20151104 hovsepian jean editedDr. Jean Michel Hovsepian, an orthopedic surgeon from Caracas University Hospital, Venezuela, was an ESCMID observer at Charité-University Medicine Berlin.


"I had the opportunity toperform an ESCMID observership at the Septic Surgery Department, Center for Musculoskeletal Surgery at Charité-University Medicine in Berlin.
As an orthopaedic surgeon, I had my goals of the Observership very clear. I am very aware of the devastating complications of a Periprosthetic and Periimplant infection. Especially in the country where I come from, Venezuela. For this reason, I was looking forward in a training with a specialist septic unit.

Since the first day of my arrival, Dr. Trampuz did a great job personalizing the Observership for me, according to my profile and my needs. Consequently, I had a great time and a wonderful experience. During this time, I improved my knowledge, learned new skills, and at the same time modified some of my therapeutic approaches. Moreover, understanding and enhancing the definition of biofilm is one of the cornerstones for a correct analysis of periprosthetic problems. For the first time, I had the awareness of taking into consideration the importance of the role of the Smalls Colony Variants and the concept of Low-Grade Infection associated with recurrent and persistent infections.

I also learn in an interesting way, their fundamental diagnostic tool. Simple, fast, economic, reliable, reproducible and with a great sensitivity and specificity. The cytology of the synovial fluid from the articular puncture quantifying the amount of leukocytes and percentage of granulocytes. At Charité, they have found a pragmatic way to standardize this procedure for improving their diagnostic and research studies, with a puncture kit.

Furthermore, I learned how to individualize the patients for selecting the best approach with an algorithm used by the team. Thus, schematizing the treatment helps you to take the best decision with evidence-based medicine and at the same time with greatest functional outcomes (e.g. deciding between one-stage, two-stage, three-stage procedures).

In addition, I had the opportunity to go to the Biofilm Research Center at Charité, where they discuss their latest outcomes and show their preliminary results weekly. After that, I saw at first hand the different diagnostic methods that they utilize: sonication, microcalorimetry and polymerase chain reaction. I discussed with the research team the details about their work. I have learned that the vortexing technique could be a great alternative to sonication, especially in institutions that don't have this technology, which may also improve the sensitivity of the diagnostic cultures.

Additionally, I was lucky enough to be invited to the Workshop on Prosthetic Joint Infection organized by the PRO-IMPLANT Foundation. This course was magnificent, I could finally understand all the critical concepts and absorb the therapeutic philosophy of the group in a compact way.

From this moment, I will make several changes in my clinical practice. I hope to use the new skills learned during my upcoming years of further training and I wish to motivate people to be more informed on this topic.

I would like to thank enormously Dr. Trampuz, his team, and the ESCMID. I really had an incredible experience and felt supported at all times. They always helped me with my questions and constantly had good explanations for my inquiries. I really felt part of the team during this month. This observership is highly recommended for anyone who wants up-to-date information about Implants Infections. It is intended for different specialties with different points of views: medical students, residents, orthopaedic surgeons, infectious diseases specialists, microbiologist and biologists."

Dr. Jean Michel Hovsepian, Caracas University Hospital, Caracas, Venezuela

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