In October 2024, Dr Ana Moreira Ferrão (Centro Hospitalar Universitário de Lisboa/Lisbon, Portugal) and Dr Juan Miguel Rodríguez Roiz (Quiron Aribau, Quiron Badalona Hospital/ Barcelona, Spain) accomplished the European Hip Society Travelling Fellowship to Ireland. This programme is offered to two young surgeons with specific interest in hip surgery, after a meticulous selection from the EHS education committee. Read their rich report here:-
Dublin
WEEK 1
We started the fellowship in the vibrating city of Dublin. First stop: the National Orthopaedic Hospital, Cappagh for the first two days. Cappagh Hospital is a public elective hospital for orthopaedics.
Mr Adrian Cassar-Gheiti who gave us a warm welcome, showed us around the hospital and took us to Operating Theatre (OR). We were able to see four cases including a bilateral total hip arthroplasty (THA) performed by posterior approach, a primary THA non-cemented and a THA revision for aseptic loosening of the cup, exchanged by a dual mobility cup. After finishing the OR, we had an enriching discussion with Mr Cassar-Gheiti about the differences between implant designs for THA, the importance of calliper systems to ensure the correct offset and length and the relevance to plan and individualize every case we perform.
The second day was also in Cappagh Hospital. We were able to scrub in for three THAs with Mr Cassar-Gheiti performed by posterior approach. We were also able to see the calliper system in action : for estimate the leg length and the offset, in the beginning of the surgery, Mr Cassar-Gheiti inserted a pin in the iliac crest, to measure the length from the pin to the greater trochanter; this procedure is repeated after the trial components are inserted to check for final length and offset. They use local intra-articular infiltration analgesia (LIA) in all cases, and oral tranexamic for first 48 hours postoperative.
After finishing OR, Mr Adrian gave us a tour around the hospital and we were very impressed to find big names in orthopaedics who have visited and made presentations in the hospital, such as Dr Ganz, Dr Wagner, Dr Allgower, Dr Rockwood and a lot more, and who are remembered by a commemorative plaque.
On the third day, we were hosted by Prof Joe Queally in Saint James Hospital, one of the biggest public hospitals in Dublin. Prof Queally gave us a tour around the hospital, and we had a lot of discussion about septic THA loosening. After that, we were able to go to OR, and see some surgeries, the biggest one was a complex revision for a cemented Charnley THA with septic loosening. The efficiency of the OR surprised us, and we were also amazed by the safety of the TOR system for cleaning up the cement from the femur canal and acetabulum.
On the fourth day we were with Prof Queally again, but now in his private practice, in Beacon Hospital, an impressive and modern hospital. We were able to assist in three THA cases: first a cemented Exeter from STRYKER and two uncemented THAs. During this day, we discussed the correct technique for cementing as in some places it is becoming a “lost art,” but necessary for some cases, especially for the older patients with osteoporotic bone. The fourth case was a trauma one: a tibial plateau fracture submitted to osteosynthesis.
The first weekend was at leisure. We had the pleasure to share a dinner with our two Dublin hosts and we also met Mr Derek Bennett.
We made the greatest possible benefit of our free time to enjoy and get to know Dublin: we visited the Temple Bar, the Trinity College library, the oldest one in Ireland and were impressed by Gaia (the spectacular illuminated sculpture of Earth). We also went to the Guinness Beer factory and store, explored the Phoenix Park (the biggest urban park in Europe), which gave us the feeling of nature and freedom. We walked around the city, shopped in Grafton Street, and had a very Dubliner experience.
Limerick, Galway, Castlebar – Mayo County
WEEK 2
Next we travelled to the west of Ireland, to Bon Secours Hospital in Limerick, where Prof Eric Masterson hosted us. On our arrival, Prof Masterson picked us up from the hotel and did a brief sightseeing tour of town. After this, he invited us to his house and we had a fantastic dinner in Adare, a typical small village nearby.
In the morning, we were able to scrub in five cases, two TKAs and three THAs, by direct lateral approach (Hardinge). For knees, he uses subvastus approach for most of the cases. We learned Profs Masterson’s tips and tricks for this approach. We also discussed with him details and designs (Zimmer/Biomet), as Prof Masterson is part of the design team of the G7 cup.
