Once again, the Icatme Hip Unit participates in a scientific event of great impact. The most innovative strategies in the prosthetic exchange are analyzed in this congress and in it prominent figures, both European and from the other side of the ocean, participate.
The fact that Dr Ribas participates in this congress is not accidental. In the early 1990s, Dr Ribas was trained in replacements of infected hip and knee prostheses in the world-famous Endoklinik in Hamburg with Drs. Steinbrink, Roig, Engelbrecht and Dr Lars Frommelt. The latter is considered today the largest microbiologist of the musculoskeletal system in the world.
Upon his return to Spain, 10 years before his last long training stay at the Mayo Clinic, Ribas shared the cases of septic replacement with Frommelt and studied their antibiotic application strategies in acrylic cements.
Today, with the new technical advances, the scientific community meets biannually in Philadelphia to establish a framework of consensus on these therapies (“Philadelphia Consensus”). Spain was behind the US and the United Kingdom the country with the largest number of delegates, just ahead of Germany.
The Spanish Society of Orthopedic Surgery and Traumatology (SECOT) through its website and in App has been the first to translate the Philadelphia Consensus from English to Spanish. The Spanish Society of Infectious Diseases and Clinical Microbiology has also established a Consensus Document.
During the ISHA 2019 Congress, held in the city of Madrid, Dr Ribas, head of the Hip Unit made a presentation in which he related his experience in the miniopen treatment of tendon ruptures of medium and minor gluteus.
The painful syndrome of the greater trochanter (GTPS) is an underestimated pathology of a huge prevalence in the general population, between 10 and 25% of the population suffers from this syndrome.
Between 48 and 60% of patients diagnosed with GTPS have medium or smaller gluteal tears that can degenerate into muscle fat tissue irreversibly if the tears are not treated properly.
On October 16, 17, 18 and 19, almost all of the members of the Hip Unit have participated in this ISHA Congress contest, the only one in the world of hip preservation surgery (a specialty that treats injuries for reduce pain and improve hip functionality).
In this edition, in which doctors, hip surgeons, specialists in rehabilitation and sports medicine participate, the most up-to-date knowledge and techniques in the field of arthroscopy, osteotomies in young adults, treatment of injuries have been discussed of cartilage and acetabular labrum, accelerated and specific functional recovery, labrum transplants.
Important has been the contribution of the Unit with the themes:
From here, we want to send our most sincere congratulations from Drs. Oliver Marín and Luís Perez-Carro, indefatigable organizers of this event, who have made it possible for Madrid to successfully host a contest of this caliber.
The next edition will be in 2020 and will be held in Ottawa.
The publication of the first Labrum transplant in the history of medicine reaches 200 downloads of specialists in hip preservation surgery.
This transplant was performed by Dr Ribas and Dr Tey in 2007 and subsequently published by said authors in the Hip-International hip scientific journal.
Currently, the Hip Unit is the medical team in Europe with the largest number of donor Labrum transplants. And their excellent results have been published in various scientific journals.
This Saturday, September 28, Dr. Ribas, together with Dr. Paolo Esopi and Dr. Sílvia, carry out, in the Dolo Hospital – Venice, a gluteus maximus transfer intervention.
What is a muscle transfer for? One of the causes of the instability of a hip prosthesis may be due to the lack of musculotendinous support of the pelvitrocating muscles and especially the middle and lower gluteus (see the update on the conference given by Dr. Ribas in the Society Hip Italian from last week in Bergamo). The absence of correctly functioning pelvitrocantereos is an invalidating situation for the patient, who is even forced to wander with one or two crutches.
This insufficiency can occur for different reasons. During the last decades, multiple techniques have been used and described to replace and / or strengthen the pelitrochanteric muscles of the hip, which go from tendon transplantation, muscle transposition with microsurgical techniques to the application of human or artificial collagen mesh-plates .
In the last two decades, the technique of transfer of the proximal third of the gluteus maximus muscle, with its prolongation of Fascia Lata acting as a tendon (fixed to the greater trochanter of the ugly) described by Professor Dr Leo Whiteside of the USA, has represented a solution biological that alleviates this pathology with clinical-functional results.
The hip unit has been doing this intervention in very specific cases for more than fifteen years.
His presence is required this year as a recognized pioneer in the treatment of lesions of the middle and minor gluteal tendons in his area of femoral insertion, often misnamed “Trochanteritis or trochanteric bursitis.” Today the Anglo-Saxon medical literature calls it Great Trochanter Pain Syndrome (GTPS).
