Fellowship report by Dr Adrian Cassar-Gheiti (Ireland) and Dr Iker Uriarte (Spain)
The location for the European Hip Society Travelling fellowship 2020 was Portugal; unfortunately, this was delayed by the COVID 19 pandemic. We managed to travel during 2022 and the 4 prestigious hosting institutions visited were in Lisbon, Braga and Porto. We were very fortunate to have met fantastic hosts across Portugal including Prof Paulo Rego and Prof Pedro Dantas in Lisbon, Dr Joao Tinoco and Dr Eurico Bandeira Rodrigues in Braga, and Dr Jorge Cruz de Melo and Dr Fernando Leal in Porto.
Week 1: Lisbon
During our first two days we were welcomed by Prof Rego at the Hospital da Luz Lisboa. He showed us various techniques in hip preservation surgery and discussed cases with various pathologies requiring osteotomies around the hip, that included patients with DDH, Perthes disease and post traumatic deformities. We assisted during hip arthroscopies with labral repair and femoral osteoplasty and multiple THA through a modified direct lateral approach. At the end of the second day we were invited for dinner at the ‘A Vela’ to experience the local seafood cuisine. We had a lovely dinner with Prof Dantas and Prof Rego where they shared their vast clinical experience as well as kept us entertained for the night.
Next we visited Prof Dantas at the Hospital CUF Descobertas, where we assisted in multiple hip arthroscopies for labral repair and femoral osteoplasty and total hip arthroplasties through a mini posterior approach. Prof Dantas went through clinical cases and the indications for hip preservation surgery, THA and complex revision hip arthroplasty.
We had a free day in Lisbon where we could explore the beauty of the city and its culture. We walked around the centre and visited the Santa Justa lift, Rua Augusta Arch and walked up the hill to visit Sao Jorge Castle to enjoy fantastic views of Lisbon. We visited also the charming Bairro Alto, with its steep streets and traditional restaurants.
Week 2: Braga & Porto
We took the train to the historical city of Braga to commence our second week of the fellowship in the North of Portugal. Over the weekend we had some free time to explore the multiple historical sites and experience the local cuisine. Braga is well known for its religious heritage and the most ancient university of Portugal.
We were welcomed by Dr Tinoco and Dr Bandeira Rodrigues at the Hospital de Braga. The team prepared a presentation of the cases we would participate in, which ranged from hip arthroscopy to revision hip arthroplasty. During the first day we assisted in hip arthroscopy and hip resurfacing procedures. We discussed the current indications and contraindications of hip resurfacing.
During the second day, Dr Tinoco performed two complex THA revisions for aseptic loosening of both cup and stem and we assisted in acetabular reconstruction using a combination of a highly porous cup, augments and revision stem.
Next we travelled by train to Porto, where we were welcomed by Dr Cruz de Melo, Dr Leal and Manuel Padin from The Porto Hip Unit at Hospital da Luz Arrabida, who are well known for organizing the Porto International Hip Meeting. They organised two full days of surgery and during the first day Dr Cruz de Melo took us through multiple procedures commencing the day with a revision of a MOM THA, followed up by a series of THAs through the direct anterior approach, including a bilateral case. Dr Cruz de Melo explained his interest in DAA and showed us patients’ testimonials of the success he had with this approach and shared his tips and tricks to successfully use this approach for THA.
This was followed by a series of arthroscopic sciatic nerve decompressions and piriformis release – it was quite interesting to see this novel technique in the management of buttock pain from piriformis syndrome. We also observed a proximal hamstring avulsion reattachment as well, which was meticulously done through an arthroscopic technique.
On our last day, Dr Cruz de Melo took us for a clinical ward round to see the post operative patients and we discussed multiple post operative rehabilitation programs, which was then followed by further primary THA through the modified DAA approach.
With our 2-week fellowship ending, we found some free time to travel around Porto, walk over the Luis I bridge, visit the touristic Ferreira and Calem wine cellars in Vila Nova de Gaia for some Porto wine tasting and go for a stroll along Matosinhos beach, where we enjoyed some excellent traditional Portuguese seafood.
Thanks
We are grateful to our departments, Department of Orthopaedic Surgery, Hospital Galdakao-Usansolo, Bizkaia, Spain, and the National Orthopedic Hospital Cappagh, Dublin, Ireland for providing us time to enjoy and learn from this unique experience. Adrian would like to thank Prof Allan E Gross (Mount Sinai Hospital, Toronto, Canada) and Prof John O’Byrne (National Orthopaedic Hospital Cappagh, Dublin, Ireland) and Iker would like to thank Prof Maziar Mohaddes (Sahlgrenska University Hospital, Gothenburg, Sweden) and Dr Matt Wilson (Royal Devon and Exeter Hospital, Exeter, UK) for their great support during the application process.
We feel extremely honoured to have received this opportunity and to have been selected for this fellowship and finally to have been able to travel after two years of pandemic. We would like to express our gratitude to the European Hip Society and the Portuguese Hip Society, in particular Prof Dantas for organising it. Special thanks go to Mrs Samantha Stokes for the excellent communication, patience and organization of the entire endeavour. Finally, we thank all those who hosted us during these two weeks, we left Portugal full of knowledge and made new friends along the way and we look forward to meeting again at the next Porto International Hip Meeting. We want to highlight the great relationship and friendship created between the two of us, Iker and Adrian, and the large amount of time we enjoyed sharing experiences and knowledge in diverse aspects of hip surgery. We think this is one aspect of the fellowship that makes it so special.