November 28, 2025 • 15 mins
Great Debate: Obesity does not need to be optimized prior to Anterior Approach 🚶♂️🦿🩺
Welcome to the AHF podcast! In this episode, host Joe Schwab brings us an engaging and humorous debate on a pivotal question: 'Do we really need to optimize obesity before an anterior hip replacement?' Dr. Nicholas Webber and Dr. Todd Kelley go head-to-head, using props and personal anecdotes to present their cases. Dr. Webber argues against the necessity of optimization, citing his experience with anterior approaches, while Dr. Kelley counters with the merits of patient participation in their own optimization. Tune in for a lively discussion filled with insights, laughter, and a live demonstration. Don't forget to like, subscribe, and share! #AHFPodcast #GreatDebates #AnteriorHipFoundation
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Joseph M. Schwab (00:00):
Hi, this is Joe Schwab and if you recognize
my voice, it's probably becauseyou've heard another episode of
the AHF podcast, which meansyou're listening again, and I
can't tell you how much Iappreciate that.
And because you're listening,again, I want to ask you a
favor, if you could share thispodcast with a colleague or a
(00:24):
friend or somebody you thinkmight be interested in this type
of content.
Or better yet, leave us a reviewon your podcast platform or give
us five stars, or you could doall of those things.
We really appreciate it and ithelps us grow.
Anyway, thank you so much forbeing a listener and a
(00:44):
subscriber to the AHF podcast.
Now let's get on with the show.
(01:05):
Welcome to the AHF podcast.
I'm your host, Joe Schwab.
I've said it before and I'll sayit again.
One of the reasons we host thesegreat debates is because
surgeons are at their best whenthey disagree passionately.
I.
At their funniest when propsstart coming out during the
opening statement.
(01:26):
Today's topic is one of thosequestions every hip surgeon
wrestles with, do we really needto optimize obesity?
Before an anterior hipreplacement, the pro position is
Dr.
Nicholas Webber, a tumorsurgeon, an anterior approach
convert, and a self-describedquote.
"immensivist" and apparentlyproud owner of an alpaca named
(01:50):
after me.
I didn't know this before thedebate, and I'm still kind of
processing that.
Opposing him is Dr.
Todd Kelley, who heard no slidesand decided that meant yes,
props, including but not limitedto pants, coins, a fake pannus,
and a demonstration that I thinkwill live in AHF history.
(02:14):
If you've ever wondered whathappens when serious surgical
philosophy meets a kindergartenpep talk about doing hard
things.
This debate is your answer.
Let's get into it.
I'd like to call to the stage Dr.
Nicholas Webber and Dr.
(02:35):
Todd Kelley, who has come withsome props.
Todd Kelley (02:38):
You said No slides.
No
Joseph M. Schwab (02:39):
slides, but I didn't say anything about no
props.
Alright, position statement: "Obesity..." this is like a (02:42):
undefined
double negative kind of thing.
"Obesity does not need to beoptimized prior to anterior
approach." The pro position, Dr.
Nicholas Webber likes some bigright, likes some big, that's
that's what you're saying.
And Charlie.
Okay.
And the con position, uh, Dr.
(03:03):
Todd Kelley, Dr.
Webber,
Nicholas Webber (03:06):
you guys don't know me, so I'm gonna tell you
about my journey a bit while I'mtelling you about that, because
you may not care.
I want you to think of.
Your three most appreciativepatients, the one that brought
you the most tamales, the onethat brought you the most
chocolate chip cookies, the onethat gave you the biggest
(03:27):
fluffiest hug you've ever had inyour life.
Think of those, and I'm gonnaintroduce myself.
I'm a tumor surgeon.
Uh.
I started doing jointreplacement when I started a
tumor program at a, a bighospital.
And of course, he imported mefrom Wisconsin to give this talk
just to kind of poke more atWisconsin.
Um, when you start a sarcomaprogram, everything's a tumor.
(03:51):
160 pound pannus tumor, a buttthat's dragging behind in a
wheelchair tumor, absolutelyperfectly fine.
Every older partner I had calledme the immensivist.
Perfectly fine being theimmensivist.
So when I got to starting mypractice, I said, okay, I'm
gonna do everything.
(04:11):
That's what everybody says.
And I did everything.
