Department of Orthopedics and Traumatology @ Ospedale San Raffaele

The main surgical excellence of the Department of Orthopedics and Traumatology directed by Prof. Salini are:

DAA direct anterior approach – Bikini approach  (surgeon Prof. Salini, Dott. Ometti)

Direct anterior hip replacement is a minimally invasive surgical technique. This approach involves a 3 to 4 inch incision on the front of the hip that allows the joint to be replaced by moving muscles aside along their natural tissue planes, without detaching any tendons. This approach often results in quicker recovery, less pain, and more normal function after hip replacement. Because the tendons aren’t detached from the hip during direct anterior hip replacement, hip precautions are typically not necessary. A “bikini incision” anterior hip replacement uses an incision in the horizontal direction along your natural skin folds and follows Langer’s lines (sometimes called cleavage lines).. This approach can be used on both men and women. 

About 250 operations are performed a year through the use of robotic surgery procedures.

Sport Traumatology ( surgeon Prof. Salini, Dott. Placella)

The rupture of the anterior cruciate ligament (ACL) is one of the most common injuries  in sport active patients. In particular sports  including changes in direction, jumpings and landings, such as soccer, volley, rugby and basket-ball.  The ACL is an anatomical knee structure bridging the tibia and the femur, it is one of the main restraint of both tibial anterior translation and knee rotational stability.  The rupture of the ACL could lead to subjective and objective knee rotational instability (“giving away“ sensation), increasing the risk of further knee traumas and further meniscal and chondral lesions.  An higher risk of knee osteoarthrosis has been reported in literature due to ACL injuries. The surgery is highly recommended in all patients with positive ACL rupture MRI findings experiencing rotational instability and willing to return to knee pivoting activities. The aim of the surgery is the anatomical reconstruction of the damaged ligament, using an autograft tendon, in order to restore knee stability, therefore reducing the incidence of further meniscal and chondral lesions. The procedure is performed using an arthroscopic assisted technique, regional anaesthesia is usually choice in the surgical routine 

About 220 operations are performed a year  using the latest surgical techniques and physiotherapy re-education protocol.

Shoulder surgery ( surgeon Prof. Salini, Dott. Vitali) 

Shuolder artrhroscopy   may be performed in local anesthesia using regional nerve blocks which numb the shoulder and arm, or, according to the patient's desire and/or anesthesiologist's indication, under total anesthesia. The surgeon injects fluid into the shoulder to inflate the joint. This makes it easier to see all shoulder structures through the arthroscope. Then the surgeon makes a small puncture hole into the shoulder for the arthroscope. Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen showing the surgeon the affected site and damage.. Special instruments are used for tasks like: shaving, cutting, grasping, suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone.

Sport medicine- Regenerative Therapies ( surgeon Prof. Salini, Dott. Vitali, Dott. Ometti)

We have regenerative infiltrative therapies available which are PRP, Orthokine ,Bmac and regrafting of autologous adipose tissue (ADCS). San Raffaele Regenerative Medicine represents a national and international reference point in the application og regenerative medicine in the orthopedic, trauma and sport medicine fields. With its wide range of competencies and frequent injury, the skeletal system provides a rich testing ground for the field of regenerative medicine. Likewise, intra-articular ligaments, articular cartilage and menisci have almost no ability to heal after injury.  Mesenchymal Stem Cells (MSCs) have the ability to contribute to tissue healing through the production of a wide range of growth factors . MSCs are able to “feel” the environment in which they are used and react accordingly by releasing the molecules necessary to counteract the pathological microenvironment. In inflammatory situations, including chronic ones, they promote the restoration of the normal physiology of the treated tissue. The tissues normally used to obtain MSCs are bone marrow, through suction from the iliac crest (pelvic bones) and adipose tissue, through a small liposuction (normally from the abdomen ADSC).  An important finding is that since it is always an autologous use, no significant adverse effects have ever been found in any of the described techniques. . MSCs are multipotent stem cells with a strong capacity for self-renewal as well as a differentiation capacity to form chondrocytes, adipocytes and osteocytes. Bone marrow and adipose tissue (ADSC) have been the most source for harvesting MSCs. About 250 operations are performed a year .

Traumatology ( surgeon Prof. Salini, Dott. Mancini)

The Orthopedics and Traumatology unit is part of the European Pathway Association network as a trauma center for trauma Fast Track and immediate functional recovery of fractures in the elderly and in polytrauma patients.

About 250 operations are performed a year using the latest minimally invasive and computerized surgery techniques.