Episodi
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In this special recap episode, I revisit highlights from recent episodes of Straight from the Hip, covering topics including social media’s influence on patient narratives, burnout and work-life boundaries, and the evolving landscape of hip preservation.
I share insights from conversations with Joel Wells, Chris Iobst, and Ben Domb, respond to listener questions, and reflect on how centers of excellence and training in hip surgery should be defined.
The episode also touches on recent findings in infantile hip dysplasia from guests like Evelyn Kuong, Harry Kim, Shevaun Doyle, and Wesley Theunissen, emphasizing thoughtful, evidence-based care.
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This week, I’m talking about simulation in healthcare and medical education. Whether in surgery, anesthesiology, or even hip dysplasia screening, simulation allows for repeated practice, error correction, and improved confidence—all without putting patients at risk.
To explore this, I’m joined by Rodrigo Rubio, professor of anesthesiology and director of the Center for Simulation at the American British Cowdray Hospital in Mexico City, and Carlos Vidal, an orthopedic surgeon leading an initiative to teach physicians how to perform ultrasound screening for hip dysplasia using a simulation model.
We begin with a unique perspective—how the principles of stage magic can enhance healthcare simulation. Just like a magician creates an illusion that captivates an audience, a well-designed simulation must immerse the learner in an experience that feels real. We discuss the principles that make this possible, from shaping perception and managing attention to leveraging cognitive biases to reinforce learning.
From there, we shift to the practical side of simulation in orthopedic education. Ultrasound screening for hip dysplasia is a critical skill, but traditionally, it has been challenging to teach due to limited patient exposure. Simulation provides a way to overcome this, allowing physicians to practice on phantom models before transitioning to real infants. We discuss how this method builds technical proficiency and removes the anxiety of making a mistake on a real patient.
Beyond ultrasound, we explore different types of simulation models, how they fit into medical training, and how we can apply concepts from aviation safety—like checklists, crisis management, and high-fidelity simulations—to improve surgical training. We also touch on the future of medical education, including virtual reality and augmented reality.
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Episodi mancanti?
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On today’s episode, I sit down with Wesley Theunissen, an orthopedic surgeon based at the Máxima Medical Center in Veldhoven, Netherlands. He recently published a compelling study on spontaneous recovery in stable dysplastic hips, challenging the traditional approach of immediate bracing.
Hip dysplasia management remains a controversial topic, particularly in mild cases. Some hips initially classified as dysplastic can normalize over time with natural development and adherence to hip-healthy practices. Theunissen and his team found that over 90% of Graf IIb hips improved spontaneously, raising important questions about the necessity of early intervention. We discuss the predictors of spontaneous resolution, both positive and negative, and what this means for clinical decision-making.
From there, we shift the conversation to the downsides of bracing, even for mild dysplasia, particularly its impact on parents and caregivers. Another of his studies provides quantitative insights into the parental experience, revealing the emotional and logistical burden that bracing can place on families. We explore how information overload and uncertainty can make the process overwhelming for parents.
We then turn to a third study, which focuses on strategies to improve information delivery for parents. His research highlights that young parents overwhelmingly prefer visually supported, personalized information, which can help reduce anxiety and improve adherence to treatment recommendations. However, we also acknowledge the challenges of implementing these strategies in overburdened healthcare systems.
Throughout our conversation, we touch on the logistics of running an infant hip clinic, the influence of surgeon bias, and the role of experience in guiding clinical decisions.
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On today’s episode, I’m joined by Dr. Evelyn Kuong, a consultant in the Department of Orthopedics and Traumatology and an Honorary Clinical Associate Professor at the University of Hong Kong.
We start by discussing her recent research on predicting residual dysplasia at skeletal maturity after closed reduction for developmental dislocation of the hip, identifying age-specific acetabular index cutoffs that can help guide decision-making when monitoring patients post-reduction.
From there, we dive into her work on establishing normative radiographic values for hip dysplasia in a pediatric Chinese population. Her findings reveal significant differences compared to Northern European reference values, highlighting the importance of region-specific data in diagnosis and treatment. We also explore the broader implications of these differences—considering not just genetics but also environmental and lifestyle factors, particularly in today’s increasingly globalized world.
We touch on the limitations of standard radiographs in assessing a complex, three-dimensional structure like the hip while recognizing their practicality as the most widely accessible imaging tool worldwide.
