The Netherlands: Nijmegen – Delft – Breda – Maastricht – Nijmegen
In October 2018, Dr Pedro Santos Leite (Centro Hospitalar e Universitário do Porto, Portugal) and Dr Mattia Loppini (Humanitas University, Humanitas Research Hospital, Italy) performed the European Hip Society Travelling Fellowship. This programme is offered to promising young surgeons with specific interest in hip surgery. It was a great honour for us to be selected. We would like to thank the ExCom of the European Hip Society (EHS), and Prof Willem Schreurs, who finished his role as President of the EHS this year. Dr Mattia Loppini would like to thank Prof Guido Grappiolo, the Head of his department, and Prof Eleftherios Tsiridis, the Secretary General of EHS, for their support during the application process. Dr Pedro Santos Leite would like to thank Prof António Oliveira, the Head of his department for all the support. Finally, a really special thanks to Mrs Samantha Stokes, for her precious help and care before, during and after the fellowship.
This Travelling Fellowship was organized by Prof Willem Schreurs resulting in a two-week program including centres of excellence in hip surgery in The Netherlands.
The first week of our trip was spent in Nijmegen, the oldest city in the Netherlands. In this beautiful city, located in the east, close to the German border, we had the opportunity to visit three different centres.
Radboud University Medical Centre (UMC) was our first stop in the first two days and Prof Willem Schreurs and Dr Wim Rijnen our hosts. The orthopaedic department of this centre is one of the most experienced worldwide using bone impaction grafting. We had the privilege of participating in two acetabular revisions with bone impaction grafting with Prof Schreurs, who showed us all relevant tips and tricks. During the afternoon of this intensive first day, we had a scientific meeting in the orthopaedic department with a lecture of Prof Schreurs on bone impaction grafting philosophy and clinical results of this technique. We also had the opportunity to give a talk to the team about our clinical and research activities with an inspiring discussion on different strategies for the management of severe acetabular bony defects, periprosthetic joint infection and types of fixation in primary hip replacement. After this meeting, we had a fabulous dinner in a famous restaurant in Nijmegen with Dr Wim Rijnen, Dr Gijs van Hellemondt and Dr Enrico de Visser who were also our hosts in Nijmegen. On Tuesday [9th October], we participated in two more acetabular reconstructions with bone impaction grafting with Dr Wim Rijnen as team leader.
The third day was very special. Dr Gijs van Hellemondt picked us up in the morning at Sint Maartenskliniek, a large orthopaedic hospital in Nijmegen, where we had the possibility to collaborate in a complex surgery, a revision of a severe acetabular defect with a 3D printed implant. Dr Gijs and his colleague Dr Maarten Spruit have a very significant experience with this technique, with more than 80 cases treated so far. We also had the chance to discuss extensively with Dr Gijs the best strategies to have a good exposure of the acetabular side and to get the proper position of the custom implant, advantages of this technique and its results.
In the afternoon, we attended the international session organized by the EHS during the congress of the Dutch Orthopaedic Society in Rotterdam. The programme included interesting talks such as the future of Dual Mobility cups from EHS President Prof Jean-Alain Epinette (Bruay-Labuissière, France); the restoring of bone defects with 3D-printed metal cups form Prof Gunnar Flivik (Lund, Sweden) or bone grafting from Dr Wim Rijnen (Nijmegen, Nederland); the use of long modular stems in revision surgery from Prof Roberto Binazzi (Bologna, Italy); the Warwick agreement on arthroscopy for femoroacetabular impingement from Dr Enrico de Visser (Nijmegen, Nederland). [continued… scroll down]
On Thursday, we spent all day with an excellent surgeon, Dr Enrico de Visser at the CWZ Hospital Nijmegen, and joint preserving hip surgery was the main topic. We assisted to a surgical hip dislocation (for femoral neck/acetabular rim osteoplasty and labral reattachment) and two hip arthroscopies. In the evening, we had a nice dinner with Dr de Visser and other people of the OR enjoying traditional food and local beer.
On Friday, we came back to Sint Maartenskliniek and participated in surgery including complex femoral and acetabular revisions. Dr Gijs van Hellemondt was definitively a very enthusiastic host. He taught us many tips and tricks on femoral revision surgery, presented Sint Maartenskliniek’s flow-chart for the management of femoral revision and finally surgical strategies for the management of abductor deficiencies. We had also the possibility to make a guided tour in the hospital that is equipped with top innovations in rehabilitation field, such as GRAIL (Gait Real-time Analysis Interactive Lab) and exoskeleton robots.
The weekend was free to enjoy Amsterdam. Here, we visited all the best attractions of the city. Sunday evening we had a nice dinner in Delft to finish this break before a second busy week.
On Monday, 15th October, we visited Dr Stephan B. Vehmeijer, the National Representative of the EHS for the Netherlands, at the Reinier de Graaff Hospital in Delft. This day was especially dedicated to the anterior approach and to “one day” primary hip surgery. Dr Vehmeijer shared his knowledge and experience, and we had a very inspiring and educational discussion on the philosophy of fast-track in total hip arthroplasty.
On Tuesday, we went to Amphia Hospital in Breda to visit Dr van Houten and Dr Bolder. They showed us the direct superior approach and made a very nice presentation with its results compared with the standard posterior approach.
On the next two days, we visited Dr René H.M. ten Broeke and Dr Jan A.P. Geurts in Maastricht Medical Centre. It is a large academic orthopaedic centre with an extensive experience in revision surgery and periprosthetic joint infections. Here, we had the opportunity to participate in complex acetabular revisions (Paprosky tipe III) managed with bone impaction grafting and femoral revisions. On Thursday, we visited the research laboratories of the orthopaedic department and had a nice presentation about their main research lines. Dr ten Broeke was very kind with us arranging for the evening a very nice visit to Maastricht, one of the oldest cities of The Netherlands, and a superb dinner with him and Dr Geurts in a fabulous Italian restaurant.
On the last day of the fellowship, 19th October, we came back to the starting point – the Radboud UMC in Nijmegen. Prof Schreurs was once again fantastic with us, constantly sharing and teaching. Prof Schreurs is a great man, a great “pair of hands”, for us a great example to follow. Thank you!
In these two busy weeks, we met excellent surgeons and wonderful people. We would like to thank all the professors and their colleagues for their hospitality, they really took care of us. This fellowship allowed us to increase our knowledge in hip surgery, exploring different philosophies and techniques. We will bring with us all the useful things we learnt to improve our daily practice.