This Fellowship took place in Denmark, in 3 leading areas of orthopaedic surgery: Vejle, Aarhus and Copenhagen. Dr Jetse Jelsma from The Netherlands and Dr Corinne Zurmühle from Switzerland, present their report…
Vejle
Our fellowship started in Vejle, a city with a population just over 60,000 inhabitants. The word ‘Vejle’ derives from the old Danish word wæthel, meaning “ford” of “wading place” due to its location at a busy crossing over Vejle River. Professor Claus Varnum brought us together for a meet and drink on Sunday 7th of April at ToRVEhallerne, a trendy spot with a large range of gins. We discussed about personal experiences and differences in training and healthcare between Denmark, the Netherlands and Switzerland. A good start for the week!
During our week at Lillebaelt Hospital in Vejle the focus was placed on fast-track and day-case arthroplasty as well as robotic-assisted arthroplasty. The concept of outpatient hip prosthetics through a posterolateral works good and is well established in Vejle. Completely new territory for us fellows. The team showed us their piriformis-sparing posterolateral approach, robot-assisted and navigated hip arthroplasties to optimize cup and stem position.
We experienced the journey of the patient from outpatient clinic to surgery and postoperative care in day-case surgery. The consultation hours have been optimized to such an extent that only necessary, efficient consultations are carried out. Impressive workflow and patient flow was interesting to see. The well-established study nurses are certainly one of the working horses in that patient flow. An open-minded atmosphere and philosophy of the team helps to optimize the process. Interesting discussions about country specific standards led us to many valuable discussions. Large differences were found between the three countries in postoperative thrombosis prophylaxis. These findings prompted a rethink of country-specific circumstances and traditions. Furthermore, we would be informed about the nationwide study on perioperative antibiotic prophylaxis, which will provide us with important findings on single versus repeated administration of antibiotic prophylaxis in the coming years. we are looking forward to the results. As a nice and personal end to the week in Vejle, we enjoyed a hip team dinner at Jacobsen with ‘traditional’ Danish food before heading on to Aarhus.
Aarhus
Our second week took place at Aarhus. The second biggest city of Denmark with ±300,000 inhabitants and a population of 800,000 within 30 minutes from the center of the city. Aarhus is known as Smilets By (lit. City of Smiles). The Aarhus University Hospital is number 23 on the list of 2,400 hospitals in 30 countries. A new, modern hospital with ±10,000 employees and ±850 beds, in service since 2018. The hospital is the result of a series of mergers between the local hospitals. It covers such a large area that in-hospital bikes and scooters are frequently used. Not getting lost was one of the most important tasks every day. Fortunately, there were good situation maps or computers on every level that showed you the way, including the walking distance.
The team around Prof Stig Jakobsen focus especially on the complex hip arthroplasties and hip preservation surgery. We were introduced to the fluoroscopy-guided minimally invasive transartorial approach for periacetabular osteotomy and their postoperative management of those patients. In many of the revision hip arthroplasties or complex deformities three-dimensional visualization and planning is very helpful. A visit to the in-hospital 3D printer laboratory allowed us to understand this additional potential of the collaboration with engineers. Discussion led us to integration of research in daily business and foundation of projects in different countries. The different options like research in the free time, reserved research time, grants or other sponsors are reality in the different countries. The research unit at Aarhus University Hospital works on different topics with especial focus on infections of the musculoskeletal system. Study setting allows to study effects in pig models to better understand distribution of antibiotics in the perioperative situation. Thanks to Mads Bue for showing us the research lab.
After a private city tour by Stig Jakobsen in Aarhus we enjoyed a delicious dinner at “Den Rustikke” – a wonderful place with menus based on local suppliers and sustainability.
Copenhagen
The last week took place at Bispebjerg Hospital in the capital of Denmark in Copenhagen with its ±600,000 inhabitants. A collaboration with the Rigshospitalet allows to treat hip patients with classical hip arthritis, young patients with hip preservation and complex trauma and infection cases. Professor Søren Overgaard showed us his way of very efficient performance of periacetabular osteotomy. Insights how customized cups prothesis can be used in complex cases were possible. To complete the hip preservation surgery, insights of hip arthroscopies by a sports surgeon was part of our experience. Lively discussions on diagnostics and treatment options for young patients with femoroacetabular impingement and hip dysplasia were very welcome.
The very scientific program at the end of the fellowship with participation in a research meeting, various scientific presentations and reflections on our own country-specific traditions, as well as future study ideas, were very valuable contents of the last week together with the team around Søren Overgaard. The sushi dinner with Prof Overgaard and Prof Cecilia Rogmark even gave us a brief insight into the hip traumatology and working conditions in southern Sweden.
In general, these three weeks have shown Denmark at his best. A well-organized country which is also reflected in its health care. The surgeons have 30 minutes to see patients in outpatient clinic, which results in clear explanations, no unnecessary imaging and high patient satisfaction. Procedures are categorized into three groups nationwide: regular (primary THA), specialized (hip arthroscopy) and highly specialized (PAO). The specialized and highly specialized procedures are only allowed in certain centers, creating expertise in those centers. The balance between private life and work is perfect due to the 37h/week contract (on loan, except in private). Working days were approximately from 08:00 – 15:30. We experienced a tremendous hospitality in all centres and from all surgeons. It was a once in a lifetime experience.
‘Mange tak’
Thank you very much
