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Non-surgical treatments

In managing many pathologies, recent knowledge and methods are applied in the field of regenerative medicine to achieve bone regeneration and the development of healing processes, including soft tissues. Regenerative medicine is used both in degenerative pathology (osteoarthritis in the initial phase, chronic tendinopathies), for sports injuries (traumatic and micro traumatic chondroplasties, traumatic or wear tendon injuries), and in traumatic pathology (periprosthetic fractures, re-fractures on synthetic means, pseudarthrosis).

Hyaluronic acid injections

Generally used in the treatment of osteoarthritis, or to prevent cartilage suffering, hyaluronic acid is injected directly into the joint to alleviate pain and inflammation and to increase lubrication. This is because hyaluronic acid is a fundamental component of the synovial fluid located inside the joints, protecting the cartilage from wear due to excessive loads. A decrease in hyaluronic acid increases the friction between the joint surfaces, so it is essential to restore it. It is used to decrease the patient’s painful symptoms and recover movement. There are different types and are chosen based on the pathology that afflicts the patient. The injections are not permanent and must be repeated every 6-12 months.

Cortisone injections

For treating joint pathologies with an inflammatory component or delaying a surgical intervention, cortisone, or corticosteroids, injections are sometimes used as conservative therapies. Here, the cortisone is injected directly into the affected joint, releasing the anti-inflammatory and immunosuppressive capacity of cortisone and relieving the pain. There are two types of cortisones which are chosen based on the required action and pathology. Corticosteroids are useful when an immediate effect is required. It is also a powerful and effective anti-inflammatory and pain reliever.

Platelet-Rich Plasma (PRP)

Platelet-Rich Plasma (PRP) consists of taking a sample of blood from the patient which is then centrifuged using special equipment. Part of the platelet-rich centrifuged fluid is subsequently injected back into the patient’s joint. The aim is to obtain the maximum possible platelet concentration, which exploits autologous growth factors (i.e., belonging to the same patient) and their regenerative capacity. The liquid is rich in anti-inflammatory factors and can help reduce joint pain, improve movement and quickly return the patient to his/her daily activities. Traumas and acute injuries such as knee sprains, ruptured ligaments, strains, and muscle strains are treated with PRP. This can speed up the healing process in tendon injuries, which happens very slowly; also, in post-surgical repair for wound healing. Among the advantages, it limits the possibility of rejection, speeds up the postoperative course, and does not present allergies or immunological reactions.

Stem cells

The use of transplanted stem cells has developed extensively in the latest scientific frontier. Stem cells have been found to possess the capacity to regenerate cartilage, bone, tendon, and skin. They are applied within orthopaedic practice to treat knee, hip, ankle, and osteoarthritis, with the advantage of healing minor injuries and stabilizing severe injuries. Stem cells are present in the umbilical cord, within the placenta, the amniotic fluid, and in the bone marrow, blood, and adipose tissue (connective tissue with the function of storing energy in the form of fats). They can replicate and differentiate in one or more damaged tissues, pairing and regenerating them. The fact that the patient is their own donor limits the number of cases of rejection.

Procedure

1. First consultation

Indication for surgery.
If other exams are required, patient is going to have a second appointment.

2. If surgery is needed

Patient is put on waiting list.

3. Surgery Day -1

Patient comes to the hospital.
Need to fast xx hours prior to arrival?
What to bring?

4. Surgery Day 0

Spinal anaesthesia, eventually sedation.

Surgical procedure.

Patient goes back to his ward and Fast Track protocol starts.

5.Length of stay

Depending on surgery outcome, patients may need to stay between 3 to 5 days.

70% of the cases are outpatient; ie. patients go home right after surgery.

6. After discharge

35 days of DVT prophylaxis.

Blood thinners and stockings. ???

7. Follow ups

7-10 Days post-surgery: For medication

20 Days post-surgery: Stiches removal

6 Weeks post-surgery: Check up with X-ray (They have to get an x-ray prior to visit?)

8. More follow-ups

Spinal anaesthesia, eventually sedation.

Surgical procedure.

Patient goes back to his room and Fast Track protocol starts.

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