For the reader here are the most important points of his Presentation:
1 / The Great Trochanter Pain Syndrome (painful trochanter syndrome – GTPS, which causes pain in the lateral side of the hip and functional limitation) occurs between 10 to 25% of the population at some time in life, mostly in middle-aged women, according to a review article by the newly appointed head of the hip preservation surgery unit at the Hospital for Special Surgery in New York, Professor Bryan Kelly.
2 / Among different mechanical and biological causes, the fall in the production of estrogens during menopause, which alter the quality of tensile strength of the tendons, especially in the shoulder and hip *, stands out.
2 / Other reviews show that between 40 and 68% of cases of GTPS are ruptures at the level of the insertion of the gluteus medius / minor.
3 / An inadequate treatment, depending on the degree of rupture, can put at risk the fatty degeneration of the muscle and its loss of function with the consequent lameness and functional limitation.
4 / Different degrees of injury are distinguished, according to the combined Thomas-Milwaukee classification, from which medical evidence emphasizes different treatments according to the stage.
5 / The hip unit was a pioneer in Europe in the treatment of middle and minor gluteal tears. In their study presented in 2018, at the European Hip Society in The Hague (EHS), the good clinical-functional results of the treatment of tears are demonstrated, according to the mini-invasive technique for this pathology launched in 2007, with and more than 12 years of experience through mini-invasive and arthroscopic technique.
6 / Dr Ribas explains the algorithm in the treatment of these injuries.
* Salini et al. “Prevalence of and risk factors for asymptomatic rotator cuff tears in postmenopausal women.” Menopause 2014 Mar; 21 (3): 275-80.
The interest in learning to perform the mini-invasive periacetabular osteotomy in super hip surgeons grows in Spain and Portugal.
The mini-invasive periacetabular osteotomy for the treatment of Residual Dysplasia of the young adult, its injuries and its multiple pathological associations, is starting a growing interest in the countries of Southern Europe, both in patients and specialists due to the excellent results obtained with said technique.
During this summer, Dr Manel Ribas and Dr Carlomagno Cardenas, specialists in this intervention, doctors specializing in this technique, have carried out demonstration interventions before young surgeons of great renown, recognition and projection, both in Madrid and in Porto.
On the other hand, the active participation of the hip unit in the world hip preservation congress (ISHA society), which will be held in Madrid from October 16 to 19, is ready.
On this occasion, the XXI Congress of the Spanish Society of Hip Surgery was held in the city of Elche, Valencian Country and was able to count on the presence of Dr Ribas, chief member of the Hip Unit.
Dr. Ribas, 15 years after the publication of his article “Current evidence in the treatment of femoroacetabular shock” in the Spanish Journal of Orthopedic Surgery and Traumatology of the article, has made a presentation on the evidences of this pathology.
In his presentation, Dr. Ribas pointed out, point by point, all those evidences that today doctors and patients should know. The most outstanding, with the highest level of evidence, is that it has been shown that the surgical treatment of femoroacetabular shock presents better clinical-functional results than the best non-surgical treatment and simply rehabilitation.
Different randomized, multicenter, comparative studies (level of evidence 1) have been carried out that corroborate this. These studies have been published even in high-impact scientific journals such as “The Lancet.
On May 24, Dr. Manel Ribas was named Honorary Member of the Russian Hip Society, in the Russian city of Nizhny, Novgorod.
His entry reading, pronounced in English and translated into Russian, has been “Novel soft tissue-sparing mini-invasive techniques in primary total hip replacement” (new techniques of primary hip prosthesis with soft tissue protection).
It is widely known that the Hip Unit is a European reference center and precisely with the figure of Dr Cardenas-Nylander, as well as the Head of Teaching of the entire ICATME department. The Hip Unit provides courses in corpses, training and specialists from South and Central Europe, also from Russia, the USA and Japan.
The Superpath technique has shown, according to data from the Australian Registry, up to a reduction of 91% in taking analgesics to hospital discharge, as well as autonomy in daily life in 85% of cases at 2 weeks.
With the appointment of Dr Manuel Ribas as an honorary member of the Russian Hip Society, a member of the third generation of doctors from the Ribas family revisits Russia 130 years later. 130 years after a doctor of the family-Saga of the Doctors Ribas, the also prestigious professor Dr Manuel Ribas, specialist in Internal Medicine and Epidemiology and former president of the Academy of Medical Sciences of Catalonia and the Balearic Islands until his death, brother of the Pulmonologist Joan Ribas, (different populations of Catalonia take their name as a street or avenue, such as the well-known Avenida del Dr Manuel Ribas and Perdigó de Badalona for example.
