In a Dutch oven, brown Italian sausage and pork ribs in a bit of olive oil. Pierce the sausage casings while the first side is browning. Remove and set aside.
Make meatballs by mixing all ingredients. Scoop out tablespoons of mixture and form into balls. Brown in oil left in the Dutch oven, adding more if needed. Remove when browned but not cooked through.
Add garlic to Dutch oven and sauté till fragrant; do not brown. Add tomato paste and cook for a few minutes. Add the rest of the sauce ingredients and bring to a simmer. Add the meat (sausage, ribs, meatballs) to the sauce.
Simmer for about 3 hours with the lid partially covering the pan. Stir every half hour or so to prevent the bottom from burning.
Remove the ribs from the sauce, pull the meat from the bones discarding any excess fat, and return the meat to the sauce. Serve over spaghetti.