Straight From The Hip

This episode is part three of this mini-series dedicated to Patient Leadership. Today, we approach hip dysplasia from a different, essential perspective: behavioral health.I’m lucky to be joined by Dr. Kelly Rabenstein, a Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina in Charleston. She is a licensed psychologist working in Bio-Behavioral Medicine, and our conversation explores the psychological dimensions of developmental hip dysplasia that are often present but rarely addressed directly.We discuss parental anxiety at the time of diagnosis, the behavioral challenges surrounding treatment adherence in infancy, and the longer-term psychological impact on adolescents and young adults living with hip dysplasia. We talk about how uncertainty is processed, how medical language shapes perception, and how clinicians can communicate in ways that reduce fear while preserving clarity.This episode is forward-looking. If hip dysplasia is a condition that can span decades, then behavioral health cannot be peripheral to care. It must be integrated from the beginning. I think you will find this discussion thoughtful, practical, and deeply relevant to both clinicians and families navigating this journey.

In this mini series, of episodes, I’ve been exploring the lived experience of hip dysplasia, not just the science, but what it actually feels like to live with this condition.Today’s guest is Samantha “Sammy” Krathen, one of the founders of a community called The Hipsters: the-hipsters.com Sammy brings a perspective we don’t hear often enough in medicine, the voice of a teenager navigating hip dysplasia while still figuring out who she is, what matters to her, and what life should look like.For Sammy, this journey isn’t only about doctors’ visits or recovery from surgery. It’s about being a high school student, going to summer camp, building friendships, and forming an identity while dealing with something that many people around her can’t see or fully understand.That perspective matters. For other young people going through the same experience, it can be reassuring to hear that they’re not alone. And for clinicians, it’s a reminder that behind every diagnosis is a person whose life continues far beyond the clinic or the operating room.

This episode is part of a Patient Leadership Series, where I highlight the voices of individuals who have lived with hip dysplasia and chosen to turn that experience into action.Today I’m speaking with Gemma Barber from the United Kingdom. Gemma has lived with developmental dysplasia of the hip and has become a powerful advocate within the UK community. Through her advocacy work and her recent Springtime fundraising ball in the Wirral, near Liverpool, supporting hip dysplasia awareness, she has helped build support networks for families navigating diagnosis, treatment, and long-term uncertainty.In this conversation, we talk about what it means to grow up with hip dysplasia, how different healthcare systems shape the patient experience, and why peer support remains essential even in countries with universal healthcare. It is a discussion about resilience, community, and the importance of making sure no family feels alone when they hear the words hip dysplasia.

This is a special video episode of the podcast meant as a public service announcement to help parents understand what matters for baby hips!

On this podcast, I've explore developmental dysplasia of the hip from every angle: the science, the evolution of treatment, the lived experience, and how patients and families make sense of a diagnosis that can follow them across decades.Today’s episode is a wide-ranging conversation with Betsy Miller, author of The Parents’ Guide to Hip Dysplasia, (https://betsymillerbooks.weebly.com), a book she published nearly twenty years ago, around the same time the International Hip Dysplasia Institute was founded. Betsy wrote that book not as a physician, but as someone who had been treated for hip dysplasia as an infant and later realized how little practical, accessible information existed for parents facing a brace, a cast, or surgery. With a background in technical writing, she set out to create the resource she wished had existed.Although she did well for many years, she was later told she had residual dysplasia, something that came as a surprise. We discuss how hip dysplasia can remain silent for decades, why some people do not realize they have it, and how the field of hip preservation emerged in response to these late presentations.We also talk about how people get their information in 2026, whether books still matter, the challenges of nonprofit education, and what happens when hip preservation is no longer enough. Betsy ultimately underwent bilateral hip replacements and is now writing a new book, Hip Replacement at Any Age, aimed at younger patients who often feel alone in a space dominated by older adults.It is a thoughtful conversation about information, identity, and how a diagnosis in infancy can echo throughout a lifetime.

