
  • Lesions of the labrum and the acetabular cercinema 
  • Osteonecrosis of the femoral head
  • Total painful hip prosthetic
  • Post trauma
  • Medial and lateral snapping hip
  • Mobile bodies (extraneous bodies)
  • Synovial Chondromatosis (pathologies of the Collagen)
  • Lesion of the round ligament
visit anesthetist hip como

BEFORE THE INTERVENTION

After visiting the orthopaedic specialist the patient organizes the pre-hospitalization with the ward’s secretary. During this phase the patient will be subjected to blood tests, chest x-rays, electrocardiogram and will be examined by an anaesthetist and cardiologist. Once the general conditions have been evaluated the staff will confirm the surgery and supply the patient with the dates of hospitalization and the intervention.  
Restoration of hip surgery como

THE HOSPITALIZATION

Subsequently the patient will be examined by the doctor to set the therapy regarding any other sicknesses already under treatment. Once the surgery has been completed the rehabilitation will begin. Usually the stay in the ward is about 2 days for non invasive surgery. Otherwise, in the case chondroplasty was required for cartilaginous lesions, the stay is of 3 days. Again 3 days of treatment is carried out after Femoroacetabular impingement
riabilitazione anca como

THE TREATMENT

The patient can begin moving around with the aid of forearm crutches from the day after the surgery. Flexion exercises of the operated hip in bed can also be carried out. The post surgery rehabilitation schedule consists of:
  • Walking with forearm crouches with a partial load from the 1st day after surgery for 2/4 weeks.
  • Subsequently with one contra lateral forearm crutch for 1 week. 
  • Exercise bike set on “0” 15 minutes three times a day from the 2nd day after surgery for 4 weeks
  • Swimming freestyle or backstroke, or gentle gymnastics for strengthening the muscles of the lower limbs from the 14th day after surgery for 4 weeks.
  • Resumption of normal work activities 2/4 weeks after surgery.
recovery hip  como

AFTER THE RECOVERY

The patient is followed by the specialist who carried out the surgery through regular checks (14 days after surgery, 3 months after surgery, 6 months after surgery, 12 months after surgery and then yearly checks). During the checks the patient will be examined and undergo a hip x-ray that is usually performed at the 6 months, 1 year and during the subsequent annual checks.
como surgical anesthesia

WHAT TYPE OF ANAESTHESIA?

The anaesthetist can evaluate the best type of anaesthesia to use on the patient according to the general state of health and any associated diseases. Usually an epidural is applied that anaesthetizes only the lower limb. Therefore the patient is awake and breathes autonomously but, if necessary, can be sedated by the anaesthetist for the purpose of reducing emotional stress. With this type of peripheral anaesthesia it is also possible to apply a (peridural) sensor that monitors the pain during the first days after surgery.
duration surgery hip como

HOW LONG DOES THE SURGERY LAST?

The duration of the surgery varies according to the pathology to be treated. Usually surgery lasts 60 minutes (30 minutes in the case of a lesion to the labrum – 60/60 minutes in the case of treatment for Femoroacetabular impingement). After the surgery the patient is examined by the anaesthetist and the surgeons in the anaesthesia room for any monitoring and subsequently brought back to the ward in the bed. In addition, in the totality of the cases (more than 1,500 patients) it has never been necessary to carry out a blood transfusion.

HIP REPLACEMENT SURGERY

THE INSERTION OF A PROSTHESIS FOR THE TREATMENT OF ARTHROSIS

Total hip replacement or arthroplasty has spread very widely over the last 40 years. This is one of the most widespread surgical procedures around the world and the World Health Organization estimates that in the western world (Europe and the United States) about a million patients a year undergo this surgery. It is a surgical procedure in which new technology, in the choice and selection of bio-compatible metallic alloys such as titanium and the new ceramics have surely brought considerable improvement and increased the duration and the functionality of the prosthetic implants. This surgery is efficient and decisive for the treatment of hip arthrosis or Coxarthrosis, both the primary and secondary types.