Finally, we wrap up with a discussion on spinal muscular atrophy and the impact of disease-modifying drugs like Nusinersen. Dr. Kuong’s research suggests that while these treatments improve certain functional outcomes, they haven’t addressed hip instability. With longer life expectancy and better function in these patients, there may be a case for a more proactive surgical approach—particularly in SMA type 2.
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On today’s episode, I’m joined by Dr. Shevaun Doyle, a pediatric orthopedic surgeon from the Hospital for Special Surgery in Manhattan, New York. Dr. Doyle has an extensive practice focusing on both operative and nonoperative treatments for infantile hip dysplasia.
We dive into her recent paper on nerve palsy in children undergoing brace treatment for hip dysplasia. We discuss whether the term "palsy" is accurate, explore rare nerve issues that can arise, and unpack possible mechanisms behind these complications. While these nerve issues almost always resolve, they can complicate treatment of the underlying condition.
In a twist, Dr. Doyle flipped the script and interviewed me about my approach to managing failed Pavlik harness treatments and cases presenting at an older age. We talk about defining success after a closed reduction, counseling families on the spectrum of pathology, and the challenges of treating complex cases.
We also touch on another paper she co-authored, which examines health states as a measure used in value-based care.
This conversation reinforces that nonoperative treatment remains the gold standard for managing hip dysplasia.
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In today's episode, I speak with Dr. Harry Kim from Texas Scottish Rite for Children about a condition that I have often said that I love to think about but hate to treat:Legg-Calvé-Perthes, or juvenile osteochondritis of the proximal femoral epiphysis. This condition has intrigued and frustrated orthopedic surgeons for over a century due to its unpredictability.
We begin by delving into Dr. Kim's groundbreaking research utilizing perfusion MRI to better characterize this enigmatic disease. Perfusion MRI offers new insights into the vascular dynamics of the femoral epiphysis, shedding light on the revascularization process that has remained poorly understood.
Our conversation explores the feasibility of conducting such studies, including the logistical and technical challenges involved. We also discuss how emerging tools like artificial intelligence and machine learning could enhance the accuracy and efficiency of interpreting the vast amount of data generated by these imaging studies.
Dr. Kim shares patterns identified in revascularization as it occurs within the epiphysis, and we examine the implications these findings may have for future treatment strategies. This leads to a thoughtful discussion of current treatment options, both surgical and non-surgical, and the subtle nuances that influence the decision-making process for each approach.
We also reflect on the long-term outcomes for patients with Legg-Calvé-Perthes disease, considering the benefits and limitations of using social media platforms to identify and study a large cohort of patients with extended follow-up data. Social media offers unique opportunities to gather patient perspectives and outcomes over time, but it also presents challenges in data validation and representation.
Throughout the episode, we touch on a variety of related topics, bringing valuable insights into the management and understanding of this complex condition.
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In today’s episode, I speak with Dr. Ben Domb, a leading orthopedic surgeon and founder of the American Hip Institute in Chicago, a center dedicated to advancing hip treatments through education and innovation.
We discuss a recent paper he published on the treatment of so-called Borderline Hip Dysplasia. The study found no significant difference in outcomes for the condition when patients underwent either a Periacetabular Osteotomy or arthroscopic capsular plication.
We talk about the nuances of borderline hip dysplasia, the difficulty in standardizing surgical treatment, and the development of a comprehensive center of excellence for treating hip pathology.
We consider the three core pillars of medicine: delivering high-quality patient care, advancing knowledge through research, and fostering education for clinicians and patients.
We examine the importance of tracking outcomes and balancing education with a busy practice.
We explore the evolution of the subspecialty of “hip preservation” and the various routes that one can take to become a hip preservation surgeon, as well as the trend in all of medicine to super-specialize
We also touch on new mediums for transferring knowledge and building a personal brand, amongst other things.
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On today’s episode, I have the privilege of speaking withDr. Chris Iobst, a world-renowned expert in limb deformity surgery and, more importantly, a remarkable human being. While my focus is usually on hip pathology, today’s discussion is especially timely as it touches on a criticalissue that impacts all professionals, including orthopedicsurgeons—overcommitment and burnout.
Dr. Iobst recently experienced a life-changing event thatshifted his perspective, prompting deep introspection about his career and life. He was gracious enough to share insights from a book he is writing, designed as a manual for surgeons, offering a cautionary tale aboutthe dangers of taking on too much.
