Out inside hip surgery technique reduces complications, time and costs

My vocation for medicine makes me give the best of myself. That is my daily goal. I have had real teachers, including my family. With their example and advice I have completed my professional and personal training to dedicate myself to my passion: surgery. Institut Margalet is the reflection of this philosophy at the service of my patients. We are an exceptional group of professionals, dedicated to achieving the best and striving to achieve it.

How did you decide to dedicate yourself to hip arthroscopy?

I have always been fascinated by arthroscopy: diagnosing pathologies by visualizing a joint with a small lens connected to its camera and repairing injuries without the need for open exposure. I knew it would be the surgery of the future and I learned this incredible art from my teachers. I became a convinced arthroscopist. That was how I entered the fascinating world of the hip. It was the year 2002 and in Spain there were very few surgeons who performed this type of surgery. Being one of the pioneers at a national level and getting started in one of the most complex and important joints of the human body was a professional challenge. It was hard and complicated. The technique used was very demanding, reserved for expert surgeons, with a long and costly learning curve.

How did you become one of the world’s leading innovators in arthroscopic surgery?

The spirit of research is innate. It is an aptitude that leads you hand in hand towards innovation. I had learned this complex arthroscopic technique and had dedicated years of work to it, but I had the impression that I could improve what we were doing, that the technical limitations that made it an exclusive technique for a few could become reproducible, that the complications that our patients presented after 4 or 5 hours in the operating room could be eliminated. From failure, success can be achieved.

From failure to success?

I was a national opinion leader in this technique and part of my activity was to train surgeons from all over the country and to implement it in different hospitals in Spain. I often thought that my teaching work was sterile, given the complexity and difficulty of the process. The economic issue was also a burden, since the infrastructure necessary to perform this technique was expensive, in terms of material and very specific instruments. Thus those years of teaching went by until, at a national congress held in Vitoria, I was invited to perform a live hip arthroscopy and, in front of a hundred surgeons in attendance, it happened. In spite of trying, we could not access the hip. That was when I said to the room: “can we give up and think that it was impossible or try to do something different? For the first time, I performed an alternative technique to be able to approach that joint and solve the patient’s injuries. This is where the Out Inside technique was born.

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How does one become known worldwide for the Margalet out inside technique?

That day, on the plane back to Barcelona, my mind was spinning, thinking about the opportunity that had been put in front of us, a new arthroscopic approach. From that first moment, many hours of work began: cadaveric dissection, development of the technique, examining each step. I wanted to be sure that our new technique was better than the existing one. We had achieved a simple access route, with basic instrumentation, which reduced surgery time to 1 hour, and with fewer complications and lower economic cost. Those were months of hard work, writing and publishing papers, presenting it at different national congresses. But after those first months of innovation in the world of arthroscopy, I was criticized because of envy and commercial and private interests. My method was questioned, because it was simple and accessible, different and innovative; it could not be that a Spanish surgeon had developed a new technique, faster, cheaper, simpler and with fewer post-surgical complications. The companies that had invested millions of euros in developing specific instruments in the classical technique saw their development and monopoly threatened. The criticism of some colleagues, out of ignorance or because they saw my technique as a direct competition and not as a benefit, made those early years a hard stage in my professional career.

How do you fight against adversity?

When something is difficult, you have to put double effort and double passion into it. I believed in my technique. I embarked on different international meetings showing my technique outside my country, trying to make true the saying that no one is a prophet in his own land. Rome, Paris, Portugal, USA… I felt very small, but I defended with passion and courage every step of my technique, until I consolidated what we represent today: to be the international reference center in hip arthroscopy, training surgeons from all over the world and dedicating part of my activity to disseminate it in different international hospitals.

It is one of the most important centers in Europe.

Our goal is to be able to offer our patients the best. The impossible does not exist, we have to fight to achieve it and only in this way it can be achieved. Our center has the best technology for the study, diagnosis and treatment of hip pathologies. We are one of the international reference centers dedicated to joint reconstruction and regeneration.