Today I’m joined by Maurizio De Pellegrin from Parma, Italy, and we’re going to do something I enjoy: highlight a set of practical contributions, then stress-test what the data really support. We start with a question parents ask all the time—often more urgently than they ask about the hip itself: Will treatment delay my child’s milestones? De Pellegrin’s recent work examines walking age and motor development in severe DDH, and it helps us speak to families with greater precision about timing, severity, and what happens when treatment begins early.From there, we tackle a classic piece of folk remedy: double diapering. It’s common advice, it sounds plausible, and it persists. We’ll review what happens when you actually measure hip position with and without it, and what that should mean for pediatric counseling.Then we shift to ultrasound biology, what the labrum looks like, and how it changes in dysplastic and dislocated hips during stabilization. I’m especially interested in echogenicity: whether it’s a risk marker, a response marker, or both.Finally, we’ll go beyond typical DDH and discuss hip ultrasound in Hurler syndrome (MPS I) after hematopoietic stem cell gene therapy, what ultrasound can still tell us when anatomy is atypical, and what the next outcome questions should be.

Today’s guest is Dr. Thomas Youm from NYU Langone Health a high-volume hip arthroscopist.The focus of the conversation is a niche but common clinical scenario: femoroacetabular impingement syndrome in the setting of borderline hip dysplasia—typically defined by a lateral center-edge angle between 20 and 25 degrees. We use several recent papers from Dr. Youm’s group as the starting point, but the discussion stays practical: when a hip lives near that borderline zone, where undercoverage and potential instability may coexist with impingement morphology, who truly benefits from arthroscopy, who should be screened out, and what long-term outcome studies can—and cannot—claim.We talk about definitions that drive everything: how “borderline dysplasia” is operationalized beyond a single angle, how FAIS is defined and selected for surgery, and how labral and capsular management can shift a hip toward stability or toward symptoms.We talk about imaging as decision-making, not just documentation: what plain radiographs miss, how MRI can (and should) classify the labrum and cartilage more meaningfully, when CT adds value for combined femoral and acetabular version, and how those parameters change counseling and surgical indications.We talk about dynamic assessment—especially the role of ultrasound to evaluate motion-dependent instability in select patients—and how that complements static imaging when the story and exam do not match the radiographs.We also spend time on endpoints. We talk about what “survivorship” means when studies use revision arthroscopy and conversion to total hip arthroplasty, and how that aligns—or fails to align—with the outcomes that matter most to patients: pain, function, athletic participation, and the possibility that some hips may later need a reorientation procedure rather than another arthroscopic intervention.

This 50th-episode recap of Straight from the Hip brings together some of the most important themes we’ve covered over the past block of conversations: how we share knowledge, how we generate and question evidence, and how we safely push the field forward. I revisit episodes with Nick Fletcher on podcasting as a serious medium for medical education; Simon Thomas and Emily Dodwell on long-term outcomes, fragile statistics, and what that means for counseling families; Perry and Jon Schoenecker on the tension and harmony between clinical experience and basic science; and Valerie Parrish on what IHDI 2.0 is actually doing for real babies and families right now. We then move into innovation and leadership with Dror Paley, Michael Vitale, and Dan Sucato, touching on moral ambition, safety culture, robotics, FHRO, and the real value (and limits) of rankings. It’s a chance to zoom out, connect the dots, and respond to some of your questions about where hip preservation is going next.

Today I’m joined by Dan Sucato, Chief of Staff at Texas Scottish Rite for Children, an institution that currently sits at the top of the U.S. News & World Report rankings for pediatric orthopedics.We start with Perthes, specifically, one of the most complex reconstructions we have for the post-Perthes deformity: femoral head reduction osteotomy. Dr. Sucato is one of the few surgeons worldwide to have published on this procedure. I was able to pick his brain about when he considers it, how he executes it, whether it can realistically be taught, and how to think about adolescents and young adults with painful, misshapen femoral heads who are still “too young” for arthroplasty. We dig into what problem FHRO is really trying to solve, how he selects patients, what he tells families about risk and recovery, and where he draws the line between attempting salvage and accepting that a hip is no longer reconstructable.From there, we shift into leadership. I asked him what it actually means to lead a program that everyone else sees as “number one”: what metrics he trusts more than USNWR, how he balances volume, access, and complexity, and how he protects trainees and staff from chasing rankings instead of chasing better care. We talk about culture, humility, and how to build a place where people can speak up, disagree, and still move in the same direction.It was a grounded, honest conversation about hard hips and real leadership.

