Osteitis pubica is part of one of the different sources that can cause “groin pain”, in English “groin pain”. This term that a priori could seem very simple arises as an international agreement of specialists in the field in the city of Doha in 2015.
Groin pain encompasses different pathologies or origins: hip and its different pathologies – disruption of the inguinal wall – pubic symphysis.
The pubic ring is like the center of the wheel of a mill subject to different forces that would be its antlers: Abdominal muscles and pyramidalis, lateral muscles of the abdominal wall, the adductors, pectineum. In fact, its terminal fibers intersect, forming the supracapsular plates of the symphysis.
Sports activities that require abrupt changes in speed are those that make people more prone to suffer from pubic osteitis, the closest example we have is soccer.
It is the first technique that exists regarding treatment properly consisting of an autologous arthroplasty of the pubic symphysis that restores the damaged joint.
Although it can be seen as a radiological finding, those cases in which patients present local symptoms, in many cases resistant to conservative treatments, long evolution should be taken into account. they are clinically sometimes radiological is not clinically sufficient to indicate any procedure in this regard.
There are four hospitals in the Quirónsalud group included by Newsweek magazine in its latest World’s Best Specialized Hospitals 2022 ranking. This ranking includes the best centers in the world in 10 medical specialties. These are the International Ruber Hospital, the Quirónsalud Madrid University Hospital, the Teknon Medical Center and the Dexeus University Hospital.
Ruber International appears among the best hospitals in the world in the specialties of Neurology and Oncology, in positions 101 and 162 respectively. In addition, the Teknon Medical Center also appears in the ranking of the best centers in the fight against cancer, in position 124.
Newsweek’s World’s Best Specialized Hospitals 2022 ranking includes Hospital Ruber Internacional, Hospital Universitario Quirónsalud Madrid, Centro Médico Teknon and Hospital Universitari Dexeus Likewise, in the Traumatology and Orthopedics category, Newsweek magazine has recognized the prestige of the Quirónsalud Madrid University Hospital and Dexeus University Hospital. Both are in positions 76 and 118 respectively of this ranking.
The ranking is done in collaboration with Statista. Its preparation has been carried out from a survey of more than 40,000 professionals from more than 20 countries. Doctors, managers and directors of hospitals and other health professionals have participated.
The latest World’s Best Hospitals 2021 ranking included Fundación Jiménez Díaz University Hospital as one of the 200 best hospitals in the world. In that year it was one of the few Spanish centers to appear in this classification. In addition, the specific ranking of the 100 best hospitals in Spain, both for public and private health, included a total of 12 Quirónsalud centers, 10 of them among the top 50.
Newsweek Newsweek magazine, founded in 1933, has since reported on advances in medicine, science and health promotion. Each year it produces different reports to identify and recognize the best health institutions.
Within the framework of the mini-invasive surgery of the hip, both implantation of hip prosthesis in osteoarthritis and in joint conservative surgery of the hip , for example in non-arthritic femoroacetabular impingement. Ribas reveals which cases of femoroacetabular impingement are the most indicated for simple arthroscopy and which are combined with anterior mini-approach. Already in 2016 in the Journal of the European Hip Society (EHS) Hip-international together with his team published these indications.
1st photo: general view of one of the 12 rooms, face-to-face and virtual participation of more than 2000 participants.
2nd photo: announcement of the session in the Paris room of the German Congress.
3rd photo: virtual address by Prof Tsiridis (Greece) Vice President of the European Hip Society (EHS)
4th photo: On the stage you can see Prof Marco Ezechieli who was trained at Hospital Dexeus.
5th photo: photo of the faculty: profs Thaler, Ezechieli, Ribas, Siebert and Thorey.
6th photo: session title: New techniques and Modern Hip Surgery.
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.
Dr Ribas participates in the first post-pandemic blended congress in Italy, the most important held in that country regarding hip pathology and surgery with two lectures, the periacetabular osteotomy in dysplasic sports patients and the evidence of femoroacetabular impingement after more than fifteen years.
Ribas is a benchmark around the world for both themes. Not only do patients of different nationalities come to him, but also hip specialist doctors interested in learning from him.
