ARTHROSCOPY: LESS PAIN, BONE CONSERVATION AND PRESERVATION OF FEMORAL NECK

The Orthopaedics and Traumatology Unit of the Clinica San Francesco carries out several operations for hip prostheses, useful to treat the more invalidating diseases of this articulation. Nowadays, before turning to the articulation replacement, is possible to carry out hip arthroscopic operations, a widespread procedure for the other articulations, but much less in respect to hips.

This kind of operation is reaching excellent results in treatment of selected diseases and the Clinic surgeons have stored up a wide case record that permitted to verify the efficacy.  

Hip arthroscopy

The surgical procedure of arthroscopy has considerably developed over the last years and allows to carry out a successful hip prosthesis operation without particularly intrusive procedures. It is a procedure that permits to evaluate and treat intra and extra-articular diseases, using a video camera and minimally invasive instruments, introduced by 5mm incisions. This involves evident advantages for the patient:

• contained blood loss
• better conservation of tissues
• less pain for patient
• limited stay times

At the Clinica San Francesco, one of excellence centres for hip operation and prostheses, surgical skills and technologies exist, permitting to carry out this top-level procedure both on athletes (who frequently are affected by this disease) and patients afflicted by initial forms of hip wear.

The Femoroacetabular Impingement (FAI) represents the more frequent indication for arthroscopy hip operation. It’s a question of morphological anomalies charged to femoral neck and/or acetabulum that, if not treated, damage the articular cartilage, flowing inevitably into hip arthrosis. The FAI, in its initial manifestations, is especially observed in young persons (20-45 years old) of both genders. It is proved that an intense physical activity can predispose to FAI, but also the infancy pathologies can favor the conflict onset. The symptoms are characterized by pain, typically in inguinal site, but sometimes irradiated in gluteal or lateral region, caused by flexion manoeuvres and hip internal rotation.

Thanks to the arthroscopic procedure is possible to remove the conflict and treat with repair or reconstruction, fibrocartilage lesions called acetabular lip (like a gasket), a fundamental structure for wellbeing of hip articulation.

The arthroscopy can also be used to remove intra-articular mobile bodies, as consequence of hip dislocation or diseases as chondromatosis, to evaluate and treat the persistent pain after hip prosthesis implant or to carry out the detension of some inflamed and aching tendon structures (like iliopsoas tendon or tensor muscle of deep fascia of thigh) in internal or external snapping hip.

Finally, in arthroscopy, the diseases linked to hip instability can be treated and the round ligament, in cases when it suffers a break caused by a single or multiple traumas, can be reconstructed.

The “core decompression”, linked or not to arthroscopic procedure, is used in the treatment of hip femoral head osteonecrosis; it means emptying the bone necrosis area (circulatory suffering of femoral head) by percutaneous way under radiologic control and possibly by articular arthroscopic way, creating premises for a tissue regeneration in order to prevent the structural collapse. The indication for this procedure is reserved for initial cases of disease.

Hip replacement surgery

Our Hip Surgery Unit carries out arthroprosthesis operations to treat the most serious arthrosis cases, leading to important reduction of articular mobility and fractures of femoral neck in elderly man. At the Clinica San Francesco various hip prostheses are applied (constructive material, design, flow surfaces coupling, bone conservation with preservation of femoral and lining neck), using the traditional procedure, the navigation (using a system that allows to achieve more precision in the application of traditional implant) and the robotic (using the Mako Rio system).

Furthermore prostheses of different morphology (straight, anatomical, neck and lining conservation), prevalently not cemented, of different material (metal alloys, titanium, hydroxyapatite, et cetera) and with ceramic flow surfaces, mixed in polyethylene and ceramic/metal depending on specific clinic case. Our philosophy is to use bone tissue conservation prostheses, preserving the femoral neck thanks to innovative design and, in very selected cases, coating the femoral head.

Postoperative antalgic treatment

In postsurgical phase the patient is followed by an anesthetist who takes care of prevention and treatment of prosthetic painful symptomatology, turning to the most innovative procedures (selective block of nervous branch, peridural tubes, continuous administration of analgesic minidoses, et cetera) and the use of state of the art drugs.