Michael Vitale, Chief of Pediatric Spine Surgery at Columbia, joins me to talk about one thing: how to make surgery safer.We walk through why he became obsessed with safety, and how high-stakes spine surgery forced a rethink of teams, errors, and systems under pressure.We break down core principles: planning, standardization, human factors, checklists that actually work, and psychological safety in the OR.We talk innovation: navigation, robotics, AR—how to adopt new tech without creating new failure modes.Finally, we discuss metrics, outcomes, and performance measures, and why the future of quality in orthopedics depends on transparency, benchmarking, and shared learning.

If you’ve listened to this show in the past or our sister show (Hip & Happening), you already know today’s guest: Valerie Parrish, the Director of Patient Advocacy and Engagement at the IHDI. This episode was recorded right after our IHDI 2.0 symposium in New York, In this conversation:We talk about baby positioning and baby-wearing. We get into early detection and why we still miss hips — and how that might change with smarter imaging and motion tools.We discuss improving brace treatment We explain why kids are not just “small adults” how we are helping build pediatric shape libraries and patient-specific modelingWe talk about surgical precision in theory vs reality: and where augmented reality may fit in the future.And we end with a big idea: “normal” is not universal. Which matters for screening, labeling, and deciding who needs an operation.

Today’s episode is a real privilege. I had the chance to sit down with Perry and Jon Schoenecker, a father and son who represent two distinct but complementary approaches to orthopedics. Perry is a giant in clinical orthopedics, with decades of work shaping how we think about hip dysplasia, hip preservation, and surgical decision-making. Jon, meanwhile, brings a different perspective, grounded in basic science and biomechanics, with a focus on the biology of bone and cartilage and how those insights can drive the future of our field.In this conversation, we talked about how each of them found their way into orthopedics and what drew them to the hip in particular. We revisited the evolution of hip dysplasia care, what has been learned across generations, and what still challenges us today. We explored Legg–Calvé–Perthes, not just from a clinical standpoint but also through the lens of biology and healing mechanisms.We also discussed biomechanics, the role of cartilage in joint preservation, and how an understanding of basic science can inform and sometimes challenge established surgical approaches. Together, Perry’s wisdom from decades of clinical experience and Jon’s innovative, science-driven lens make for a fascinating dialogue about where the field has been and where it’s going.Finally, we looked ahead to the future of orthopedics, what the next generation of surgeons and scientists should focus on, and how we can balance tried-and-true clinical experience with the possibilities offered by new discoveries in biology and technology.It was a rich, wide-ranging discussion that blended experience and innovation in a way that few conversations can; for me it was a truly special experience and I hope you enjoy listening to it as much as I did recording.

Today’s episode is a bit meta, in the best way. We’re talking about podcasting as a medical medium: not just a way to pass time on a commute, but a tool to reshape how we communicate, teach, and share orthopedic knowledge.My guest is Dr. Nick Fletcher from Atlanta. He’s a Professor of Orthopaedic Surgery at Emory, the Medical Director of the Spine Program at Children’s Healthcare of Atlanta, and the host of Interview with a PediPod, the official podcast of The Pediatric Orthopedic Society of North America. He’s published more than 70 peer-reviewed papers and served in leadership roles across POSNA and SRS. But today, we’re not talking about any of that directly.We’re asking: what does it mean to teach without a podium? What are the risks and rewards of creating content that’s accessible but unfiltered? And in a field that values precision and peer review, where does a medium like podcasting fit?We get into the ethics of self-promotion versus service, the technical choices behind producing a credible medical podcast, and why audio might just be the most human way to talk about medicine. And of course, we discuss how podcasting can help people and especially doctors, become better listeners, thinkers, and communicators.This was a thoughtful, practical, and energizing conversation with someone who’s not only advancing spine and hip care, but also rethinking how we share what we learn.