Primary arthrosis arises as a joint degenerative process. It is the classic arthrosis that manifests at a mature age and causes the patient pain and limits movement.

On the other hand secondary arthrosis is the one that forms as a consequence of diseases that cause damage to the joint. The most common pathologies that cause hip arthrosis are:

  • dysplasia
  • avascular necrosis of the femoral head
  • rheumatic diseases such as rheumatoid arthritis and psoriatic arthropathy

In any case, secondary arthrosis can also manifest after a trauma, such as fractures of the femoral head or neck or fractures of the acetabulum. In these cases we talk about post traumatic arthrosis.

In all these cases total hip replacement consists of removing the damaged and irregular arthrotic joint surfaces that no longer allow more than adequate movement of the limb.

These surfaces are then replaced by the prosthesis that in the specifics is made up of 3 essential elements: the cup which is inserted in the acetabulum, the stem which is inserted in the femur and the spherical head that is inserted into the stem and that articulates with the cup.

This is how the new joint is formed, with a harmonious sliding between the two surfaces in a manner that eliminates the pain and give back normal mobility to the joint.

DESCRIPTION OF THE TREATABLE PATHOLOGIES


•Coxarthrosis

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

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,

•Perthes’ disease

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

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. 

•Psoriatic arthropathy

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.

THE CHOICE OF THE RIGHT PROSTHESIS


•Coating Prostheses


Prosthesis surgery resolves efficiently and permanently pain and limitation of movement through substitution of the hip with an artificial joint. But not all the Patients require the same hip prosthesis! The choice of the most suitable prosthesis for each Patient requires an accurate analysis of the clinical and social characteristics of each individual by the doctor. 
The factors that most influence this choice, in addition to the disease and the type of arthrosis which affect the Patient, are age, general clinical conditions, social and working conditions, the level of activity and the expectations of the Patient.

•Standard hip prosthetics

As stated previously, the “classic” total hip replacement is made up of three elements, the cup that is inserted in the acetabulum, the stem that is inserted in the femur and the spherical head that is inserted in the stem and articulates with the cup. This “standard” system is excellent for the majority of cases and can be applied in 3 different ways, defining 3 types of prostheses according to how they are inserted into the bone. 

- Uncemented prostheses: 
the anchoring of the prosthesis occurs thanks to the integration of the components of the prosthetic with the bone tissue with the placement of “cementing” materials These are recommended for the majority of cases, especially in patients in which the quality of the bone is still well preserved. 
- Cemented prostheses: 
the anchoring of the components is entrusted to cementation with polymethyl methacrylate (PMME) that allows adherence of the prosthesis to the bone by its interposition. These are especially recommended for cases in which the quality of the bone is precarious, as in Patients affected by rheumatoid arthritis or in Patients of an advanced age.
- Hybrid prostheses: 
one of the two components is cemented and the other is not. These are the least widespread and represent a possible choice in specific cases where one of the two bone parts is particularly compromised compared to the other.

•Coated hip prosthesis

this type of prosthesis is particularly recommended for very young patients with excellent bone quality.
It has the following advantages:

1)it respects the original anatomy of the hip better
2)restores better joint functionality (even for sport)
3)guarantees better stability
4)allows the maximum possible bone savings


Unlike the standard prosthesis, the coated prosthesis is made up of only two elements: the cup that is inserted in the acetabulum, the femoral head that is inserted as a “coating” for the arthrosis femoral head and is articulated directly with to the cup. In brief, in the coated prosthesis the head and the neck of the femur are not cut away to insert the stem inside the femur but the femoral head itself is shaped and covered by the prosthesis. 

•The hip prosthesis that keeps the neck or with a “mini stem”

This is a hip prosthesis like the standard (cup-stem-spherical head) but with the difference that the neck of the femoral stem is preserved and the femoral stem is of smaller size. These prostheses are also recommended for young Patients with good bone quality.

SURGICAL TREATMENT

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.