Professor Manuel Ribas was the right hand of Dr Bartolomé Robert, who was the mayor of Barcelona. Manuel Ribas never yielded to his work in the service of patients and has in his file one, which he considered a “black stain”: having lost the oppositions in Madrid in a hand to hand with his colleague also Professor Ramón y Cajal.
What I would not know is that two generations later Antoni Ribas, today professor of Oncology at UCLA and president of the International Society of Oncology, discovered immunotherapy against melanoma.
In the circles of the Ribas family, by the way very united, with meetings and family meals, it is said that “if one day Ribas can be a Nobel Prize winner”, Antoni can surely be.
A detail of Professor Manuel Ribas (1888): not knowing German, he moved to make his stay of specialized training in Internal Medicine in Germany. It sounds familiar, right?
Dr. Manuel Ribas, hip surgeon, did his final year’s work in History of Medicine in a seemingly simple way:
“Medical Biography of Professor Manuel Ribas i Perdigó”, year 1981.
Leading European specialists in double hip mobility and mini-invasive approaches participate in this edition of the, under the auspices of the Stryker North American Multinational Company.
It discusses the role of double mobility in hip prosthesis, mini-invasive surgery by direct superior approach that preserves muscle tendons and joint capsule (DSA: Direct Superior Approach), the role of rapid recovery with this approach and what the new materials bring
The program was integrated by Dr Jorge Guadilla (Vitoria), Dr Manuel Ribas, Professor Jean Alain Epinette (Lille and current president of the EHS-European Hip Society) and Dr Jesús Mas (Alicante).
In the afternoon practical sessions (cadaver-Lab) of instruction in the technique were carried out to the specialists assembled, coming from Spain and Portugal.
The “Double mobility” is not a current concept, it was developed in France in the mid-seventies. Because of its intrinsic mechanism of rolling one sphere over another, the lowest rate of prosthetic dislocation is obtained (first cause of revision during the first 5 years according to data from the Australian Prosthetic Registry). In France, currently almost 50% of surgeons use this technique, but it was not until the end of the first decade of the twenty-first century that its use has increased with the appearance on the market of the new polyethylenes with high cross-linking.
Different reports have shown a perfect combination in hyperlaxed patients, with neuropathies, muscular deficit of the hip, in obesity, in patients with lumbosacral fixation where the pelvis remains in an invariable position, in the treatment of advanced dysplasia, in deankylosis, etc. . and in prosthetic replacement surgery
The minimally invasive DSA approach allows the implementation of a double mobility system. The hip unit of the University Hospital Dexeus has a protocol of the technique according to individualized pathology and after a meticulous preoperative planning.
The mini-invasive approaches with tendinomusculocapsular, anterior direct and supracapsular protection assisted by the Superpath (R) portal as DSA have been implemented for years in the Dexeus University Hospital, being a reference center where specialists and residents in the specialty of Orthopedic Surgery and Traumatology meet. official MIR training program.
Sponsored by Brazilian Hip Society (SBQ), Dr. Manel Ribas as head of the Hip Unit of the Dexeus University Hospital (Quirónsalud group) participates with the presentation of 9 lectures that deal with topics ranging from pathology, its prevention and hip treatment in the young and in the athlete, whether elite or amateur and occasional.
Specialists surgeons from different parts of Brazil, sports doctors and rehabilitators attended this meeting. The event, organized by the well-known Prof. Lafayette Lage of Sao Paulo, was attended by renowned and renowned specialists such as Professor Javier Pérez Torres from Bogotá, Jorge Cruz from Meló, Fernando Leal, Manuel Padín from Oporto, and other renowned specialists from both sides of the Atlantic.
The importance of early detection of mechanical pathology of the hip was highlighted, as well as the treatment of the effects-causing lesions, mini-invasive surgery and its effect on the rapid recovery of patients.
Special emphasis was placed on modern mini-invasive techniques used to protect the capsule and its structures, in patients of all ages with osteoarthritis. Said prevention results in an increase in stability and a faster recovery by reducing the sensation of pain since the pain receptors remain unchanged, as well as the mechanoreceptors, and faster functionality is obtained.
On April 25 and 26, the annual Congress of SETRADE (Spanish Society of Sports Traumatology) was held in Palma de Mallorca, where two of the most recognized and world-renowned Spanish hip specialists attended: Dr. Luís Pérez Carro of Santander and Dr. Manuel Ribas of Barcelona.