On this episode I have a candid conversation with: Dror Paley, the founder of the Paley Orthopedic & Spine Institute in Florida, the Paley European Institute in Poland, and the Paley Institute Middle East in Abu Dhabi. He’s a pioneer in deformity correction and one of the surgeons who introduced the Ilizarov method to North America. In hip surgery, he developed the SUPER Hip procedure, along with more than a hundred other techniques.But this episode isn’t about applause. It’s about ambition, controversy, and what it means to innovate in a field that often resists disruption.We talked about the cost of leadership: how innovation can be mistaken for ego, how financial success can attract criticism, and how doing what’s right isn’t always what’s expected.We explored brand building, the moral imperative behind patient care, and the obligation to advance the field itself. We discussed the challenges of being a disruptor and the complicated path to peer recognition.On the clinical side, we covered complex hip reconstructions including the SUPER Hip, femoral head reduction osteotomy, and the so-called “extreme PAO.”I asked him some hard questions: Where’s the line between surgical creativity and overreach? What scares him more: stagnation or automation?We also talked about the future of limb reconstruction, the promise of regenerative medicine, and the potential of integrating what’s increasingly referred to as “One Medicine.”This was a wide-ranging conversation with someone who’s changed the field and taken a few hits for it. I hope you find it as provocative and inspiring as I did.

On today’s episode, I talk with Emily Dodwell of the Hospital for Special Surgery in New York.  We begin discussing her background and how she views some of the known facts about hip dysplasia, such as risk factors and current best practices for non-operative treatment, leading into variation in screening strategies around the world. We talk about a population-based study she published using data from New York state to determine the rate of surgery for hip dysplasia in infants and variations thereupon how this sheds light on the state of affairs in a highly developed region. We discuss health economics and so-called “Parent-Derived Health State Utilities,” a useful tool to evaluate the burden of treatment for patients and parents of patients  with hip dysplasia. Finally we discuss the fragility of our evidence base and a paper she coauthored looking at another measure called the fragility index which shows that the science may not be anywhere near strong enough for the decisions we make, ending on a philosophical discussion of what would it take structurally to improve the science from both a power and transparency standpoint, whether randomized control trials are truly feasible in surgery or prospective registries may be the best we will have for the foreseeable future.  

This week, I speak with Dave Bailey, the CEO of OrthoPediatrics, an American bioscience company based in Warsaw, Indiana, that designs, develops, manufactures, and distributes orthopedic implants and instruments for pediatric issues.I invited Dave to discuss the intersection of industry and patient care. His vision talk at a recent event resonated with my mission to provide the best care to as many patients as possible.We explore Dave's professional background and leadership journey, his vision for OrthoPediatrics, and the company's commitment to education and its vital role in the industry.We delve into challenges like funding and competition, industry-research collaboration, and how surgeons can partner with industry to enhance patient care.We also examine economic and operational considerations, balancing cost, quality, and accessibility. We also discuss a recent paper analyzing pediatric device innovation, highlighting the rarity of such advancements through the FDA process.We conclude with a forward-looking vision of how innovations are improving patient outcomes.

On today’s episode, I talk with Simon Thomas, Consultant Paediatric Orthopaedic Surgeon at the Bristol Royal Hospital for Children. Trained in both the United Kingdom and Canada, including under the legacy of John Wedge and Robert Salter in Toronto, Simon offers a perspective shaped by two systems with different approaches to developmental dysplasia of the hip.We begin by examining how training lineage and institutional norms influence clinical decisions, particularly concerning surgical timing, the use of the Pavlik method, and criteria for progression to open or closed reduction. We discuss the landmark study he co-authored with Wedge and Salter, following patients for over 45 years after open reduction and innominate osteotomy, and what such long-term data can teach us about survival, revision, and functional outcomes. We talk about the strength of the evidence in orthopedic surgery and the reasons for the demise of a prospective randomized control trial set up in the UK, looking at the presence or absence of the ossific nucleus when considering surgical treatment of developmental dislocation of the hip that could not be implemented due to logistics, and turn to his work on the medial approach and how to balance the risk of complications with surgical completeness.Finally, we zoom out and reflect on the broader themes: what defines success in pediatric hip surgery, what a 50-year prospective study should look like, and whether certification diplomas should be widespreadThis episode is a masterclass in long-term thinking, featuring a thoughtful surgeon who has witnessed hips transition from Pavlik harness to total hip replacement.