So part of everything is doingeverything that people don't
want to do.
For 15 years, I became this endof the road type of surgeon, all
posterior for 10 years.
So I've been there.
Uh, Ben Domb came and gave atalk, uh, at Aurora and said.
(04:32):
There are all these outliers inthe posterior approach.
I stood up and said, you don'tdo anyone with A BMI under 25,
or excuse me, over 25.
He said, absolutely, yes I do.
I made all these excuses fordoing the anterior approach
three times.
I tried to do the anteriorapproach in my patient
population, which is A BMI ofwho knows, and I'll tell you a
(04:52):
little bit about that the firsttime.
Blood bath.
I don't know what I'm doing.
Why am I a tumor surgeon doingsomething that's so difficult?
Second time, okay, I'll do this.
I stayed up all night thinkingmy of my anterior approach the
next day and I said, why did Ithink about that?
And my osteosarcoma resection, Ididn't think about, forget it.
(05:13):
My one kind of take home tothose of you who are posterior
surgeons, have someone come andvisit you, teach you how to do
an anterior approach.
Someone did that to me, changedmy life and I'm gonna really get
into things.
I have an alpaca at home namedJoe Schwab, not necessarily
'cause Joe Schwab helped me dothat, but he may have.
So to the question, I don't knowif you have a kindergartner in
(05:34):
kindergarten, they say, can youdo hard things?
I changed from being a pureorthopedic surgeon to a dad, and
I want my kids to know you cando hard things.
We have more and more literaturesaying yes, there are still
complications with.
Obese patients, however, istheir patient satisfaction the
(05:55):
same?
Yes.
Is it better?
Maybe not.
Do we have problems withincisions?
Absolutely.
Do we have problems withincisions in little old ladies
who have really thin skin?
Do we have problems in women whohave had C-sections?
A hundred percent there areproblems.
Is that a reason to say obesityneeds to be optimized?
What does that even mean?
(06:15):
Think of A BMI of 37, big strongconstruction worker.
Think of a BMI of 47, someonewhose belly you can tape to the
side do a perfect approach.
I don't have a problem doing anyof that.
We can change their BMI, we canchange all the controllable
factors, but in real life, doesit need to be optimized?
(06:37):
The answer is no.
And Dr.
Kelley, you and your kids, theycan do hard things.
Joseph M. Schwab (06:44):
Four minutes.
Todd Kelley (06:46):
Alright, sir, we're going South side Chicago on you
here.
Right here.
Right here.
Alright.
Tell a little story first.
Medical College of Wisconsin.
I'm on an interview forresidency.
Interviewer asks me, hands me asack of coins, says, reach in
there, count up, tally up thosecoins.
I say All, all right, startdoing it.
(07:07):
And uh, the idea is, okay, yougotta figure out what you're
doing with your hands.
You've gotta communicate, yougotta think all at the same
time.
So I'm gonna challenge you to,let's do this anterior style.
Come on over here.
These are my pants.
They're, they're relativelyclean.
I want you to reach in my frontpocket there and count up those
coins and tally'em up.
(07:27):
And let's see what you get.
Now all you guys are thinking,where's he going with this?
Right?
No, no, no.
You can't look at it.
We're doing hard things here.
We're doing hard things.
You gotta feel it.
You gotta feel it.
You gotta feel it.
What do you got there?
Come on.
I only got four minutes here.
Nicholas Webber (07:42):
We got, we got a quarter here.
50 cents.
Todd Kelley (07:45):
You're too slow.
Nicholas Webber (07:46):
60.
65 cents.
Todd Kelley (07:49):
60.
Brilliant.
You can, you can count, you cando math.
Alright.
Wow.
Here we go.
Um, now this, this pair of pantshere, there's a little extra
tissue in here.
You can just throw these on thefloor.
I'll, I'll clean it up.
I'm gonna ask you to reach inand do that same task, anterior
(08:10):
style.
Now, while you're doing that,I'm gonna tell another story
here.
Um, early in my career, I go toa Matta course and I ask Matta,
Hey, I, I need some advice onobese patients.
How, how do I, how do I navigatethis?
And, and Dr.
Matta, you know, he's pretty,he's pretty blunt.
He says.
He says, yeah, just tell'emthey're too fat.
They'll go away.
(08:30):
Right?