COURSE OF THE SURGERY

Before the surgery: after visiting the orthopaedic specialist who recommended the surgery, the patient will be sent to hospital admissions to organize the pre-hospitalization. This involves the execution of blood tests, chest x-rays, electrocardiogram and the patient will be examined by an anaesthetist and cardiologist and any other specialist examinations requested. In this way the general conditions will be evaluated and the surgery confirmed, Subsequently the date of admission and the surgery will be set.

Admission: the Patient will be examined once again by the ward doctor who sets the medical treatment for any other diseases that may already be under treatment. Immediately after surgery the rehabilitation will begin. The average stay in the ward is about 4 days in the surgery ward followed by 2-3 weeks of recovery in the rehabilitation ward.

After recovery: the Patient will be followed by the specialist who carried out the surgery with scheduled checks (30 days after surgery, 3 months after surgery, 6 months after surgery and thereafter yearly). During the checks the patient will be examined and subject to x-ray examination of the operated hip, generally during the 6 month, 1 year and during the subsequent yearly checks.
rehabilitation anca como

REHABILITATION

With the assistance of the physiotherapist the patient will be able to regain mobility of the joint the day after surgery.
Initially Flexion exercises and rotation of the operated hip will be carried out in bed to recover mobility of the joint. Subsequently, after 2-3 days after surgery the patient will be able to begin walking with the use of two forearm crutches, progressively increasing the load on the operated leg

Post surgery rehabilitation programme
  • Walking with two forearm crutches with partial load from the 2nd day after surgery for 3 weeks.
  • Subsequently one contra lateral forearm crutch for 2 weeks. 
  • Exercise bike set on “0” 15 minutes three times a day from the 10th day after surgery for 3 weeks.
  • Swimming freestyle or backstroke, or gentle gymnastics for strengthening the muscles of the lower limbs from the 21st day after surgery for 3 weeks.
  • Return to sedentary work activity and driving a car 6 weeks after surgery.
  • Return to normal non-sedentary work or light non impact sporting activity 12 weeks after the surgery.
  • Return to sporting activity with impact 24 weeks after surgery.

QUESTIONS AND ANSWERS

  • What type of anaesthesia is used for the surgery?
The anaesthetist can evaluate the best type of anaesthesia to use on the patient according to the general state of health and any associated diseases. Generally an epidural is applied that anaesthetizes only the lower limb. Therefore the patient is awake and breathes autonomously but, if necessary, can be sedated by the anaesthetist for the purpose of reducing emotional stress. With this type of peripheral anaesthesia it is also possible to apply a (peridural) sensor that monitors the pain during the first days after surgery. In some cases the surgery will be carried out under general anaesthetic.

  • How is the pain checked after surgery?
An infusion pumped is mounted during surgery for checking post surgery pain,
After surgery the ward doctor and the nurses together with the anaesthetist who manages the pain therapy will check the functionality and the capacity of the pump for the pain and integrate the therapy with anti-inflammatory medication and minor or major pain relievers.

  • How long will the surgery last?
Obviously the duration of the operation varies according to the disease to be treated. However, on average a duration of 90 minutes is indicative.

  • What are the risks related to the surgery?
The incidence of complications tied to hip replacement is rather low compared to other surgery. An international estimate estimates an average incidence of 2.5%. In my personal case history of more than 1,500 operations carried out since 1995 the incidence of complications is equal to 2.1%.

  • Dislocation:
Consist of the dislocation of the head of the prosthesis beyond the cup with the appearance of pain and limited functionality. This is a risk for the patient in the first 3 months after the operation. In the first months it is important to avoid excessive movements such as flexing the hip more than 90° (sitting in a chair that is too low, on the toilet without a riser, crossing legs). This is predisposed by poor muscle tone that is reduced after the first months thanks to good physiotherapy. It is important to carry out specific expedients (using a riser for the toilet, not using the bidet and taking a shower for personal hygiene).