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.

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.

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. 

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.

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.

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.

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.

On today’s episode, I have the privilege of speaking with Dr. 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 critical issue that impacts all professionals, including orthopedic surgeons—overcommitment and burnout. Dr. Iobst recently experienced a life-changing event that shifted 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 about the dangers of taking on too much. We discuss Overcommitment and people-pleasing, particularly among high-functioning professionals. We talk about Societal pressures and internal motivations that 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 to avoid burnout in their career.

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.

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!

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. 

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.

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.

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. 

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.

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.

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.

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.

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.

This week I recap the most recent episodes and answer some audience questions.

This week I speak with William Morris of the Texas Scottish Rite for Children, in Dallas. He recently published two papers questioning the efficacy of bracing for reducing the incidence of acetabular dysplasia after a closed or open reduction We discuss the treatment of developmental dislocation of the hip by attaining stable reduction whether by closed or open means, and what acetabular dysplasia signifies He talks about the challenges of performing a retrospective study which encompassed over 40 years experience at the Texas Scottish Rite, as well as the difficulties of interpreting handwritten notes in old medical records  We discussed the theoretical benefit of bracing as well as the physiology implied in the development of the hip joint We discuss surgeon preference and prescribing bracing based on acquired dogma rather than proven science We talk about ways to supplement acetabular development other than bracing And we talk about the possibility of setting up a randomized control trial to determine the efficacy of bracing.

This week, I speak with Blaise Nemeth, a pediatric orthopedist affiliated with the University of Wisconsin in Madison. He is one of the few non-operative pediatric orthopedists in the United States also known as NoPos. We talk about the pathway to becoming a non-operative pediatric orthopedist and the value they can bring to benefit patients as well as his career path We discuss practical issues, including the financial aspects of incorporating non-operative orthopedists and advanced practice providers. He explained his approach to diagnosing and managing hip dysplasia in infants and how to integrate other specialties when dealing with complex patients. We examine the bias in most literature regarding Legg Calvé Perthes, where surgeons have typically run research, which creates a bias towards surgical treatment. We discussed slipped capital femoral epiphysis and speculated on the rapid rise in popularity of GLP-1agonists for weight loss and their implications for musculoskeletal medicine, specifically pediatric orthopedic conditions. We also talked about the support structure and networks available to non-operative orthopedists.

In today's episode, I have the honor of speaking with Dr. Stuart Weinstein, a distinguished figure in pediatric orthopedics and a renowned expert in hip dysplasia. Dr. Weinstein's illustrious career includes leadership roles in prominent orthopedic societies and groundbreaking research on the long-term outcomes of various orthopedic conditions.   Our conversation delves into the rich history of orthopedic surgery at the University of Iowa under the initial guidance of Arthur Steindler, exploring its pivotal contributions to our understanding of hip dysplasia spanning over a century. Dr. Weinstein shares insights into the transformative impact of Ignacio Ponseti's contributions to hip dysplasia treatment and reflects on his own extensive career devoted to pediatric orthopedics.   With unparalleled enthusiasm, wisdom, and eloquence, Dr. Weinstein discusses historical perspectives, current best practices, and his vision for the future of treating patients with hip dysplasia, offering a compelling glimpse into the evolving landscape of pediatric orthopedics.