So that didn't work for me.
So here's my discussion with,with, with obese patients.
You doing okay?
Yeah.
Here's my discussion with obesepatients.
I say, listen, I, I, we're gonnado a good job for you, but I, I,
I need you.
Help me help you.
Right?
We, we ask smokers to quitsmoking.
We ask diabetics to, to work ontheir blood sugar.
(08:54):
I, I tell them, Hey, we're gonnado a good surgery for you, but I
ask you, I ask you to lose alittle bit of weight.
Let's come back in a couple ofweeks and and we'll see where
we're at.
Plenty of research out therethat, that looks at.
Oh, you know what I, I forgot.
I forgot.
The pan is here.
We're gonna hang this pannus uphere too.
Alright, now, now you mentionedyou can get through this pannus
(09:15):
here, right?
So CORR, CORR study 2023 lookedat how low that pannus hangs on
an x-ray.
Higher, uh, higher risk of woundcomplications, higher risk of,
uh, infections, higher risk offractures when there's a pannus
in your way there and you here,just tape that here, just tape
that up and out of your way.
(09:36):
You can just tape that pannusup.
You just keep working there.
And, um.
So plenty of research that looksat higher risk of infection,
higher risk of DVT, higher riskof fracture in obese patients.
If we don't, and we're justtalking about modifying, we're
just talking about optimizing'em.
And I think it's reallyimportant to say here, we
(09:58):
optimizing their care is notdelaying their care.
It's not denying them care.
It is just ensuring that theyhave a good outcome.
Alright.
My, my second point, the reasonI'm doing this is, is to show
you that yes, this is hard andyes, we can do hard things, but
I don't think we can do our bestat it.
Right.
I mean, he, I don't know thatyou even found a coin in there.
(10:20):
I certainly do.
Right, right.
So, so, you know, this is hardand I think we can make errors
if we're not optimizing ourpatient.
The other thing is, is you know,there's a lot of research out
there that looks at you.
We know joint replacementsurgeons, there's a high
physiologic load doing obeseanterior approach, um, higher,
uh, or, uh, orthopedic load onon us.
(10:42):
So I think you have to thinkabout yourself here a little bit
too.
These are
Joseph M. Schwab (10:46):
get through one minute rebuttal.
Nicholas Webber (10:49):
So here's what happens when you tell patients
to optimize their body massindex.
What happens is they diet, theygo on wegovy.
And what happens is that.
Your pannus goes away, right?
Everything that you need to getout of your way to do an
anterior approach goes away ahundred percent.
It does not if their pannushangs to their knees.
(11:13):
My wife is here and I, and Ilove her, and we drive by this
farm every day, and this guy'spannus.
He hangs down to his knees.
I made him lose weight.
I did the 10% thing.
And he did, and I think he lostit from his shoulders.
So I'm almost positive, almostpositive.
I wanna optimize body massindex, but it's not necessarily
(11:33):
optimizable.
You have to treat thesepatients.
I have to treat patients withosteosarcomas.
If they're BMI is 70, we're in asimilar situation.
There are people that are justas debilitated by their
arthritis as they are by theirosteosarcoma.
In one way or another, we gottado what we gotta do.
Joseph M. Schwab (11:49):
One minute rebuttal.
Todd Kelley (11:50):
I'm gonna take you through another scenario.
You got two patients.
One patient comes into youroffice, their BMI is 40 and they
say, doc, you gotta help me.
Give me some pain meds, do mysurgery.
I I, I need to get this done.
And I give them that sameconversation, come back in two
months, lose weight.
Their BMI starts at 40.
I got another patient whose BMIcomes in at 42 and I give them
(12:11):
that same instruction.
Now this one comes back with aBMI now of 40, so now they're
both at 40.
Right.
Which one do you think is gonnado better with that surgery?
Same.
Otherwise, I think if you plugthat into Christoph's algorithm,
you're gonna see that thispatient who did lose some weight
(12:31):
and optimize their care does alittle bit better.
And, and the reason is thepsychological term for that is
called locus of control.
One has an external locus ofcontrol.
They want someone else to dosomething for them.
The other has an internal locusof control.
They are able to kind of takecontrol and do some things for
themselves to get them in abetter position to go that
surgery.
(12:52):
Thank you.
