We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Osteoarthritis is a condition that causes the cartilage developed by the bones to protect them from the wear caused by using the knee to break down. Once this deterioration has started, it develops progressively. At advanced stages of the condition, this breakdown causes pain and prevents patients from walking or standing normally. There are currently no medications to halt the breakdown at this stage.
When the pain cannot be managed with the usual painkillers, total knee replacement surgery is required, also known as arthroplasty.
The aims of knee replacement surgery are to:
During surgery, joint surfaces that are missing cartilage are replaced by an artificial implant made of chrome, cobalt or titanium.Once the affected part has been removed, the metal implant is put into place and fixed to the bone using cement.
At Valld’Hebron Hospital, we perform up to 500 knee replacement operations a year.
Stroke treatment requires immediate care in specialized units by expert neurologists. Early intervention reduces mortality and long-term disability, and accurately identifying the onset time of symptoms is essential.
In the case of ischemic strokes, the purpose of treatment is to undo or remove, in the shortest possible time, the clot that is cutting off the natural blood circulation in the brain. There are two ways to do this:
In haemorrhagic strokes, the treatment aims to stop the bleeding that has been caused by the rupture of a vessel and prevent the increase in size of the haemorrhage. Therefore, regular monitoring of the patient is performed to gauge the level of consciousness and any neurological deficits. This is maintained for at least the first 72 hours after suffering a stroke. We also perform intensive monitoring of blood pressure, blood sugar levels and temperature to foresee possible complications.
Brain bleeding can cause inflammation of the surrounding brain tissue (known as oedema). If this happens, it is necessary to administer medication intravenously to reduce it. In people who are being treated with oral anticoagulants or who have alterations in haemostasis (a process that the body performs to slow down bleeding), it should be corrected as soon as possible.
In more severe cases, specialists may recommend surgery to drain the bleeding. The decision on surgical treatment is made based on factors such as the location and size of the haemorrhage, age, and the patient’s medical history. This is a difficult decision as it is not always possible to access it without causing damage to other areas of the brain.
The purpose of neurorehabilitation is to regain lost or diminished neurological functions as a result of a stroke. However, there are phases of recovery:
The interdisciplinary team involved throughout the different stages works so that the patient has the maximum independence and adaptation to their environment. To meet these goals, it is advisable to start recovery as soon as possible and, from the initial stages, foster the participation of patient and caregivers.
It should be mentioned that there is “Spontaneous recovery”: this is when the brain has the ability to recover from the damage it has suffered on its own. This recovery, however, may not be enough to reduce the sequelae. That is why it is advisable to always follow the instructions of specialists.
An interdisciplinary team deals with the recovery of a patient who has suffered a stroke. Each of the professionals acts according to the evolution of the condition and the needs that arise at any given time:
Other professionals such as doctors, nurses and orthopaedic technicians are also involved in the rehabilitation process.
In this disease, which has no symptoms, the most important thing is the prevention of its most dreaded complication, fractures. Both treatment and prevention must be supervised by a primary care doctor or specialist.
To prevent osteoporosis and the risk of fracture, a diet rich in calcium, magnesium, and vitamin D, found in legumes, avocados, and nuts, is recommended.
If you don't get enough calcium in your diet, taking supplements may be necessary. The National Osteoporosis Foundation recommends a daily calcium intake of 1000 mg for most adults and 1200 mg for women over 50 and men over 70.
This vitamin is important to help the body absorb calcium from the foods we eat. The recommended daily dose is between 400 and 800 international units (IUs) for adults under 50, and 800 to 1000 IUs for those over 50. These are the current guidelines from the National Osteoporosis Foundation. You may need a different dose, depending on the levels of vitamin D in your blood, sometimes up to 50,000 units per week for 12 weeks.
There are also medications containing antiresorptive or bone-forming agents, such as bisphosphonates, parathyroid hormone (PTH), monoclonal antibodies, and others, which can be prescribed by a doctor based on a patient's comorbidities (what other disorders or diseases they have) and preferences.
Doing a moderate physical activity with some impact is recommended, such as jumping, walking, or dancing, along with other activities like yoga and tai chi, which have additional benefits when it comes to preventing falls and fractures.
Exercise slows muscular atrophy, improves joint mobility, directly promotes bone formation, and improves neuromuscular coordination.
The rehabilitation specialist is one of the people in charge of advising the family and the patient about treatment. The rest of the orthopaedic team and the team physiotherapist at the hospital will monitor the progression of this deformity. There are several different treatments for scoliosis, the use of which depends on the type, curvature, and the patient’s age.
The most negative consequence of scoliosis is that it can affect pulmonary function. To avoid this and aesthetic changes, different treatments are used.