After this, we started in The Galway Clinic with Mr Derek Bennet, an impressive private hospital with a lot of accreditations (like Joint Commission) and a warm atmosphere. We scrubbed with Mr Bennet in six cases, all THA by modified lateral approach (Hardinge). He showed us how to section and repair the gluteus medius to avoid a limping gait. We were impressed by the fast OR turnover between cases and the quick synchronization with all the team.
After OR that night, Mr Bennet organized a nice dinner in a typical seafood restaurant in Galway city center, with him and Mr John Kelly.
We spent our second day in The Galway Clinic with Mr Kelly, learning Direct Anterior Approach. There were five THAs scheduled for that day, and we were able to scrub in all. Mr Kelly taught us all the technical tips and tricks that he designed over time to be more efficient, like the use of a DAA double offset instrumentation and the Medenvision® grippers. These instruments self-attach to the surgical table and to a Homman elevator, so they stay in place without human assistance. As noted previously, the turnover in the OR was very efficient.
Then we travelled to the north of Ireland to Mayo, a beautiful county in a rural environment, surrounded by nature everywhere.
The next morning, we went to Mayo University Hospital, a public busy hospital in the city of Castlebar, hosted by Mr Derek Bennett. Again, we did a small tour around the hospital and then we went to the OR, where we scrubbed in three revision arthroplasties. All the cases were well-planned and for every case the assistant surgeon wrote on a blackboard the step by step for the surgery to be performed. This habit helps a lot, especially the nurses and assistant team, in knowing exactly the plan. The first case was a failed osteosynthesis of a proximal femur fracture treated by DHS, requiring extraction and hybrid THA implantation with a cemented stem. The second case was the second stage revision of a septic failure of THA, taking out the hip spacer and implanting a new THA (non-cemented). In the last case, we saw the first stage revision of an infected TKA, with the implantation an articulating knee spacer.
After the OR we participated in the orthopaedics team meeting, to discuss the cases for the next week.
At the end of the day, we went to Westport (Mr Bennet’s hometown) to have dinner in a nice restaurant with all the team and the Zimmer Biomet representatives.
In the morning, the Zimmer Biomet team organized a visit to their factory in Galway, where almost 80% of all the Zimmer hip implants used in Europe are produced. They show us the 3D printers for the implants and the next steps in the manufacturing. Every implant is revised, one by one, by a human expert before advance in the fabrication process, ensuring the quality of the final product.
Final destination: Cork
On the last weekend we travelled south to the coastal city of Cork.
We made a pleasant trip to the Ring of Kelly, Killarney town and Killarney National Park, an amazing Irish treasure with a lot of wildlife and stunning, wild landscapes.
On Monday we went to Mater Private Hospital in Cork, for a full OR day with our host Mr Karuppiah Mahalingam. We were able to scrub in five cases, all THA by “bikini” approach, including one bilateral THA. Mr Mahalingam has been doing DAA for almost 20 years and has the greatest number of simultaneous bilateral THA done by this approach worldwide.
He gave us many tips and showed us the Alexis soft tissue skin retractor, a useful tool to avoid muscle damage during the acetabular reaming. After the OR we went to Kinsale, where Mr Mahalingam lives. There, he shared with us a nice lecture about bikini DAA approach, and we went for dinner in a beautiful place close to the sea.
On our last day of the fellowship, we spent all day in the OR with Mr Nikos Davarinos and Mr Mahalingam. Together, they had six THA by bikini approaches, two TKAs by subvastus approach and one anterior cruciate ligament reconstruction, and we had the chance to alternate between the two ORs.
After two and a half weeks, it was hard to accept that this amazing adventure was over. We found in Ireland an impressive culture with warm and kind people. Everywhere we went, we felt more than welcome and appreciated. The natural beauty of this country is out of this world, and we know we must return to explore it deeper.
We are incredibly grateful to the European Hip Society for giving us this amazing opportunity to gain experience and to grow as surgeons and as humans. Both of us are better surgeons now, applying a lot of the knowledge learned in our practice. We are also grateful to all the big surgeons who hosted us and taught us tips and tricks with such kindness. Finally, we would like to express our gratitude to Ms Samantha Stokes, who made this fellowship possible, with all her help, support, and kindness.
We, the fellows, had an amazing experience together, sharing many things in common, especially the passion for hip surgery, and for sure, we started a friendship that will last forever.