Joseph M. Schwab (12:52):
Thank you, gentlemen.
Excellent debate.
Excellent.
For all the humor in thisdebate, and there was a generous
amount, including a livedemonstration of anterior
approach coin retrieval throughtwo layers of pants.
Both Dr.
Webber and Dr.
Kelly were wrestling with thesame fundamental question.
(13:12):
How do we give high riskpatients the safest path forward
without judging, delaying orabandoning them?
Dr.
Webber reminded us that somepatients just need someone
willing to take on a hard case.
Dr.
Kelly reminded us that askingpatients to participate in their
own optimization is part ofcompassionate care.
(13:36):
Both of them reminded us thatpannus height apparently matters
more than any of us learned inresidency.
No matter which side you leantoward.
It all comes back to thepatient, their pain, their
goals, their effort, and yes,maybe even their sense of humor.
(13:56):
Thank you for listening to thisepisode of the AHF podcast.
As always, please take a momentto like and subscribe so we can
keep the lights on and keepsharing great content just like
this.
Please also drop any topic ideasor feedback in the comments
below.
You can find the AHF podcast onApple Podcasts, Spotify, or in
(14:21):
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation.
One word, episodes of the AHFPodcast come out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
(14:42):
and pannuses happy and healthy.
Hi, this is Joe Schwab and if you recognize
my voice, it's probably becauseyou've heard another episode of
the AHF podcast, which meansyou're listening again, and I
can't tell you how much Iappreciate that.
And because you're listening,again, I want to ask you a
favor, if you could share thispodcast with a colleague or a
(00:24):
friend or somebody you thinkmight be interested in this type
of content.
Or better yet, leave us a reviewon your podcast platform or give
us five stars, or you could doall of those things.
We really appreciate it and ithelps us grow.
Anyway, thank you so much forbeing a listener and a
(00:44):
subscriber to the AHF podcast.
Now let's get on with the show.
(01:05):
Welcome to the AHF podcast.
I'm your host, Joe Schwab.
I've said it before and I'll sayit again.
One of the reasons we host thesegreat debates is because
surgeons are at their best whenthey disagree passionately.
I.
At their funniest when propsstart coming out during the
opening statement.
(01:26):
Today's topic is one of thosequestions every hip surgeon
wrestles with, do we really needto optimize obesity?
Before an anterior hipreplacement, the pro position is
Dr.
Nicholas Webber, a tumorsurgeon, an anterior approach
convert, and a self-describedquote.
"immensivist" and apparentlyproud owner of an alpaca named
(01:50):
after me.
I didn't know this before thedebate, and I'm still kind of
processing that.
Opposing him is Dr.
Todd Kelley, who heard no slidesand decided that meant yes,
props, including but not limitedto pants, coins, a fake pannus,
and a demonstration that I thinkwill live in AHF history.
(02:14):
If you've ever wondered whathappens when serious surgical
philosophy meets a kindergartenpep talk about doing hard
things.
This debate is your answer.
Let's get into it.
I'd like to call to the stage Dr.
Nicholas Webber and Dr.
(02:35):
Todd Kelley, who has come withsome props.
Todd Kelley (02:38):
You said No slides.
No
Joseph M. Schwab (02:39):
slides, but I didn't say anything about no
props.
Alright, position statement: "Obesity..." this is like a (02:42):
undefined
double negative kind of thing.
"Obesity does not need to beoptimized prior to anterior
approach." The pro position, Dr.
Nicholas Webber likes some bigright, likes some big, that's
that's what you're saying.
And Charlie.
Okay.
And the con position, uh, Dr.
(03:03):
Todd Kelley, Dr.
Webber,
Nicholas Webber (03:06):
you guys don't know me, so I'm gonna tell you
about my journey a bit while I'mtelling you about that, because
you may not care.
I want you to think of.
Your three most appreciativepatients, the one that brought
you the most tamales, the onethat brought you the most
chocolate chip cookies, the onethat gave you the biggest
(03:27):
fluffiest hug you've ever had inyour life.
Think of those, and I'm gonnaintroduce myself.
I'm a tumor surgeon.
Uh.
I started doing jointreplacement when I started a
tumor program at a, a bighospital.
And of course, he imported mefrom Wisconsin to give this talk
just to kind of poke more atWisconsin.