In the following photograph Ribas appears with Italian doctors trained in the hip unit of the Dexeus University Hospital, Icatme Foundation.
(photo from left to right: Dr Loris Perticarini, Dr Federico De Meo, Dr Edoardo Guazzoni and Dr Alberto Fioruzzi, all of them already expert hip surgeons in the transalpine country)
The congress had the telematic participation of speakers from the American continent.
During the month of September, the official congress of the European Hip Society (EHS) is held in the French city of Lille. It is the first congress to be held in a mixed format (face-to-face and online). This time it’s dr. Manuel Ribas who addresses the participants.
EHS members appointed ambassadors are experts in hip surgery and pathology. During their professional career, they also represent the EHS in national congresses in different European countries as instructors in the most modern techniques in hip pathology and surgery, contributing their knowledge.
Question. What implications does body movement have in a healthy life?
Answer. Above all, movement is life. The first fundamental implication is that a life without movement is not a complete life. On the other hand, the movement itself helps life to manifest itself in the healthiest way possible.
Q. What are the main pillars of our movement?
R. The main pillars of our movement are first of all the bones, which are articulated between them through the musculoskeletal system through the joints, which are the hinges that connect two or more bone segments.
These joints receive the order of the brain to move thanks to the nerves, which reach the level of the muscles, which are the third element of the musculoskeletal system and which, by contracting, order the joint to practice a movement in space.
Q. What main factors affect our mobility? How can we act to protect these three pillars of mobility?
R. The first factor is time, age. Obviously it is a factor that the human being cannot control, but that it can modify in the most physiological way possible throughout life, by maintaining movement.
Another fundamental factor is body weight. If we are overweight, it is evident that it is a factor that determines an increase in the wear and tear of the musculoskeletal system. This is a modifiable factor over time because we can influence our body weight.
The third element that influences the pillars of movement are injuries, which can be chronic or acute. In this second type we have to face the type of injury and optimize its recovery or maintenance over time to be able to reestablish a physiological movement.
Q. What aspects make our joints often susceptible to discomfort and pain?
R. First of all is the passage of time again, but the fundamental factor is sedentary lifestyle. The more a joint moves throughout life, the less susceptible it is to injury. The more you move, the more bearable the passage of time and joint wear and tear becomes.
Lesions, mostly degenerative in nature, also play a role. It is normal for there to be wear over time, but the idea is to have controlled and minimized wear throughout life.
Q. How can we influence our mobility and joint health through food, nutrition?
R. It is evident that we are what we eat. Therefore, the more varied our diet is and the more it consists of foods with high nutritional value, the closer it is to the Mediterranean diet that corresponds to the country in which we live, the greater the positive impact on the musculoskeletal system.
“There are times when it will be necessary to refer to a diet with an increased protein intake, which may be an adjustment of the diet or a supplementation with protein-type preparations: chronic injuries, after surgery or in recovery from acute injuries”
A varied diet will allow us to have all the fundamental nutrients and all the substances, such as vitamins, that our joints need to stay healthy and flexible over time.
Obviously, in two aspects, it will be necessary to refer to a diet with an increased protein intake, which can be an adjustment of the diet or a supplementation with protein-type preparations. In the phase of chronic injuries, after surgeries or in the recovery phase of acute injuries, it is very important to have and increase the protein intake, because proteins are the small bricks that build our muscles and allow us to maintain our muscular heritage the more intact and recover more quickly from injuries.
Q. What other tips would you give to maintain and improve our joint well-being? And to prevent injuries in sports activities and / or accelerated joint wear?
A. To keep the musculoskeletal system healthy, you have to let this system do what it is built for: movement. We have to remember that we were born to move and that we need to move to live in the healthiest and healthiest way possible.
It is very simple, we have to move, and how ?: at least doing a light exercise of 20 or 30 minutes a day, such as walking. A simple walk helps us keep all the systems working in the best way and also helps cardiovascular well-being.
“It is proven that the more exercise you do throughout your life, the better you maintain muscle mass”
With 120 minutes a week, two hours distributed, it would be the background that the body needs to live in the best possible way.
