Istituto Ortopedico Galeazzi IRCCS offers quantity and quality in musculoskeletal care

The staff of Istituto Ortopedico Galeazzi — Italy’s only private orthopaedic hospital with the title of institute for research — is dedicated to treating musculoskeletal disease. The institute is renowned for providing high-volume orthopaedic surgical procedures, for its excellent administration and for its physicians who are active in research and education.

“I believe Galeazzi has an inimitable characteristic among the orthopaedic institutes in Italy, namely the co-existence of a strong but flexible organization, an accurate management, and top-level professionals,” Prof. Giuseppe Banfi, MD, the scientific director of Istituto Ortopedico Galeazzi, said. “The high number of patients treated in the Institute is a real and effective background for modern research. In this case, quantity is quality,” he told Orthopaedics Today Europe.

Galeazzi Institute has 14 operating rooms used 5 days a week, one emergency operating room open 24 hours a day, and a hospital with 351 beds, eight of which are for intensive care. The Institute has orthopaedic, maxillofacial, plastic and vascular surgery departments, as well as rehabilitation medicine and neurosurgery departments. Its orthopaedic subspecialties include hand surgery, foot surgery, and hip and knee arthroplasty and surgery, shoulder, sports traumatology, pediatric, trauma, infection and tumor units; there are three spine units at the hospital.

Unusual start

The institute got an unusual start. In 1964, founder Prof. Ernesto Zerbi was chief at Istituto Ortopedico Pini, a leading institution in Milan. Zerbi had strong ideas about how a hospital should be run, and “he was not happy at all about the way in which Istituto Pini was managed at the time,” Roberto Giacometti Ceroni, MD, consultant orthopaedic surgeon at Istituto Galeazzi, said.

So, Zerbi quit.

“It was the first case in Italy,” Giacometti Ceroni said.

A chief quitting his lifelong post was unheard of.

Began as private hospital

Zerbi moved to a small private clinic, and in 1965 re-established it as a private orthopaedic facility.

“At that time in Italy, a private hospital was very strange,” said Giacometti Ceroni, who retired in February as chief of the hip department. As head of the new venture, Zerbi hired five inexperienced orthopaedic surgeons and determined the hospital’s organization, admission and treatment protocols, Giacometti Ceroni noted.

He said it was critical to Zerbi that a physician head up the organization, not an administrator, so the physician would understand every detail about the hospital. Now that the institute has grown to include a 700-person staff, a single surgeon, of course, is unable to manage the organization without an efficient administrative staff. Therefore, the organization today resembles a more traditional hospital.

The Institute, in northwest Milan, has a 10-floor, 32,000 square meter facility that comprises inpatient wards, intensive care units, a clinical laboratory and multiple operating suites. Images: Istituto Ortopedico Galeazzi

Learning center

Zerbi encouraged his staff to learn and to travel to leading hospitals in Italy and abroad to do so, Giacometti Ceroni said. As a result, the institute developed close ties with Maurice Mueller and the Mueller Foundation, and its physicians quickly became top specialists in their fields, with five original staff members becoming key members of large orthopaedic societies in Italy and Europe.

Institute physicians also shared their knowledge through educational courses, a tradition that has continued. In 2008 and 2009, Luigi Zagra, MD, chief of the hip department, president of the European Hip Society (EHS) and Orthopaedics Today Europe Editorial Board member, organized EFORT instructional courses. The 2009 course was held in combination with the EHS. In 2012, Istituto Ortopedico Galeazzi physicians will organize the EHS meeting, and this year are organizing the EuroSpine 2011 meeting scheduled for October 19-21 in Milan.

The Galeazzi Institute also welcomes residents from the University of Milan.

“We have a lot of residents in different departments,” Zagra said. The institute has an active fellowship program.

Seat of regional arthroplasty register

With its location in Milan, the capital of Lombardia, the largest region in Italy, in 2004, the Lombardia Health Authority, Galeazzi and the University of Milan agreed to establish the Registry of Orthopaedic Prosthesis of Lombardia (ROLP) and run it out of Galeazzi. Annually, nearly 17,000 hip replacements and 11,000 knee replacements are performed in the region, according to Zagra, the director of ROLP.

“ROLP is involved with international societies like ISAE and EAR and international projects like ICOR. We collaborate with other national and regional registries and have been involved in the Italian national registry projects as a member of its steering committee. There is a lot of work to be done in this developing field and we are proud to be a part of it,” Zagra told Orthopaedics Today Europe.

Special designation

In 2006, after a rigorous examination, the Italian Health Ministry recognized Istituto Ortopedico Galeazzi as an Institute for Recovery and Care of Scientific Characteristics or IRCCS, a designation recognizing the high level of clinical research done at the facility, Zagra said.

“Among the 41 scientific institutes in Italy, only two — Galeazzi and Rizzoli — have the scientific mission concerning orthopaedics,” Banfi said.

This important designation has increased the institute’s “impact factor” more than fourfold and led to many national and international research grants from independent sources as well as major orthopaedic device manufacturers and pharmaceutical firms, he said.

According to Banfi, those grants have fostered many research projects, including:

• Using adipose tissue mesenchymal cells for osteochondral defect repair;
• Identifying and evaluating biochemical markers of adolescent idiopathic scoliosis;
• Studying the genetics of intervertebral disc degeneration; and
• Using biologics in arthropathic psoriasis.

In 2010, Galeazzi researchers won the Bando Metadistretti, a 1.7 million euro grant from the Lombardia Region for their work developing antibacterial textiles, Carlo L Romanò, MD, professor, Reconstructive Surgery Center for Bone and Joint Infections and incoming president of the European Bone and Joint Infection Society, said. The technology equips textiles to resist bacterial colonization and reduce the spread of nosocomial infections, he said. Galeazzi will start using the textiles in September.

In addition, in a collaborative European Commission-funded project, Galeazzi researchers working with researchers from 11 other centers and private companies in eight European countries develop a fully resorbable hydrogel that may act as a carrier for antibiofilm and antibacterial drugs. It may be used to coat orthopaedic implants to prevent bone and joint infections. Their study will start in the coming months and last 3 years, Romanò said.

Key clinical research includes hip gait analysis studies using different head diameters, a study into operative blood loss using various anticoagulation factors and one using different systems of coagulation, Zagra said.

Although Prof. Zerbi died in 2010, his legacy lives on. In the last decade the hospital has shown exponential growth with many well-established orthopaedic surgeons joining the staff. Since 2000, Istituto Ortopedico Galeazzi has been part of Italy’s biggest health group — the San Donato hospital group — yet remains a private hospital that works with the public health system. – by Colleen Owens

Reference:

• www.galeazzi-gsd.it.
• Giuseppe Banfi, MD, can be reached at +39 0266214057; email: Giuseppe.banfi1@unimi.it.
• Roberto Giacometti Ceroni, MD, can be reached at +39 0266214735; email: Roberto@giacometticeroni.it
• Carlo L. Romanò, MD, can be reached at +39 022614907; email: carlo.romano@grupposandonato.it or carlo.romano@unimi.it.
• Luigi Zagra, MD, can be reached at +39 0226214825-4735; email: luigi.zagra@rolp.it.
• Banfi, Ceroni, Romanò and Zagra can be reached at Via Riccardo Galeazzi, 4, 20161 Milan, Italy.
• Disclosures: Banfi, Ceroni, Romanò and Zagra have no relevant financial disclosures.