Um, when you start a sarcomaprogram, everything's a tumor.
(03:51):
160 pound pannus tumor, a buttthat's dragging behind in a
wheelchair tumor, absolutelyperfectly fine.
Every older partner I had calledme the immensivist.
Perfectly fine being theimmensivist.
So when I got to starting mypractice, I said, okay, I'm
gonna do everything.
(04:11):
That's what everybody says.
And I did everything.
So part of everything is doingeverything that people don't
want to do.
For 15 years, I became this endof the road type of surgeon, all
posterior for 10 years.
So I've been there.
Uh, Ben Domb came and gave atalk, uh, at Aurora and said.
(04:32):
There are all these outliers inthe posterior approach.
I stood up and said, you don'tdo anyone with A BMI under 25,
or excuse me, over 25.
He said, absolutely, yes I do.
I made all these excuses fordoing the anterior approach
three times.
I tried to do the anteriorapproach in my patient
population, which is A BMI ofwho knows, and I'll tell you a
(04:52):
little bit about that the firsttime.
Blood bath.
I don't know what I'm doing.
Why am I a tumor surgeon doingsomething that's so difficult?
Second time, okay, I'll do this.
I stayed up all night thinkingmy of my anterior approach the
next day and I said, why did Ithink about that?
And my osteosarcoma resection, Ididn't think about, forget it.
(05:13):
My one kind of take home tothose of you who are posterior
surgeons, have someone come andvisit you, teach you how to do
an anterior approach.
Someone did that to me, changedmy life and I'm gonna really get
into things.
I have an alpaca at home namedJoe Schwab, not necessarily
'cause Joe Schwab helped me dothat, but he may have.
So to the question, I don't knowif you have a kindergartner in
(05:34):
kindergarten, they say, can youdo hard things?
I changed from being a pureorthopedic surgeon to a dad, and
I want my kids to know you cando hard things.
We have more and more literaturesaying yes, there are still
complications with.
Obese patients, however, istheir patient satisfaction the
(05:55):
same?
Yes.
Is it better?
Maybe not.
Do we have problems withincisions?
Absolutely.
Do we have problems withincisions in little old ladies
who have really thin skin?
Do we have problems in women whohave had C-sections?
A hundred percent there areproblems.
Is that a reason to say obesityneeds to be optimized?
What does that even mean?
(06:15):
Think of A BMI of 37, big strongconstruction worker.
Think of a BMI of 47, someonewhose belly you can tape to the
side do a perfect approach.
I don't have a problem doing anyof that.
We can change their BMI, we canchange all the controllable
factors, but in real life, doesit need to be optimized?
(06:37):
The answer is no.
And Dr.
Kelley, you and your kids, theycan do hard things.
Joseph M. Schwab (06:44):
Four minutes.
Todd Kelley (06:46):
Alright, sir, we're going South side Chicago on you
here.
Right here.
Right here.
Alright.
Tell a little story first.
Medical College of Wisconsin.
I'm on an interview forresidency.
Interviewer asks me, hands me asack of coins, says, reach in
there, count up, tally up thosecoins.
I say All, all right, startdoing it.
(07:07):
And uh, the idea is, okay, yougotta figure out what you're
doing with your hands.
You've gotta communicate, yougotta think all at the same
time.
So I'm gonna challenge you to,let's do this anterior style.
Come on over here.
These are my pants.
They're, they're relativelyclean.
I want you to reach in my frontpocket there and count up those
coins and tally'em up.
(07:27):
And let's see what you get.
Now all you guys are thinking,where's he going with this?
Right?
No, no, no.
You can't look at it.
We're doing hard things here.
We're doing hard things.
You gotta feel it.
You gotta feel it.
You gotta feel it.
What do you got there?
Come on.
I only got four minutes here.
Nicholas Webber (07:42):
We got, we got a quarter here.
50 cents.
Todd Kelley (07:45):
You're too slow.
Nicholas Webber (07:46):
60.
65 cents.
Todd Kelley (07:49):
60.
Brilliant.
You can, you can count, you cando math.
Alright.
Wow.
Here we go.
Um, now this, this pair of pantshere, there's a little extra
tissue in here.
You can just throw these on thefloor.
I'll, I'll clean it up.
I'm gonna ask you to reach inand do that same task, anterior
(08:10):
style.