We discuss Overcommitment and people-pleasing, particularly among high-functioning professionals.
We talk about Societal pressures and internal motivationsthat drive individuals to take on too many responsibilities, leading to burnout and dissatisfaction.
We consider The importance of learning to say "no"and prioritizing self-care for increased respect and a healthier work-life balance.
We then analyze some of the root causes of overcommitment, including fear and its many different forms
We talk about strategies to combat overcommitment and
prevent burnout, how to break the cycle of overcommitment, confront these fears, and set boundaries for better professional fulfillment and personal well-being.
This is an essential conversation for anyone striving toavoid burnout in their career.
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This week I speak with Joel wells MD associate professor of orthopedic surgery at the University of Texas A&M and we discussed the complexities of the role that social media plays in patient perception and self reported outcomes specifically after having periacetabular osteotomy for the correction of acetabular dysplasia.
We talk about the complexities of social media in medicine and discuss how it is crucial to consider both the benefits and risks these platforms pose. Social media has become a powerful tool for sharing health information and connecting patients, it also has a darker side—one where misinformation, pseudoscience, and unchecked narratives can flourish.
The issue goes beyond just pseudoscience. Today we are seeing patients turn to social media to share their postoperative journeys, including complications, in ways that don’t always align with traditional clinical data. This raises important questions about how we validate patient experiences and the role that online platforms play in shaping perceptions of medical outcomes.
We explore these dynamics and their implications for both physicians and patients, with a particular focus on PAO surgery.
We consider the fact that the most common complication reported was pain and that the complication posts were made late in the postoperative period, highlighting a potential disconnect between patient perception and clinical outcomes.
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This week, join me for a recap and 'Ask Me Anything' episode! I've shifted to a bi-weekly or monthly format to better fit your schedules and allow you to catch up on past episodes. Over the last ten episodes, we’ve explored topics beyond the hip, including surgical techniques and medical publishing, and your feedback has been invaluable. Tune in as I answer your questions and delve into the topics you’ve been curious about. Keep those questions coming to keep our discussions engaging and relevant!
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This week, I speak with Dr. Paul Beaulé, Professor and Chief of the Division of Orthopedic Surgery at the University of Ottawa, Canada. He has dedicated his career to understanding the hip and is a world-renowned author and hip preservation surgeon.
In our conversation, we delve into a recent randomized controlled trial he led and published. It compared the outcomes of patients undergoing arthroscopy in conjunction with periacetabular osteotomy versus those who did not have arthroscopy. This groundbreaking study earned the 2024 Hip Society Otto Aufranc Award.
We explore the complexities of conducting randomized controlled trials in orthopedic surgery, discuss the inherent variability in surgical procedures, and examine the nuances of interpreting MRI findings related to the acetabular labrum—a structure Dr. Beaulé has extensively researched.
We talk about the variability inherent to any surgical procedure.
We talk about the interpretation of MRI findings and the structure and function of the acetabular labrum, which he has described at length and worked diligently on for years.
Most of the discussion centers on the study's findings, which show no significant difference in clinical outcomes between the group undergoing arthroscopy and those that didn’t when undergoing a PAO.
We also talk about alternatives, including hip replacement, as well as outcomes of hip replacement after having a PAO, amongst other things.
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This week, I speak with Nancy Muir, a pediatric physical therapist based at the University of Colorado Aurora, beyond this, she is an expert on hip dysplasia, having been diagnosed running an ultra-marathon and she has been very forthcoming and gracious in sharing her story.
My relationship with Nancy spans several years, and we have worked closely together since she founded the nonprofit organization, Miles for Hips. This organization, which she established in partnership with the International Hip Dysplasia Institute, serves as a beacon of patient advocacy and awareness.
She shares her unique and often challenging journey with adult hip dysplasia, a story that many listeners may find relatable. She also delves into her decision-making process when she was considering surgery.
She talks about getting multiple medical opinions but still not finding the comprehensive information she needed about her condition, the treatment options, and potential outcomes.
We talk about a paper she is due to have published, which looks at decision aids for adult patients considering periacetabular osteotomy surgery, which she developed as part of the efforts to earn her title of Doctor of Health Science from Drexel University in 2023
We discuss qualitative research and patient expectations of receiving information at a medical visit.
We consider so-called shared decision-making, what that term means, and why it has limitations.
We talk about individual needs to understand health conditions and their huge variation, from the level of detail they want to the type of information that helps make decisions.