  • Infection
This is a terrible complication but luckily it is rare (1%). This can occur even in cases where the surgical procedure is carried out aseptically and correctly, even in the presence of antibiotic prophylaxis. Some patients are more at risk, such as those affected by diabetes mellitus and immunodeficiency. Normally infection manifests early and quick immediate diagnosis per immediate treatment.

  •  Venal thrombosis:
This is a major complication because it can cause a pulmonary embolism. With the current prevention protocols both pharmacological (coagulation factor inhibition, Low molecular weight Heparin) and physical (elastic socks) and early mobilization and rehabilitation there is a low incidence of symptomatic episodes or pulmonary complications.

  • Post-operatory haematoma:
Haematomas may occur after surgery and are located above all in the region of the glutea or lateral thigh section. These haematomas also regress spontaneously and therefore do not require specific treatment.

  • Neurological lesions:
Neurological lesions may occur in the sciatic, femoral and femoralcutaneous nerves. These lesions are rare and sadly they are often irreversible. Their incidence is less than 0.3%.

  • Is a transfusion needed after surgery?
Yes, at times a transfusion is needed to improve the general conditions and to allow rapid rehabilitation. It is possible to recover blood during and after the surgery, from the drainage of the surgical wound without removing it from the patient’s body, (as requested by Jehovah’s Witnesses). In addition, when necessary, blood removed from the patient before the surgery can be used (predisposed) if the general conditions allow. In conclusion, in any case, it is possible to resort to the use of blood from a suitable donor when necessary.

  • How is surgery performed and how long does it last?
On the morning of the surgery the patient is brought to the operation theatre in the bed by the attendants and introduced to the operating unit. Here the anaesthetists and the theatre nurses prepare the patient for the anaesthesia. Then the patient is positioned on the operating table. Then, after having prepared the operating field, the surgeons perform the operation that lasts 90 minutes on average. After the surgery the patient is checked by the anaesthetists and the surgeons in the anaesthesia room for any monitoring and subsequently returned to the ward in the bed.

  • Of what materials is the hip prosthesis made?
The stem is generally made of titanium because it is a material that adapts and integrates with the bone in such a way as to not have to use cement to fix the prosthesis. The acetabular cup is made of steel or titanium and the insert that serves as the friction with the head of the prosthesis is made of high resistance polyethylene or in ceramics or metal. Today these materials and their method of fabrication achieve a wear of the prosthesis of almost zero.

  • How long will a hip prosthesis last?
It is hard to establish this. The materials used are very resistant but the adaptation of the bone to the prosthesis is very important. In any case, it is possible to say that 15/20 years is a possible prediction.

REGENERATIVE SURGERY

REPAIRING AND TREATING DAMAGE TO THE CARTILAGE AND JOINTS

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

QUESTIONS AND ANSWERS ABOUT REGENERATIVE SURGERY

•Where are stem cells found?

In all our bodies, even of adults, but above all they are present in the blood, in bone marrow and the adipose tissue

•Are our own cells used?

Yes! They are defined as analogous. This means that every individual possesses their own stem cells and these can be used for the treatment of pathologies such as arthrosis, without running the risk of adverse reactions (such as “rejection”). Which on the other hand would occur if we used the stem cells from donors.

•Are there age limits?

Sadly yes! In women after menopause the viability of these cells reduces progressively and therefore the regenerative treatment, if it were possible, would have less chance of being effective. In men there is still a good possibility of effective treatment even after 65 years of age.

•Can all cases of arthrosis be treated, even advanced or very advanced?

If the level of the arthrosis is serious or very serious the regenerative treatment is not completely effective. In these cases the joint deformation is such that regenerative treatment on its own is not enough to restore the joint to good functionality. In all these cases we need to resort to other types of surgery, mainly prosthetic. Regenerative treatment has its place, as an infiltrative treatment, in those cases of advanced arthrosis in which it is not possible to perform other forms of surgery due to the general clinical conditions of the patient. Infiltrative treatment in these cases exploits the anti-inflammatory and pain relieving properties of the substances used in regenerative medicine. 