It would be ideal, adapting to each situation and state of health, to add a small part of physical exercise to mobility and joint elasticity throughout the day. With only ten minutes a day, dedicating this time to ourselves to move the arms, the spine, the neck and the legs, just by sitting down and getting up from a chair, we maintain elasticity.
And then, for those who are more capable or who want to improve even this aspect, it is advisable and optimal to spend ten minutes a day on muscular strength exercises. It is proven that the more exercise you do throughout your life, the better you maintain muscle mass.
Thus, as human beings need to feed and hydrate for life to manifest itself, movement should be recognized as fundamental to life.
Q. What are the main consultations you receive related to joint well-being in people between 50 and 65 years old?
R. The age group between 50 and 65 years is affected by tendon-type problems, most of the time we speak of degenerative tendinopathies, or by problems of joint wear, such as joint cartilage wear and joint stiffness.
These processes are physiologically related to the natural aging of the person, but it is in this age group when they most begin to manifest.
Also because in the life we live people tend to be quite active, but sometimes they move in an unbalanced way, in the sense that we go to work, we sit for many hours, we go home, we have dinner, then the sofa comes. And then to sleep.
We carry out many activities, but at the harmonious and global level that we talked about before, we accomplish very little. When we move little the tendons adapt and begin to lose elasticity and therefore are more susceptible to injury.
Due to the wear of injuries and cartilage we speak of multifactorial processes, between genetics, physical predisposition and mechanical structure, because there may be a predisposition to generate osteoarthritis due to problems such as mechanical axis, such as, for example, people who have bowed knees .
If we add a sedentary lifestyle to all these factors, the vicious circle of lack of joint elasticity begins, and we have stiffness, it goes with the pain and the person ends up having pain and, therefore, does not move. Thus begins a vicious cycle that is complicated because weight gain is added. Increasing weight makes us weigh more and it becomes more difficult for us to move.
You have to move and eat well to avoid entering the vicious circle.
Q. How has the situation of the pandemic affected the consultations?
R. One of the collateral effects at the social level and in the general population has also been an increase in medical consultations due to the appearance of ailments, especially in the spine and hip.
This is because during confinement we have been in smaller spaces. On the one hand, we have moved less and we have lost part of our elasticity, and this generates ailments. On the other hand, there has been an increase in teleworking and not everyone has been able to have a suitable place to work from home and bad posture and incorrect ergonomics at work have often been observed.
Thus began ailments in the hip where femoroacetabular impingement has manifested itself more frequently, especially in young patients.
“We have to return to life as normal as possible and move again” As a hip surgeon I have observed many more patients with pain at the hip joint level also in young people between 25 and 45 years old. Some have even needed surgery.
With repeated bad postures, many hours on the sofa working, watching TV in bed or sitting improperly, these painful impingement syndromes at the level of the hip have increased and all that is the pathology of the spine, such as cervical pain , back pain due to vertebral muscle insufficiency and low back pain.
We must return to life as normal as possible and move again.
Last Thursday, May 27, starting at 7:00 p.m., the webinar on Sports Medicine “Impact sport and health” took place in which Dr. Manel Ribas, head of the Hip Unit of the Department of Orthopedic Surgery and Traumatology (ICATME) from the Dexeus University Hospital and Jesús García Bragado, World Champion in the 50km march in 1993 and the athlete who has participated in the most Olympic Games in history, will talk about the importance of prevention and medical control in high-impact sports and how sports medicine has evolved, especially in hip-related pathologies.
The most important follow-up work in the world on surface prostheses for young people (with special characteristics and not implantable in all patients with a specific protocol) has been published.
This is a 22-year follow-up study of 11,382 surface prostheses in patients under 50 years of age. These prostheses have been implanted by 27 reference teams in the world from up to 13 different top-level countries, from the American, European and Oceanic continents.
In the present study it is shown that with an adequate indication, planning and technical execution, those patients (especially men with hip osteoarthritis) the durability of their implants exceeds 22 years in more than 90% of the cases. Women equal men in durability in prosthetics that can be implanted with the same sizes to most men’s head diameters.
The surface prosthesis is not implantable in all patients, this will depend on their intrinsic bone characteristics, their bone mineral density, their body mass index and the follow-up that the patient will perform. The vast majority of these are young patients involved both in high-demand physical-sports activities and in those professions that require physical effort.