This week, I had the privilege of conversing with Valerie Parrish, a highly accomplished professional in pediatric hip pathology. Valerie is a certified physician assistant at Texas Children's Hospital and has dedicated her career to the specialized area of pediatric orthopedics. Her role as an advanced practice provider has afforded her with unique insights into the job of a physician assistant, the intricacies of pediatric orthopedics, and the efficient management of a practice. We discussed the modern physician assistant movement, how it began, and how it can enhance surgical practices. we talk about both surgical and non-surgical PAs and how they can improve teaching for orthopedic trainees We talked about her education, how she became a PA, and specifically how she became involved in pediatric hip. We discuss managing complex patients with hip dysplasia in clinic and incorporating other healthcare professionals to provide an integral strategy that benefits all. We deliberated on some shared frustrations with Legg Calvé Perthes and how PA involvement can alleviate surgeons' workloads, improving patient care and outcomes. This can also increase the surgical yield of orthopedic clinics, an often-used marker of efficiency. She also talks about how developing professional relationships is a key to success, amongst other topics

This week I speak with Mr. Alexander Aarvold a consultant pediatric orthopedic surgeon in Southampton England.  He has published extensively in the field of hip dysplasia and has recently been advocating for a growth-stimulating procedure to improve the outcomes when treating developmental dislocation of the hip with open reduction by adding a procedure called a pelletoplasty We begin the discussion talking about screening and the fact that despite having a national screening program in England, the rate of late-detected hip dysplasia does not seem to have changed over the last few decades, and he has led efforts to find ways to improve this. We then talk about the risk of radiation from repeated pelvic X-rays, a topic he has researched and which parents are always rightfully concerned about. Most of the discussion was centered around a procedure he has termed the pelletoplasty a technical modification to one of the standard procedures for the surgical treatment of developmental dislocation of the hip, which has resulted in excellent outcomes.  We discuss the efficacy of the procedure, the technical details,how one can learn to do it and maintain proficiency. and we talk about the future of research in hip dysplasia.

This week, I have a conversation with Rafael Sierra, MD, an orthopedic surgeon at the Mayo Clinic in Rochester, Minnesota, who has focused his career on hip preservation as well as hip replacement with a strong focus on hip dysplasia and femoroacetabular impingement. This week's episode is a little longer than typical because we had a lot to discuss. We centered the conversation on three papers he termed the Trident, the first defining the Natural History of osteoarthritis in patients with hip dysplasia and impingement. Then, a paper that discusses how the natural history can be favorably altered by performing a periacetabular osteotomy, and finally, we talk about a paper that describes how to obtain optimal outcomes when performing this procedure We talk about the spectrum of abnormalities that can affect hips, from a shallow acetabulum in dysplasia to over-coverage and impingement We discuss the reasons why some hips become painful, and some don't, including genetics, metabolism, and level of activity. We talk about the evolution of the periacetabular osteotomy since its inception and techniques to improve outcomes. We discussed surgical variability and the level of expertise required for the performance of this procedure. And we talk about the future, including robotics and individualized approaches to complex problems,

This week I speak with Woody Sankar, Professor of Orthopedic Surgery by the Perelman School of Medicine at the University of Pennsylvania and Director of the Hip Preservation Team at the Children's Hospital of Philadelphia   We talk about outcomes of open reduction for developmental dislocation of the hip and the study he recently co-authored, which was the result of a multicentre effort led by the global hip dysplasia registry.   We talk about measuring outcomes for open reduction of developmental dislocation. Focusing on three suboptimal outcomes, Redislocation, proximal femoral growth disturbance, and residual acetabular dysplasia   We talk about surgical volume and variability and the possibility of measuring the quality of surgery   The study indicated that the rate of residual acetabular dysplasia was significantly lower in patients undergoing concomitant pelvic osteotomy, and how this finding must be contextualized.   We discuss the future of research in hip dysplasia, including the possibility of conducting a randomized controlled trial.   Amongst other things

This week, I talk with a true legend in Legg-Calvé-Perthes. Dr Tony Herring from Texas Scottish Rite for Children in Dallas Dr. Herring has had an illustrious career dedicated to helping children with all sorts of musculoskeletal problems. He developed a particular interest in Legg-Calvé-Perthes. Although he has published many articles on the subject, in 2004, he was the lead author in a study that is considered by many to be the landmark study in the understanding and treatment algorithm for patients with this condition. We talk about how he formed a study group in the 1980s, the challenges of putting together such a large multi-center study in an era before e-mail or even fax machines were commonplace. We discuss the development of the lateral pillar classification, commonly known as the Herring classification, and how it has maintained its value as the most important prognostic factor for this condition. He explained how he has been able to review all of the images from the original study by digitizing them and, with the advantage of hindsight, has found new and unexpected changes in these radiographs. We discuss treatment indications and the variability inherent to any surgical intervention. We talk about the role of perfusion MRI in dictating the vascular status of the proximal femoral epiphysis and about future research directions.