•How are the cells collected?


As previously stated, the stem cells are mainly present in the blood, bone marrow and the adipose tissue.

Collection from the blood:

A simple sample of peripheral blood is taken, .as in normal blood analysis. This blood is centrifuged to separate the cells from the liquid part. Therefore a fluid product is achieved that is very rich in cells and above all in platelets. The so-called “platelet rich plasma” or “PRP”. The quantity of mesenchymal cells in this product is very low. They are mainly present in the platelets which release substances that have a certain capacity to stimulate regeneration, as well as others that have mainly anti-inflammatory and pain relieving properties.

•Extraction of the bone marrow:

A sample is taken from the bones of the pelvis. A needle is inserted into the bone and aspiration occurs. It is generally not necessary to use anaesthesia, simple pharmacological sedation is enough. Similarly to what was stated about the collection of peripheral blood, the material from the marrow is centrifuged to select the cellular component. This component is very rich in mesenchymal cells. These mesenchymal cells come directly from the stem cells and have already had a differentiation towards the cell line that concerns the cartilaginous, bone and fibrous tissues. Lastly, this centrifuged fraction is injected directly into the joint. In the articular chamber the injected cells are stimulated towards the regenerative process.

•Extraction of subcutaneous adipose tissue:

This technique is the most innovative and takes advantage of the availability of adipose tissue for supplying the cells necessary for the regenerative process. In the adipose tissue of an adult there is a high concentration of stem cells. This procedure involves a small manual liposuction by aspiration. The adipose tissue is removed directly in the operating theatre or in the surgery, it is microfractured, purified and concentrated. A gelatinous liquid is obtained that contains a high concentration of “bioactive units”. These contain mesenchymal cells and other biological factors that stimulate and feed said cells. Also in this case the gelatinous liquid is injected into the joint where it carries out its regenerative, pain relieving and anti-inflammatory activity. As in the previous case of the extraction of bone marrow large surgical incisions are not required, nor to place sutures.

INFILTRATIVE THERAPY

INFILTRATIVE THERAPY ADVANCED SOLUTIONS FOR CONTROLLING SYMPTOMS OF ARTHROSIS

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:

  • When it is not possible to carry out complete surgery due to the clinical condition of the patient (severe myocardial disease, very advanced age, severe hepatic or renal insufficiency or in cases of neoplasia).
  • In post surgical cases when complete resolution of the symptoms is not achieved after having carried out an arthroscopy or open reparative surgery.
All these forms of infiltrative therapy must be carried out in a sterile environment (sometimes in an operating theatre) and under x-ray or ultrasound control to guarantee that the medication is injected correctly into the joint.

It is mostly necessary to perform only local anaesthetic or light sedation and the therapy is carried out as an outpatient or in Day hospital. 

There are two forms of infiltrative therapy:

  • Supplementation or VISCOsupplementation. This consists of the infiltration of medication or substances that exclusively allows the reduction or the resolution of the symptoms, even if temporarily. In this sense this therapy must be considered purely palliative.
  • The infiltration of bioactive substances. This consists of the endoarticular administration of autologous cellular substances that have a regenerative function.

(VISCO)SUPPLEMENTATION


•Infiltration with anaesthetics

The local anaesthetics injected into the joint allow temporary resolution of the pain. In some cases however, the repeated infiltration allows prolonged action thanks to the so-called “interruption in the path of pain”. In brief, the repeated local anaesthesia interferes with the physiological mechanisms that trigger the pain giving a prolonged effect. With the decrease of pain the functionality and the capacity for movement of the hip also improve. In some selected cases this method is used as a “Hip Injection Test”. In doubtful cases, when it is not possible to distinguish between endo and extra-articular pathology, the endoarticular inoculation of the anaesthetic allows the doctor to distinguish the exact origin of the pain. 


