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CUSTOM SURGERY

Total Hip Arthroplasty

Hip replacement surgeries are managed using the Fast Track protocol, i.e., with the highest degree of customization which allows patients to walk just four hours after surgery. During the surgery, the femoral head (thigh bone) and acetabulum (hip socket) are replaced to eliminate pain and restore hip function. Surgery is recommended when the pain is unbearable, when drugs are not helpful to the patient anymore and when radiographs show severe osteoarthritis. There are two access routes — anterior and posterior — and there are different prostheses, all made with the latest generation materials defined according to the patient’s characteristics and the type of pathology. The anterior route favours a faster recovery within the first six months compared to the posterior route. Still, there are no differences in terms of recovery and satisfaction 6 to 12 months after the operation. Both operations are performed with a minimally invasive technique. A small incision of about 10-12 cm is made with an accurate dissection of the tissues, reducing operation trauma and pain after postoperation.

Minimally invasive total hip arthroplasty: the anterior approach

Description of the surgery

The total hip replacement surgery (THR) with the anterior approach is usually performed under spinal anaesthesia to promote greater postoperative pain control. An incision of about 10 cm is made in the anterior compartment of the patient’s thigh to implant the prosthesis, following a plane between the muscles to preserve their anatomical integrity. Once on the joint, the femoral head that is affected by arthrosis is removed and the femur and acetabulum are prepared. The surgeon proceeds with the implantation of the definitive prosthesis. In this phase of the surgery, dynamic tests are performed to test the joint’s stability with the test components. The final components are then implanted, and the joint capsule, muscle fascia and skin are sutured. Anterior access is not recommended in cases of obesity, abnormal bone anatomy (hip dysplasia, fractures, etc.), severe osteoporosis, massive muscle mass, or revisions.

Classification
Invasive
Duration of the surgery: about 1 hour 30 minutes
What to do after surgery – postoperative care

A few hours after the surgery, the patient goes through gait rehabilitation with physiotherapists’ assistance in the ward and is immediately independent in managing his/her hygiene and personal care. The day after the surgery, the bandage is removed and the patient can walk with crutches, go up and down the stairs with the help of physiotherapists and also on his/her own. 3-5 days after the operation, the patient is discharged and should be able to follow through physiotherapy independently. Everyday activities resume in the first 3-6 weeks, while total recovery time is 3 months. In the first few weeks, it is essential to take painkillers to control pain and perform regular physiotherapy exercises which speeds up the healing process. Driving is recommended after 6 weeks. The patient should be able to go back to work between 6-12 weeks depending on job tasks. Sports such as golf, cycling, double tennis, and cycle ergometer are possible between 12-16 weeks.

PRE OPERATION
POST OPERATION

Minimally invasive total hip arthroplasty: the anterior approach

PRE OPERATION
POST OPERATION
Description of the surgery

The total hip replacement surgery (THR) with the anterior approach is usually performed under spinal anaesthesia to promote greater postoperative pain control. An incision of about 10 cm is made in the anterior compartment of the patient’s thigh to implant the prosthesis, following a plane between the muscles to preserve their anatomical integrity. Once on the joint, the femoral head that is affected by arthrosis is removed and the femur and acetabulum are prepared. The surgeon proceeds with the implantation of the definitive prosthesis. In this phase of the surgery, dynamic tests are performed to test the joint’s stability with the test components. The final components are then implanted, and the joint capsule, muscle fascia and skin are sutured. Anterior access is not recommended in cases of obesity, abnormal bone anatomy (hip dysplasia, fractures, etc.), severe osteoporosis, massive muscle mass, or revisions.

Classification
Invasive
Duration of the surgery: about 1 hour 30 minutes
What to do after surgery – postoperative care

A few hours after the surgery, the patient goes through gait rehabilitation with physiotherapists’ assistance in the ward and is immediately independent in managing his/her hygiene and personal care. The day after the surgery, the bandage is removed and the patient can walk with crutches, go up and down the stairs with the help of physiotherapists and also on his/her own. 3-5 days after the operation, the patient is discharged and should be able to follow through physiotherapy independently. Everyday activities resume in the first 3-6 weeks, while total recovery time is 3 months. In the first few weeks, it is essential to take painkillers to control pain and perform regular physiotherapy exercises which speeds up the healing process. Driving is recommended after 6 weeks. The patient should be able to go back to work between 6-12 weeks depending on job tasks. Sports such as golf, cycling, double tennis, and cycle ergometer are possible between 12-16 weeks.

Minimally invasive total hip arthroplasty: the posterior approach

Description of the surgery

In the total hip replacement with posterior approach procedure, the surgeon first makes an incision of about 10 to 12 cm at the back of the hip, sections the soft tissue and then detaches some muscles in order to reach the hip joint. The femoral head (the ball at the top of the thigh bone) affected by arthrosis is then removed and after the preparation of the acetabulum (the hip socket) and the femur, the prosthesis is implanted. Before placing the implant definitively, careful dynamic assessments are made. The capsule is then sutured and the muscles are reattached with the appropriate sutures. The surgery finishes with the suture of the muscle and skin layers.

