Report from EHS Visiting Fellows 2017

From left to right. Dr Jesús Moreta, Prof Fritz Thorey and Dr Antonios Koutalos

We would like to begin by expressing our gratitude to the ExCom of The European Hip Society (EHS), the President of the EHS B Willem Schreurs for selecting us for this excellent opportunity for our careers and Prof Thorey (pictured left) for organising this busy fellowship. We understand that it was not an easy task.  Dr Jesús Moreta (pictured left) would like to thank the Spanish Representative Prof José Cordero-Ampuero, and Dr Oliver Marín-Peña and Dr Jenaro Fernandez-Valencia for their support during the application process. Dr Antonios Koutalos (pictured right) would like to thank the Greek representative Prof George Machairas, Prof Eleftherios Tsiridis, the Secretary General of EHS and Prof Karachalios for his guidance all these years. Last, but not least we would like to thank Mrs Samantha Stokes, for her help and support before, during and after the fellowship.

In September 2017, Dr Antonios Koutalos (University Hospital of Larissa, Greece) and myself Dr Jesús Moreta (Hospital Galdakao, Spain) were honored to perform The European Hip Society Traveling Fellowship 2017. In creating this program, The European Hip Society was driven by a goal to foster the talents of young hip surgeons by providing them with an inspiring and educational two-week tour of outstanding centers for hip surgery in Germany.

We observed cases of primary hip arthroplasty through MIS Hardinge approach, MIS Watson Jones approach and periprosthetic hip infections. The highlight was observing a complex revision hip arthroplasty in a patient with severe acetabular bone defect

Our tour started in Heidelberg, at the prestigious ATOS Klinik with Prof Fritz Thorey, the German National Representive for EHS, who is a highly recognised hip specialist. Located in Germany’s most romantic city, Heidelberg, ATOS Klinik offers high level medical services within their 20 specialized centres and five operating rooms. Prof Thorey has specialised in hip arthroscopy, hip primary arthroplasty and revision hip arthroplasty. During two days in the operating theatre we observed a variety of procedures, including primary hip arthroplasty through minimally invasive Watson Jones approach with short and conventional stems and complex revision hip arthroplasty. Prof Thorey showed us some tips and tricks for supine position-anterolateral approach and how to perform an adequate surgical exposure with this approach.

Our next stop was at Herzogin Elisabeth Hospital in Braunschweig with Prof Karl-Dieter Heller. The Orthopaedic Hospital Braunschweig is one of the largest orthopaedic institutes in Germany and the only orthopaedic specialty hospital in the Braunschweig area. Prof Karl-Dieter Heller, chief of staff of the Orthopedic Hospital, is a specialist in hip and knee surgery and has a huge experience in primary and revision hip arthroplasty and arthroscopy. He was very kind and arranged many interesting topics for us. We observed several cases of primary hip arthroplasty through MIS Hardinge approach, MIS Watson Jones approach and periprosthetic hip infections. The highlight in the operating room was observing a complex revision hip arthroplasty in a patient with severe acetabular bone defect.

In addition, we received clinical and basic science lectures regarding the principles of the Metha short stem, management of periprosthetic hip infection and custom implants for complex acetabular revision. We also had the opportunity to give a talk to the whole team about our interests we could discuss the differences among the joint replacement procedures in the German, Greek and Spanish Health Systems. After this meeting, Prof Heller and the staff arranged for a nice dinner in the Hospital.

Friday afternoon we had a chance to visit some historical places in Braunschweig with a guided tour arranged by Prof Heller, and we also had a nice dinner with him.

Prof Thorey showed us some tips and tricks for supine position-anterolateral approach and how to perform an adequate surgical exposure with this approach

Our second week started with sightseeing in the beautiful city of Dresden. We visited the Dresden Frauenkirche church, the Zwinger palace and the world famous Sember Opera House. On Sunday, Prof Gunther invited us to his house for brunch and then a walk along the Elbe river ending the astonishing garden of Pillnitz Castle. A great place to discuss about hip preservation surgery, about the health systems of Germany, Greece and Spain and the future of orthopaedics. It was a perfect finish for the weekend ahead of a busy week.

On Monday we met with Prof Gunther at the University Hospital of Dresden. University Hospital of Dresden is a public hospital taking care of patients with multiple comorbidities, complex cases and infections. It is a referral centre for hip preserving surgery.

Every day we joined Prof Gunther in his office just before the morning meeting and we went through the cases of the day. He made to us short presentations about minimal invasive anterolateral approach to the hip and he showed us cases of hip preserving surgery. We scrubbed every day and we saw an acetabular fracture with posterior wall and column fracture, three complex revision surgeries and two cases of hip preservation surgery. Professor Gunther showed us his technique with minimally invasive anterior approach to the hip to treat a patient with femoroacetabular impingement (arthroscopically assisted mini open surgery).

On Wednesday, we saw a really complex cam deformity with ischiofemoral impingement and a labral tear. A surgical hip dislocation was performed in order to achieve a labral repair, femoral neck osteoplasty and an osteotomy with neck lengthening. On the social part, we had dinner with the clinic staff on Tuesday evening enjoying traditional food and local beer. On Wednesday, we also took part in a seminar about fast track surgery.

Dr Dr Jesús Moreta and Dr Antonios Koutalos at OktoberfestOn Wednesday evening we flew to Munich, a true European, busy city. The next day, we visited the University hospital (Rechts der Isar Hospital of the University of Technology Munich) and saw three cases of hip arthroscopy, a revision total hip arthroplasty and a total hip arthroplasty with minimally invasive anterior approach. Saturday was sunny and was the perfect day for sightseeing and walking in the English Garden. We spent the evening in Oktoberfest. We could not think of a better end for this fellowship.

During our fellowship, we visited beautiful places, we met wonderful people and we enjoyed complex surgeries. We would like to thank all the professors and their colleagues for their excellent hospitality. This “diamond” fellowship did increase our knowledge in hip surgery and we learnt useful things to take back in our countries and incorporate in our daily practice.