In growing children and adolescents, a conservative treatment is used; its aim is to prevent the progression of the curve. The curvature is monitored via observation and a corrective brace is applied if the curve has reached 25 degrees. This brace reduces the risk that the curve will progress, corrects the deformity, and reduces the need for surgery.
To treat small curves that are at low risk of progression, physiotherapy is recommended.
Curves of less than 20 degrees should not be treated, and those above this angular value should meet a number of requirements:
It is important that the whole team, the patient, and the family understand and accept the treatment, that regular follow-up visits are adhered to, and that everyone works together to comply with the treatment plan.
The aim of surgery is to correct and maintain the curvature. Other objectives would be to improve the individual's appearance by balancing the torso and reducing short and long-term complications to a minimum. Surgery will be considered in the following cases:
If the patient requires surgical treatment, the team of expert traumatology surgeons at the Spinal Unit will be in charge of continuing with this process.
The residency in Physical Medicine and Rehabilitation allows you to gain experience of clinical practice in rehabilitation; an area where all aspects of the specialisation are considered, from orthopaedics, neurology, spinal cord injuries, infant rehabilitation, amputations, lymphoedema, pelvic floor and speech therapy; to pulmonary rehabilitation and community-based treatment for back pain and burns.
We are an active research centre with a high number of publications, at the same time as participating in several national and international programmes. We have also received awards at different conferences in the specialisation.
The Physical Medicine and Rehabilitation teaching programme includes key aspects for research, such as training in clinical epidemiology and clinical research methodology. In addition, our residents undertake research competence courses to complement their practical work.
Why specialise at Vall d’Hebron?
Epidermolysis bullosa (EB) encompasses a range of genetic diseases characterised by excessive fragility of the skin and mucous membranes when subjected to minimal trauma. The disease appears at birth or during the first few years of life, and lasts a lifetime. Prognosis is variable, but tends to be serious. Life expectancy is 50 years, and the disease brings with it complications related to infections, nutrition and neoplastic complications. There is currently no effective treatment available.
Depending on the area of skin where blistering occurs, the disease can be divided into four main groups, and subsequently 32 subgroups.
The most common cutaneous symptoms are blisters in the areas of greatest friction such as on the hands and feet. They are skin lesions that bleed and may form scabs that are easily infected and that itch constantly. Scratching contributes to new lesions and secondary infections of already affected areas.
Once blisters have healed, millium cysts appear, atrophic or hypertrophic scars that produce webbed hands and feet, joint contractures, as well as aesthetic and functionally limiting deformities in the hands or that affect walking. All this leads to loss of independence.
In addition, the chronic wounds may produce highly aggressive skin carcinoma.
Aside from this, extracutaneous manifestations may result, such as involvement of the skin annexes, teeth and the gastrointestinal systems, the urinary tract and the respiratory epithelium.
The disease has a low prevalence rate and affects one in every 17,000 live births worldwide.
The main method of diagnosis is mapping using immunofluorescence and electron microscopy techniques. In addition, genetic diagnosis is mandatory for these patients as the disease may have different evolutions and prognoses.
Although it is being researched, at the moment there is no cure for this disease, but preventative and symptomatic treatment of skin lesions can be carried out, as well as treatment for systemic complications. When the disease appears it is vital to act quickly as patients’ life expectancy and quality of life depends on it.
Currently, new cellular and molecular therapies are being researched to combat the disease.
Critical burns are injuries caused by thermal, chemical, or mechanical energy that may affect not only the skin but also internal organ function. When extensive, they trigger a systemic inflammatory response that can become life-threatening.
Burns occur when the body comes into contact with a source of energy that raises the temperature of the tissue. This produces tissue damage in which proteins coagulate and cause the cells to die. Even a localised injury may affect the organs and internal systems.
In most cases, burns occur because our body comes into contact with a source of thermal energy, in other words, its temperature is higher than our body’s and heat transfer takes place. This is the case with flames, boiling water, hot objects and radiation from the sun. Other types of burns are caused by mechanical energy produced by friction such as dragging.
When burns are extensive and cover 15% of an adult’s body or 10% of a child or a person over 50 years old, they are called “minor burns”. When they occur, a high number of pro-inflammatory molecules are released from the burn and reach the rest of the body through circulation of the blood. During the acute stage, the permeability of the blood vessel membranes and of the body's cells is increased, which results in changes to the distribution of liquid in the body and the depression of cellular function.
To tackle the burn, a few days later the body initiates a generalised inflammatory response via a notable increase in catabolism processes in order to obtain energy resources. It also initiates a hyperdynamic response that transfers these resources to the injured areas. If the burn does not heal quickly, the inflammatory response may consume the body's resources, exhaust the patient, cause organ failure and, ultimately, death.
Once healed, however, there may be lasting functional and aesthetic consequences due to scarring or retraction. This is the case with hypertrophic and keloid scars; thickened areas of scar tissue that limit the mobility of joints, retraction of the eyelids, microstomia, and others.