Classification

Invasive

Duration of the surgery: about 1 hour 30 minutes
What to do after surgery – postoperative care

A few hours after the surgery, the patient goes through gait rehabilitation with physiotherapists’ assistance in the ward and is immediately independent in managing his/her hygiene and personal care. The day after the surgery, the bandage is removed and the patient can walk with crutches, go up and down the stairs with the help of physiotherapists and also on his/her own. 3-5 days after the operation, the patient is discharged and should be able to follow through physiotherapy independently.

Everyday activities can be resumed in the first 3-6 weeks, while total recovery time is 3 months. In the first few weeks, it is essential to take painkillers to control pain and perform regular physiotherapy exercises which speeds up the healing process. Driving is recommended after 6 weeks. The patient should be able to go back to work between 6-12 weeks depending on job tasks. Sports such as golf, cycling, double tennis, and cycle ergometer are possible between 12-16 weeks.

CHIRURGIA CON NAVIGAZIONE COMPUTERIZZATA

Protesi totale di ginocchio con tecnica di navigazione computerizzata

L’intervento visto da vicino

L’intervento di protesi totale con navigazione computerizzata viene eseguito in anestesia spinale o generale. Il chirurgo esegue una incisione longitudinale al centro del ginocchio e vengono posizionati dei sensori a livello del femore e della tibia. Dopo il set-up del sistema robotizzato si esegue la mappatura delle superfici articolari del femore e della tibia per ottenere una ricostruzione tridimensionale.

Durante l’intervento viene rimossa la cartilagine e l’osso danneggiato dal femore, dalla tibia e dalla rotula che sono sostituiti con una protesi artificiale in lega di metallo, fissate con il cemento. Un inserto in materiale plastico (polietilene) viene posizionata tra la tibia e il femore e il sistema robotizzato mostra al chirurgo in tempo reale tutti i parametri e dati per ottenere un risultato di elevata precisione. La rotula viene sostituita con un bottone sempre in materiale plastico. Al termine della procedura, i sensori vengono rimossi, i tessuti e la cute vengono suturati per piani anatomici.

Classificazione

Invasivo

Durata dell’intervento: 2 ore circa.
Cosa fare dopo l’intervento – il decorso post-operatorio

Il paziente è in grado di alzarsi e di camminare già a 4 ore dall’intervento, seguendo il protocollo Fast-track*, e la degenza ha una durata di  2-5 giorni. Nelle fasi iniziali della ripresa si utilizzano due stampelle per facilitare la camminata, quindi una stampella sola o un bastone per poi tornare a camminare in autonomia nell’arco di poco tempo. 

Nelle settimane successive all’intervento, la fisioterapia è fondamentale per ottenere un miglior risultato, da combinare con l’assunzione di antidolorifici per controllare il dolore e poter eseguire in maniera corretta gli esercizi riabilitativi. 

Le attività del quotidiano si recuperano in 3-6 settimane di tempo, con una riduzione completa del dolore dopo le prime 6-12 settimane. Si torna a una buona buona funzionalità in tre mesi, ma per un recupero ottimale sono necessari 12-18 mesi.

Timeline

For total hip arthroplasty

1. First visit

A thorough clinical evaluation of the patient is performed and radiological exams are viewed. If further tests are necessary, a second visit is scheduled.

2. If surgery is needed

The patient is informed about the type of surgery required and the hospitalization period. Upon agreement, the patient is added to the waiting list and will be contacted by the hospital clerk.

3. Eve of surgery

The patient is hospitalized and has to bring personal belongings such as undergarments, pyjamas, etc.

They have to fast from midnight.

4. Surgery day

The patient is accompanied to the operating room where they will be put under anaesthesia before surgery is performed. At the end of surgery, he/she is kept under observation for some time in the recovery room before being transferred to the ward. Thereafter, the Fast Track protocol begins.

5. Hospitalization

In average, hospitalization lasts 3 to 5 days. In most cases, the patient can be discharged to their own home. In some specific cases, the patient is sent to a rehabilitation centre for additional therapy.

6. After discharge

Physiotherapy should be continued as indicated in the ward. Crutches are used for walking and prophylaxis for deep vein thrombosis (DVT) is performed for 35 days.

7. Follow-up visits

7-10 days after discharge:
first medications

20 days post-surgery:
removal of sutures

6 weeks post-surgery:
checkup and x-rays

8. Further check-ups

3 months post-surgery:
checkup and x-ray

1 year post-surgery:
checkup and x-ray

Checkup and x-ray at 2, 5, 10, 15, 20 years. If there are complications, checkups will become more frequent.

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