She provides great insight and tools that patients and healthcare providers can apply to provide tailored treatment.
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This week I talk with Deborah Eastwood of the Royal National Orthopedic Hospital in London, England.
The name Debbie Eastwood is synonymous with excellence in Orthopedics stands as a beacon of inspiration and is one of the most influential women in orthopedic surgery. Her remarkable contributions to pediatric orthopedics have left an indelible mark in the field.
Debbie Eastwood's unwavering dedication was recently honored with the lifetime achievement award from the European pediatric orthopedic society. This prestigious recognition, coupled with her involvement in numerous national and international organizations, and her role as a teacher, is a testament to the clarity of her thought.
We begin reviewing her orthopedic journey and background. She discusses her initial approach to the developmental display of the hip and how she reached her opinions.
We consider why national screening programs do not appear to have been as successful as they should have been.
We talk about historical differences in approaching the treatment of developmental dislocation of the hip on both sides of the Atlantic,
We discuss her recent research looking at length discrepancy after the treatment of hip dysplasia and the reason behind this,
We talk about genetics and the future of research for hip dysplasia, amongst other things.
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This week, I speak with Dennis Wenger, the director of pediatric orthopedic surgery education emeritus at Rady Children's Hospital in San Diego, CA, and the professor of orthopedic surgery emeritus at the University of California, San Diego.
He has had a prolific career as a clinician educator and researcher in pediatric orthopedic surgery.
We discuss his approach to treating developmental dislocation of the hip, including different philosophies he learned from diverse parts of the world with a unique background.
We talk about the state of specialized surgery of the musculoskeletal system in children in the United States.
One of the highlights of our conversation was debating the technique he developed, which involves shortening and reattaching the ligamentum teres, and we talked about its inception, development, biomechanics, and clinical results.
We discuss a few alternatives, including a temporary transarticular pin and the importance of achieving stable concentric reduction.
Of course, no conversation with Dennis Wenger would be complete without some intriguing philosophical insights.
We talk about the difficulties with learning to perform these procedures given the, fortunately, decreasing number of late detected dislocations around the world, among other things.
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This week I have two guests; I welcome Anders Falk Brekke, who is a registered physical therapist and PhD, affiliated with the Department of Physiotherapy at University College Absalon, Region of Zealand, Denmark, the Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark and the Department of Orthopaedics and Traumatology, Odense University Hospital, Denmark.
Josefine E. Naili is also a registered physiotherapist and PhD associate professor of physiotherapy. Currently conducting research at the Department of Women’s and Children’s Health and working clinically in the Motion Analysis Lab at Karolinska University Hospital in Stockholm, Sweden.
They both have extensive research interests, including evaluating the impact of musculoskeletal disease and injury on movement and gait patterns.We talk about the mechanics of gait and the prevalence of Increased anterior pelvic tilt in patients with acetabular retroversion compared to the general population.
We discuss acetabular retroversion, how it affects hip function, its typical symptoms, and clinical presentation and radiographic evaluation.
We talk about the lack of evidence to support non-surgical treatments to change excessive anterior pelvic tilt in both symptomatic and asymptomatic adults and their efforts to prove the feasibility of an intervention consisting of an exercise program to change this
We end with a discussion of a paper they published in February 2023, which discusses the changes in functional biomechanics following a targeted exercise intervention for patients with acetabular retroversion and femoroacetabular impingement syndrome. They discuss how the intervention showed changes in the range of motion flexion and reduced anterior pelvic tilt; however, it did not change gait biomechanics or patient-reported pain.
We discuss patient adherence and its importance in any physical therapy program and discuss future research in the field, among other things.
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This week I speak with Laura Rutterford a physical therapist based in the United Kingdom.
This is a so-called crossover podcast, as she also has a podcast called Help for Hip Dysplasia, which I highly encourage you to check out.
Today, Laura shares her journey with hip dysplasia, which inspired her to become a physical therapist. This is not uncommon in the world of hip dysplasia; people who have been affected often become strong advocates.
We talk about her treatment approach and the importance of collaborative care.
We discussed screening programs and the inadequacy of many of these
We consider the rationale and basis for physical therapy in helping patients with hip dysplasia
She clarifies some misconceptions surrounding physical therapy
We talk about an individualized approach but also standardizing treatment to have a greater reach worldwide
We discuss potential areas for future research and improvement in the field and emerging trends.
