Dr. Manuel Ribas European guest at the Congress of the Italian Hip Society (S.I.D.A.) held in the city of Brescia.

8 November, 2021 by micadera
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Ribas holds two keynote conferences:

1. In the first, on current evidence, after more than 3000 articles published and indexed on femoroacetabular impingement (also known as femoroacetabular impingement or femoroacetabular impingement) he makes special mention in the following points:

Treatment of symptomatic femoroacetabular impingement is surgical, as soon as possible avoiding substantial damage to the articular cartilage. Thus, the different surgical techniques according to each particular case, both open, miniopen and arthroscopic, improve the clinic in patients who do not have substantial cartilage damage, with a rate of return to sport at the same level that ranges between 75 and 90 %, being the highest in highly competitive athletes (97%). Evidence that femoroacetabular impingement can be resolved without surgical treatment is lacking in written evidence to support it. Furthermore, in randomized comparative studies carried out in the United Kingdom between groups of operated patients and non-operated volunteer patients, clinical improvement in those operated on is very evident between 6 and 8 months.
Another important aspect that is the success of the surgery lies both in the treatment of the chondro-labral lesion (the labrum in its articular portion is very rich in pain receptors) and the mechanical cause that produced the shock, either in the femur, in the acetabulum or both.
Thus, early intervention is necessary for the good clinical success of femoroacetabular impingement, since intervention prior to irreversible joint cartilage damage is essential for long-term results.

Fig. All technical-scientific innovation runs between 4 different phases. Note how in the third phase (ascending curve and red arrows), when the scientific community truly values ​​it, the treatment of femoroacetabular impingement has experienced an exponential increase worldwide.

2. The second conference deals with the periacetabular osteotomy in the dysplastic athlete.

Residual dysplasia is known as one that causes the femoral head not to be properly covered by the cavity of the pelvis that contains it, also known as the acetabulum and causes damage to the articular cartilage (osteoarthritis) over the years due to excess concentration of loads, a bad distribution of the load towards the head of the femur. Different studies carried out in North America and Europe indicate that practically 100% of patients with residual dysplasia will suffer, but before, osteoarthritis of the hip at 60 years of age. The periacetabular osteotomy, also known by its inventor as Ganz osteotomy (emeritus professor at the University of Bern), redirects the acetabulum over the head of the femur, providing a load distribution equivalent to a healthy hip. There are not inconsiderable percentages of athletes with moderate dysplasia very much in relation to gender (more frequent in females), ethnicity and of course genetics.

Periacetabular osteotomy (Ganz, 1988) has been a before and after in the treatment of this pathology in young people and young adults. At the beginning of the 21st century, Söballe, orthopedic surgeon and professor at the University of Aarhus, developed a minimally invasive technique that greatly reduces the postoperative bleeding and postoperative pain of the patient. Ribas, who had already learned the technique from Prof. Robert Trousdale (Ganz’s North American disciple) and prof. Miguel Cabanela at the Mayo Clinic introduced the mini-invasive technique of periacetabular osteotomy in Spain in 2006. This technique has nothing to do with his minimally invasive arthroscopic technique for femoroacetabular impingement. Currently there are already more than 600 dysplastic patients operated on by Ribas, a reference in the treatment of this pathology, of which one sixth are athletes. It has been found, as is also reflected in studies carried out at Harvard and Saint Louis, that the practice of medium-cyclical impact sports even increases after surgery in the vast majority of patients. On the other hand, in those physical activities that require great impact – running – jumping, slightly more than two thirds of the patients operated on do it again, even at a higher performance. Those who do not carry out it all continue to carry out activities of medium impact.

 

Fig1. Characteristics of periacetabular osteotomy for the treatment of residual hip dysplasia.

Fig2. Advantages of the periacetabular osteotomy performed by the mini-invasive technique that was developed by prof. Söballe and that Dr. Ribas learned in 2006 and launched in Spain and instructed his disciples, including Dr. Carlomagno Cárdenas. It is currently the center of reference throughout Southern Europe.

Fig3. Patient with residual hip dysplasia. Note the lack of coverage of the femoral head on the right. On the left you can see the complete coverage using this technique.

Fig4. Case of bilateral periacetabular osteotomy. 1 in 5 cases of residual hip dysplasia are bilateral, while 4 out of 5 only occur in one of the two hips.

 

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