The Icatme Hip Unit, Dexeus Grupo Quirón Salud University Hospital in Barcelona, is an accredited world reference center, both for surface prostheses as well as for minimally invasive surgery, whether for hip replacement or hip joint preservation surgery or either hip arthroscopy such as periacetabular, femoral, combined osteotomy and AAMOT.
You can consult the entire study by clicking here.
As published in the North American prosthetics journal “Journal of Arthroplasty”, randomized comparative studies on the anterior versus posterior approach in hip prosthesis implantation do not show any significant difference either in the first year or in the second after the implantation of the prosthesis. prosthesis. On the other hand, it does depend on the experience of the surgeon.
If we add to this that the superior approach, which is the mini-invasive advance of the posterior approach, does not cause tendinomuscular damage, the result is more immediate.
The superior approaches can be the Superpath and the DSA, both used by the hip unit for years as a reference center in minimally invasive surgery by all its members.
From the Hip Unit we recommend the following video, which shows the procedure of the Superpath technique. You can see the video by clicking here.
On September 11, Dr Ribas, head of the Dexeus Hip Unit, will participate as the main speaker in the webinar: “Primary prosthesis by superior approach with soft tissue protection”, together with doctors Marcelo Lizarraga, Víctor Valladares and Christian Valladares, all of them Peruvians. The Central Military Hospital of Peru is in charge of organizing the event.
The medical team of the Hip Unit of the Department of Orthopedic Surgery and Traumatology of the Hospital Universitari Dexeus (ICATME), led by Dr. Manel Ribas, has published in the latest issue of the Spanish Journal of Orthopedic Surgery and Traumatology (RECOT) the first large series in Southern Europe of cases of periacetabular osteotomy using a mini-invasive technique in the treatment of residual hip dysplasia.
This is a retrospective study of 131 patients who underwent this technique at the Dexeus University Hospital between 2007 and 2016. The study concludes that the periacetabular osteotomy using the mini-invasive approach allows to restore the coverage of the acetabulum, correcting dysplasia, improving capacity. functional and quality of life of the operated patients.
Residual hip dysplasia
“Residual hip dysplasia is a more common pathology than is believed. At the end of growth, the head of the femur, for different reasons, may not have been well covered by the acetabulum and hip instability and alteration of the hip occurs. a series of stabilizing structures that in the long run produce pain and loss of functional capacity, which leads to the need to implant a prosthesis “, explained Dr. Manel Ribas, head of the Hip Unit of the Hospital Universitari Dexeus.
Classic approach
In recent decades there have been various attempts to try to restore these hips but it was not until 1988 that Dr. Ganz from the University of Bern developed a technique capable of correcting this pathology. It is a periacetabular osteotomy that, through four cuts around the acetabulum, allows it to be rotated in a way that provides more coverage to the head of the femur and recovers the contact of the patient’s natural cartilage between the acetabulum and the femur, protecting the joint.
In 2003 Dr. Manel Ribas was the first Spanish surgeon to perform this technique. “However,” adds the surgeon, “with the aim of continuing to improve, in 2007 at the recently opened Hospital Universitari Dexeus we performed the first periacetabular osteotomy using a mini-invasive technique described by Dr. Soballe”.
“This new surgical approach consists of making a series of blind cuts, which are visualized with the help of a radiological team in the operating room, avoiding the muscle so that we achieve less bleeding, less surgical time, less post-operative pain, a rapid functional recovery and an aesthetic improvement over the previous technique “.
The study published by RECOT compiles the first 131 cases of mini-invasive periacetabular osteotomy performed by Dr. Ribas’ team at the Dexeus University Hospital and analyzes the medium and long-term results.
According to Dr. Luis Ramírez Nuñez, surgeon of the hip unit and first signatory of the study, “the patients treated with this technique achieved correct acetabular coverage with few complications and with a significant improvement in functional results.”
“Four years after undergoing the operation, 98% of the patients did not need to undergo any other procedure since the intervention had completely solved the dysplasia,” he adds.
Underdiagnosed pathology
Dr. Ribas affirms that “it is important to be able to diagnose and treat residual dysplasia since it is an underdiagnosed pathology that is extremely confusing with other hip pathologies such as acetabular shock injury and requires a differentiated treatment”.