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This week, I speak with Raymond Liu, a pediatric orthopedic surgeon at University Hospitals, Rainbow Babies & Children’s Hospital, and the Victor M. Goldberg Endowed Chair in Orthopaedics.
He is a world-renowned expert on complex hip pathology and has published extensive research focusing on sophisticated analysis of different osteological collections.
We begin by discussing slipped capital femoral epiphysis (SCFE) and its association with athletic activity, Challenging the notion that this condition is less frequent in children involved in athletic activities.
We then examine the similarities and, more importantly, the big differences between the so-called primary Cam morphology of the proximal femur and SCFE.
He explains a paper comparing similarities in the proximal femoral anatomy between 3 distinct historical populations: a Neolithic population from the Middle East, a medieval population from Eastern Europe, and a more recent aboriginal population from Australia.
We talk about the spinopelvic relationship and its relation to the development of Cam morphology.
We discuss the epiphyseal tubercle, which he has described elegantly and signaled its importance, the distinction between stable and unstable slips, and its relationship to the blood vessels that supply the femoral head.
We also consider his current and future research endeavors, amongst other things.
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This week I talk with Ken Noonan, Professor of Orthopedic Surgery at the University of Wisconsin, in Madison, and the Editor-in-Chief of the Journal of the Pediatric Orthopedic Society of North America
We talk about understanding the landscape of medical publishing and how to measure productivity in publishing and research.
We discuss the role of Open-Access Publishing; its advantages and challenges, including maintaining quality control.
We exchange ideas about so-called predatory journals; how these can be defined, and how to identify them. We also discussed how all medical journals could be considered predatory.
We then focused on three pediatric hip conditions and discussed three papers looking at three different ways of analyzing the literature.
The first is a citation analysis on developmental dysplasia of the hip published in the journal of pediatric orthopedics B:
Moscona L, Castañeda P, Masrouha K. Citation analysis of the highest-cited articles on developmental dysplasia of the hip. J Pediatr Orthop B. 2020 May;29(3):235-247. doi: 10.1097/BPB.0000000000000715. PMID: 31923135.
The second is a systematic review of patient level analysis on the treatment of stable slipped capital femoral epiphysis published in the Journal of Orthopedics and Traumatology which looks at information that is available to patients and families:
Naseem H, Chatterji S, Tsang K, Hakimi M, Chytas A, Alshryda S. Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis. J Orthop Traumatol. 2017 Dec;18(4):379-394. doi: 10.1007/s10195-017-0469-4. Epub 2017 Aug 22. PMID: 28831651; PMCID: PMC5685987.
Finally, we discuss a paper on the global trends in research on Legg Calves Perthes, published in Frontiers in Pediatrics, an interesting journal with a very transparent and rigorous peer review model:
Qin W, He M, Qin H, Wei Q, Yan H. Global trends in the research on Legg-Calve-Perthes disease in Web of Science. Front Pediatr. 2024 Mar 7;12:1335118. doi: 10.3389/fped.2024.1335118. PMID: 38516353; PMCID: PMC10954890.
We considered ethical and methodological concerns in publishing.
and we explore future directions and opportunities, amongst other things.
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This week, I speak with Ernie Sink from the Hospital for Special Surgery (HSS) in New York.
Dr Sink is a world-renowned expert in hip preservation surgery, and today, we discuss surgical hip dislocation as an approach to treating hip pathology.
We talk about femoroacetabular impingement or FAI and its description by the group led by Prof. Reinhold Ganz in Bern, Switzerland, and the evolution towards arthroscopic approaches to treating it.
We discuss objective measures to quantify FAI, the importance of making an accurate diagnosis, and the difficulties in distinguishing subtle abnormalities.
We talk about a recent paper he published that analyzed the outcomes of the surgical dislocation approach for treating complex FAI and how he distinguishes complex FAI from milder conditions, considering it a spectrum of pathology.
We then consider two papers comparing surgical hip dislocation and arthroscopy to treat this condition.
The first, a comparison in an adult population, showed that both treatments were equally effective. We discussed surgeon preference for one or another, leading to its being offered.
A more recent study in an adolescent population found that females with subtle Cam deformities on the femoral neck who did not participate in sports were at higher risk of having a sub-optimal outcome, and we discussed this.
We conclude on the current state and future of open hip surgery in the era of arthroscopy.
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This week I recap the most recent episodes and answer some audience questions.
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