This week, we are focusing on Legg-Calvé-Perthes, a condition that continues to frustrate patients, parents, and clinicians despite being described over 115 years ago. I speak with Dan Perry, a pediatric orthopedic surgeon and NIHR research professor at Alder Hey Hospital in Liverpool, England.  We centered the conversation around the results of the British Orthopedic Society Surveillance Study, or BOSS study, on Perthes. We discussed the paper they published in 2022, looking at epidemiology in the United Kingdom. We talk about how dogma and not necessarily scientific evidence have influenced surgical Practice worldwide. He explains how they set up a prospective nested cohort of patients nationwide in the United Kingdom. We discuss the variability in treatment approaches and what led surgeons to intervene while others recommended nonoperative means. We talk about the importance of setting up randomized controlled trials but the inherent difficulties of doing so, especially with surgical interventions. We also look at future directions, amongst other things.

In this episode, I talk with Rick Gardner, a pediatric orthopedic surgeon at SickKids in Toronto. Gardner's rich experience spans various countries, notably with Cure International in Africa, providing surgical care and support to children in underserved communities. We explore our similar motivations for pursuing medicine and commitment to pediatric care, discussing topics such as effective altruism, the importance of scalability and sustainability, and the role of collaboration with local providers, governments, and NGOs. Additionally, we cover the empowerment of local healthcare professionals through training and education, the significance of conducting research with shared resources, and examine the potential for global impact through future collaborations and partnerships in pediatric orthopedic care.

This week marks the 10th episode in this podcast, and today’s episode is different; I thought this would be a good time to take stock of the first nine episodes and discuss future directions. I also thought it would be a good time to catch up on some questions that have come to me through different platforms. I'm very grateful to listeners who have sent in questions related to some of the topics we've brought up and please let me know about topics you'd like to hear about on the podcast.

This week I speak with Emily Schaefer PhD a researcher with the university of British Columbia in Vancouver.    We discuss a paper that she and her team recently published which details the development and implementation of a care pathway for developmental dysplasia of the hip in India.   Li J, Aroojis A, Mulpuri K, Shea KG, Schaeffer EK. Development of a DDH Care Pathway for India: A Study Methodology to Guide Similar Efforts in Other Countries and for Other Conditions. Indian J Orthop. 2021 Oct 22;55(6):1549-1558.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533670/pdf/43465_2021_Article_534.pdf   We discuss the difficulties in developing a pathway and even greater ones when implementing it. We discuss how they involve different stakeholders and got their input and then how to control quality to maintain this project going.   The care pathway was published in the Indian journal of Pediatrics:   Anne RP, Li J, Schaeffer E, Aroojis A, Mulpuri K, Murki S. Care Practices of Indian Pediatricians for the Screening and Diagnosis of Developmental Dysplasia of the Hip. Indian J Pediatr. 2022 Sep;89(9):911-915. doi: 10.1007/s12098-022-04200-5. Epub 2022 Jun 22. PMID: 35731501   https://link.springer.com/article/10.1007/s12098-022-04200-5   We discussed tailoring the pathways to adapt to different settings and the future of collaborative efforts worldwide.

This week, I am speaking with Eduardo Novais, MD. Associate Professor of Orthopedic Surgery at Harvard Medical and part of the Orthopedic Center and the Child and Young Adult Hip Preservation Program at Boston Children’s Hospital We discuss a paper that he recently coauthored: Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction We discuss whether it is possible to predict residual acetabular dysplasia based on post-reduction MRI after closed or open reduction for developmental dislocation of the hip, the logistics of obtaining MRI immediately after a procedure, outcomes and the future of research for hip dysplasia.