Burns are graded depending on their severity and they also look different:
Burns are a common, serious and debilitating traumatic injury that mainly results from accidents in the workplace, the home or traffic accidents. The Spanish Society of Family and Community Medicine estimates that three out of every thousand people a year suffer burns requiring medical attention. Primary care centres (CAPs) deal with most cases, but 15-20% will require admission to hospital.
Diagnosis is clinical and treatment must be carried out by highly specialised professionals as this is not a common pathology.
Depending on the degree of the burn, treatment may be:
Most burns are avoidable and therefore the main tools for prevention are education and legislation in society.
Stroke is a sudden disruption of blood flow to the brain caused by a blocked or ruptured blood vessel. The lack of oxygen can lead to irreversible brain damage, making early recognition and immediate medical care essential.
Strokes are a medical condition caused by an alteration in blood circulation to the brain. This alteration is due to an artery becoming blocked (ischemic stroke) or the rupture of a blood vessel (haemorrhagic stroke), preventing blood from reaching the brain and therefore temporarily or permanently altering brain functions. When blood flow is impeded, the affected part of the brain does not get the nutrients and oxygen it needs. As a result, brain cells can die, causing severe after-effects.
For this reason, if a person is suspected of having a stroke, the Emergency Medical Service should be notified immediately by calling 112. Acting quickly is essential in order to minimise or eliminate possible after-effects.
Strokes can be grouped into two broad categories depending on the reasons behind them:
When blood flow is temporarily interrupted (for between one and 24 hours), this is known as a Transient Ischemic Attack (TIA); however, if the duration is longer or the brain scanner detects necrosis (neuronal death), it is considered an ischemic stroke. TIA is a predictor of vascular disease and, in the case of stroke, is a warning that the person is at risk. In fact, 40% of people who suffer a stroke have previously suffered a TIA.
In the event of the sudden onset of one or more of the following symptoms, action should be taken quickly by calling 112:
Anyone can suffer a stroke, regardless of age and physical condition, although they are more common in the elderly. About 75% of cases occur in people over 65, although they increasingly affect young adults due to their lifestyle habits (between 15 and 20% are under 45). Strokes can also affect children: in Catalonia alone, 900 children live with a disability as a result of a stroke.
This disease can also be known by other names, such as apoplexy, cerebral vascular accident, seizure and thrombosis. In Catalonia, more than 13,000 people are admitted each year for a stroke and, unfortunately, they are not always reached in time to save the patient.
To determine the cause of a stroke it is necessary to perform a brain scan (CT). The scan can be completed by reviewing the condition of the cerebral and cardiac vessels, taking into account risk factors and chronic diseases presented by the patient. However, it is not always possible to discover the origin.
Knowing the cause of a stroke allows us to establish the most appropriate treatment to prevent it from happening again. Depending on the aetiology (cause), it can be classified as:
If a stroke is suspected, a neuroimaging test (a CT or MRI) should be performed as soon as possible, which will tell us about:
Specialists may request other tests such as a chest x-ray (performed upon admission as a first assessment), a doppler or transcranial duplex (to see whether there is a possible intracranial occlusion or stenosis, and where it is located), blood tests (to find out the status of risk factors, immunological and coagulation study, serologies, hormones, renal function, etc.) or a cardiological study (if a cardioembolic stroke is suspected).
After diagnosis, specialists may ask to repeat the tests to detect any changes by comparing the images, or request other tests.
Stroke treatment should be applied immediately, as rapid action can lessen the effects. However, a rehabilitation period is usually needed to eliminate or reduce possible after-effects.
After suffering a stroke, the risk of having another is higher, so it is necessary to take medication to reduce the risk, always following medical guidelines. The first year after suffering a stroke is when there is the highest risk of relapse.
Suffering a second stroke may have a fatal outcome. In survivors, it leads to an increase in the degree of disability and risk of dementia, as well as a higher rate of institutionalisation.
The impact may be different for each patient. Symptoms will be more or less severe depending on the area and volume of the brain affected, as well as the general state of health prior to the event.
In the case of a transient ischemic attack (TIA), which does not usually leave after-effects, or ischemic strokes, if the patient responds well to treatment, recovery is virtually immediate. At other times, the recovery is longer term and takes weeks or months, leaving some sort of after-effects.
There may also be a worsening of the patient due to neurological causes or complications such as fever, infections or others. In more severe cases, it can lead to death.
Once the patient is discharged, the primary care team takes responsibility for the patient, and will monitor risk factors and other chronic diseases. In complex cases, patients will need to visit specialists, such as neurologists.
The return home after hospital discharge will vary depending on the severity of the incident and the patient's family situation. Similarly, reintegration into daily life will depend on the after-effects experienced by each patient.
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