The conference has been presented with a new and interesting format, where the experts sit on the stage, a rapporteur updates current knowledge by way of summary -by the way, many congratulations to the rapporteurs of the different round tables – and then an interactive dialogue is established between the moderator and the assistants.
On this occasion, Dr. Manuel Ribas participated as an expert and moderator at the “Femoroactabular Shock”, “Residual Dysplasia” and “Peripheral Hip Syndromes” (deep gluteus, ischiofemoral, infratuberal and trochanteric) tables. In these days, the current limitations of hip arthroscopy in different areas and the importance of the periacetabular osteotomy in the case of labral lesion due to Residual Dysplasia (insufficiency of femoral head coverage) were highlighted.
The Dexeus University Hospital is a reference in all of Southern Europe in the treatment of Periacetabular Osteotomy by a mini-invasive technique.
Dr. Ribas will soon move, as representative of the European Hip Society (EHS) to the Russian city Nizhny Novgorof (the third in number of inhabitants) to participate in the annual congress of the Russian Hip Society.
On January 28, Dr Manel Ribas attended the Grand Gala of the Sports World. The celebration took place at the National Art Museum of Catalonia (MNAC) in the city of Barcelona. Among the guests were personalities from the world of sports such as Leo Messi, Ivan Rakitic, Samuel Umtiti, Bob Beamon, Eddy Merckx, Marc Márquez, Carlos Sainz and Juan Carles Navarro among others.
Juan Godó was in charge of hosting, and he was the one who handed out the prizes to the best sportsman of 2018 to the Catalan pilot Marc Márquez and to the dumbbell León, Lydia Valentín.
The members of the Scientific Committee of the European Hip Society meet in Milan and establish the 16 symposiums and instructional courses to be held during the next edition.
The EHS Meeting is the most important hip surgery congress held on the continent every two years. This edition will be held at the Palais des Congres de Lille, on 1 and 2 October next 2020.
Dr. Manel Ribas celebrates his 7th birthday, out of the 8 maximum allowed, as a member of said committee.
On November 30, the XXIII Round Table on the prevention and treatment of athlete injuries was held in the Agora Room in Sitges. As every year, the topics have been radiant today: “Myths and truths about sports nutrition”, “Treatment of residual dysplasia in the athlete” or “Chronic posttraumatic encephalopathy”.
Dr. Manel Ribas, before a large audience full of personalities of medicine and the world of sport, said: “The residual dysplasia is not exclusive of an evolutionary sequel of newborns, diagnosed and treated for congenital hip dislocation. Impact on the adolescent can produce an early closure (in its maturation phase) of acetabular triradiate growth cartilage.Accordingly, there is a lack of acetabular coverage of the femoral head “.
After the appearance of the periacetabular osteotomy (1988), different authors in Europeans and Americans have shown an excellent rate of return to sport, either in medium or high impact modalities.
In light of the news that some media have spread, we must inform our patients that no implant – hip prosthesis, of those that have been and are being implanted in our University Hospital, are subject to withdrawal or alert to the Spanish Agency and international monitoring and control agencies.
We wish to emphasize that all these implants are approved and comply with European regulations.
We hope to transmit to you in this way a message of total tranquility.
Dr Manuel Ribas
Unidad de Cadera
Hospital Universitari Quirón-Dexeus
Dr. Ribas presents his results with implantation using mini-posterior and supracapsular mini-invasive technique assisted by portal (superpath) with short stems and ceramic-ceramic friction torque in the Congress that has held the European Hip Society Meeting in the city of The Hague this September.
The head of the Hip Unit has presented the mini-invasive periacetabular osteotomy technique for the treatment of hip dysplasia and its results in athlete after more than 15 years of accumulated experience. Since 2006, in his mini-invasive approach described and learned from his creator, Professor Kjeld Söballe.
The majority of patients treated with this technique (95%) resume their sports activity, either with a high or medium impact (UCLA score 8 to 10), with a better clinical and functional profile.
Between 48% and 60% of the calls “Trochanteric bursitis, trochanteritis, – (also known today as Great Trochanter Pain Syndrome – GTPS) – contains, in different stages, injury or even tendon rupture of the gluteus medius and / or minor that will require your Treatment. The risk of not doing so is the very degeneration of the fat (the muscle fibers are transformed into non-contractile fat tissue) of these muscles, which are fundamental in sustaining the body through the lower extremities in activities of daily life.
Dr. Ribas, in 2007, developed a reparative technique for cases of breakage with very good results and that were precisely presented at this congress. This technique has been performed by different members of the unit for years and even in cases of partial rupture, Dr Cárdenas and Dr Astarita repair it using an arthroscopic technique.