The Hip Unit of the Dexeus University Hospital is a benchmark in the performance of this technique that is performed on a regular basis. Since Dr. Ribas’s first intervention in 2007, nearly 500 surgeries have been performed using this technique.
This news has been published on the Quirón Dexeus Hospital website. You can see it by pressing here.
As readers already know, Dr. Ribas’ grandfather was a prominent internist, specialist in pulmonary pathology and infectious diseases, who practiced in Barcelona in the late 19th and first half of the 20th century. He was the Head of the Hospital de la Santa Creu y Sant Pau, and had to face the cholera epidemic that broke out in Barcelona and the Spanish flu epidemic. Professor Ribas had as his assistant the one who later became a professor of medicine in Zaragoza and Madrid, and the Nobel Prize in Medicine: Professor Santiago Ramón y Cajal.
He wrote numerous books and reported works of enormous impact in the Europe of the time. He spoke perfectly German, having trained as an internist in Germany (perhaps someone is familiar).
Regarding epidemics, he publicly expressed an opinion that seems taken from the present, only 100 years ago:
“For an epidemic to be considered over, one or more of the following conditions must exist: That more than half of the population is immunized. That the germ loses virulence. That there is an effective treatment to combat it. Let there be a vaccine for the population.”
We believe that 100 years later his thinking is still very current.
The program of the “Primeiro Simpósio Internacional de Atualizaçao em cirugia do quadril”, held on May 1, 2019 in the Aula Magna of the Hospital de Santa Caterina de São Paulo, is now available in its entirety on the YouTube platform.
In the images we can see Dr Ribas with Dr Lage de São Paulo, famous hip surgeon around the world for his classification of acetabular labrum ruptures, and organizer of the contest.
We can also see Dr Ribas together with Dr Jorge Cruz de Melo, a recognized doctor in Portugal, also Porto FC staff.
Within a week we will celebrate 2 months from the restart of elective surgical activity with the greatest success: no reported case of Covid complication19 in our center.
The months at the top of the contagion curve, when confinement was normal and necessary, and we only intervened in those strictly urgent hip surgeries, are behind us.
When the contagion curve stabilized, always below 1, it was time to resume elective activity, that is, the vast majority of hip surgeries: surgery for femoroacetabular shock, dysplasia and osteoarthritis of the hip in its different presentations by mini-invasive techniques.
From the beginning of May we proceeded through the “Safe Hospital” protocol. Hospital Seguro is a protocol that includes a series of both physical and clinical-diagnostic measures whose objective is to protect all Covid patients, both negative and cured, from possible Covid positives, both in outpatients and in emergencies. operating room area, intensive care and hospitalization plants.
Thanks to the implementation of this protocol and the positive response not only from healthcare personnel but from all the patients cared for (at this time ICATME works at full capacity) we have been able to carry out our activity without any reports from Sars-cov- two.
As with other infectious agents, human beings must adapt to coexist in this new phase.
Thank you all that made this posible. Even so, adapting does not mean letting your guard down at any time and anywhere beyond the hospital environment.
Now, although already during the high curve of the pandemic in Spain, patients could move between Autonomous Communities to be treated in hospital centers with the corresponding document, with the lifting of the State of Alarm Decree, said movement between Autonomous Communities enters a new phase of normality, which never excludes 3 premises for their own good and that of others: distance, hands and mask
After the intervention of the Hip Unit in the recovery of Aritz Aduriz, football player of the Athletic Club de Bilbao, the team of the Hip Unit has participated in the documentary “Six Dreams”, soon on Amazon Prime.
In this second season of this Spanish-produced documentary series, iconic figures from our national soccer will be followed: Borja Iglesias (Betis), Aritz Aduriz (Athletic Bilbao) or Santi Cazorla (Villareal).
The Basque footballer from Athetic de Bilbao has successfully undergone surgery on his left hip at the Hospital Universitari Dexeus Quirónsalud, in Barcelona.
The operation, realized by Dr Ribas and his team, has been carried out with absolute normality and without any complications.
The official news of the club is echoed, you can access it by clicking here.