•Infiltration with cortisone

Cortisone drugs have a marked anti-inflammatory and analgesic effect. Cortisone drugs are infiltrated together with an analgesic to increase their analgesic effects. Generally, a cycle of three weekly infiltrations is performed that can be repeated every 6 months on an outpatient basis.


•Infiltration with hyaluronic acid

Hyaluronic acid is a natural constituent present in the joints. Its main function is lubrication of the joint as it is a viscous substance. The term VISCOsupplementation is derived from this. Therefore hyaluronic acid is injected into the hip to ease the sliding of the articular surfaces. This too is a palliative therapy that can be repeated in cycles that also allow the reduction of pain. At the present time there are various molecules of hyaluronic acid available for infiltrative therapy. Those of low molecular weight and those of high molecular weight. The former have a structure more similar to natural molecules and require a greater number of infiltrations to reach reasonable effectiveness. The latter less natural molecules have a longer lasting effect and thus require a lower number of administrations.

INFILTRATION WITH BIOACTIVE SUBSTANCES

•PRP or Platelet Rich Plasma

A simple extraction of peripheral blood (such as for laboratory tests) allows to select through centrifugation the fraction of platelet rich plasma. Once this has been injected into the joint the platelets release their bioactive substances and contribute to forming a clot inside the site where the cartilage is damaged. The purpose is to favour the regenerative and reparative process of the joint. Furthermore, the substances released also have a pain relieving and anti-inflammatory effect, For reasons of cellular viability it is more appropriate to perform this treatment in patients with an age less than 55 years in women and 65 in men. The treatment can also be performed as an outpatient procedure. 

•Extraction of autologous bone marrow

Bone marrow is rich with stem and mesenchymal cells which are selected and concentrated, again by centrifugation.  Also in this case infiltration of this substance into the joint eases the regenerative and reparative effect but in a stronger manner compared to PRP. The extraction of the bone marrow, even if it is not invasive, is in any case more demanding compared to peripheral blood withdrawal and needs to be performed with local anaesthetic. Anyway, it does not require skin incisions or to place sutures. It is necessary to perform the procedure in the operating theatre and also in this case it is more appropriate to perform this treatment on patients with an age less than 55 years in women and 65 in men.

•Extraction of autologous Adipose tissue

The adipose tissue of adults contains higher quantities of bioactive complexes used in regenerative medicine. A minor liposuction is performed by manual aspiration. The seat of the withdrawal is usually the region of the glutea or lateral region of the thigh, or the umbilical area of the abdomen. The tissue removed is treated through a procedure that takes the name of microfractured Therefore it is purified and concentrated and then injected into the hip. The extraction of adipose tissue needs to be performed under local anaesthetic. Anyway, it does not require skin incisions or to place sutures. It is necessary to perform the procedure in the operating theatre and also in this case it is more appropriate to perform this treatment in patients with an age less than 55 years in women and 65 in men.

BOOK AN APPOINTMENT

DOTTOR ANDREA FONTANA

To contact Doctor Andrea Fontana and book an appointment at his surgery, ask for information or other, you only have to fill in the form in this section.

 You will quickly receive clear and precise answers that satisfy every need.

Doctor Fontana receives and operates in two surgeries



•Centro Medico Polispecialistico (Multi-specialist Medical Centre)- Belegotti - CMP
Via Frova, 34 - Cinisello Balsamo, in the Province of  Milan, Italy.
Telephone: +39  02 66012960

•Centro Diagnostico Comense (Como Diagnostic Centre) - CDC
Viale Varese, 75 – Como, Italy.
Telephone +39  031 262136
 
An email address is also available for clients dr.andreafonta@libero.it.

DR. ANDREA FONTANA - CENTRO DIAGNOSTICO COMENSE CDC VIALE VARESE 79 (COMO), Italy TEL +39 031262136

DOCTOR ANDREA FONTANA IS A SPECIALIST IN ORTHOPAEDICS AND TRAUMATOLOGY AND OFFERS THE HIGHEST COMPETENCE AND TRAINING IN THE CARE OF DISEASES OF THE HIP.


Torna su