Straight From The Hip

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.