Now, while you're doing that,I'm gonna tell another story
here.
Um, early in my career, I go toa Matta course and I ask Matta,
Hey, I, I need some advice onobese patients.
How, how do I, how do I navigatethis?
And, and Dr.
Matta, you know, he's pretty,he's pretty blunt.
He says.
He says, yeah, just tell'emthey're too fat.
They'll go away.
(08:30):
Right?
So that didn't work for me.
So here's my discussion with,with, with obese patients.
You doing okay?
Yeah.
Here's my discussion with obesepatients.
I say, listen, I, I, we're gonnado a good job for you, but I, I,
I need you.
Help me help you.
Right?
We, we ask smokers to quitsmoking.
We ask diabetics to, to work ontheir blood sugar.
(08:54):
I, I tell them, Hey, we're gonnado a good surgery for you, but I
ask you, I ask you to lose alittle bit of weight.
Let's come back in a couple ofweeks and and we'll see where
we're at.
Plenty of research out therethat, that looks at.
Oh, you know what I, I forgot.
I forgot.
The pan is here.
We're gonna hang this pannus uphere too.
Alright, now, now you mentionedyou can get through this pannus
(09:15):
here, right?
So CORR, CORR study 2023 lookedat how low that pannus hangs on
an x-ray.
Higher, uh, higher risk of woundcomplications, higher risk of,
uh, infections, higher risk offractures when there's a pannus
in your way there and you here,just tape that here, just tape
that up and out of your way.
(09:36):
You can just tape that pannusup.
You just keep working there.
And, um.
So plenty of research that looksat higher risk of infection,
higher risk of DVT, higher riskof fracture in obese patients.
If we don't, and we're justtalking about modifying, we're
just talking about optimizing'em.
And I think it's reallyimportant to say here, we
(09:58):
optimizing their care is notdelaying their care.
It's not denying them care.
It is just ensuring that theyhave a good outcome.
Alright.
My, my second point, the reasonI'm doing this is, is to show
you that yes, this is hard andyes, we can do hard things, but
I don't think we can do our bestat it.
Right.
I mean, he, I don't know thatyou even found a coin in there.
(10:20):
I certainly do.
Right, right.
So, so, you know, this is hardand I think we can make errors
if we're not optimizing ourpatient.
The other thing is, is you know,there's a lot of research out
there that looks at you.
We know joint replacementsurgeons, there's a high
physiologic load doing obeseanterior approach, um, higher,
uh, or, uh, orthopedic load onon us.
(10:42):
So I think you have to thinkabout yourself here a little bit
too.
These are
Joseph M. Schwab (10:46):
get through one minute rebuttal.
Nicholas Webber (10:49):
So here's what happens when you tell patients
to optimize their body massindex.
What happens is they diet, theygo on wegovy.
And what happens is that.
Your pannus goes away, right?
Everything that you need to getout of your way to do an
anterior approach goes away ahundred percent.
It does not if their pannushangs to their knees.
(11:13):
My wife is here and I, and Ilove her, and we drive by this
farm every day, and this guy'spannus.
He hangs down to his knees.
I made him lose weight.
I did the 10% thing.
And he did, and I think he lostit from his shoulders.
So I'm almost positive, almostpositive.
I wanna optimize body massindex, but it's not necessarily
(11:33):
optimizable.
You have to treat thesepatients.
I have to treat patients withosteosarcomas.
If they're BMI is 70, we're in asimilar situation.
There are people that are justas debilitated by their
arthritis as they are by theirosteosarcoma.
In one way or another, we gottado what we gotta do.
Joseph M. Schwab (11:49):
One minute rebuttal.
Todd Kelley (11:50):
I'm gonna take you through another scenario.
You got two patients.
One patient comes into youroffice, their BMI is 40 and they
say, doc, you gotta help me.
Give me some pain meds, do mysurgery.
I I, I need to get this done.
And I give them that sameconversation, come back in two
months, lose weight.
Their BMI starts at 40.
I got another patient whose BMIcomes in at 42 and I give them
(12:11):
that same instruction.
Now this one comes back with aBMI now of 40, so now they're
both at 40.
Right.
Which one do you think is gonnado better with that surgery?
Same.
Otherwise, I think if you plugthat into Christoph's algorithm,
you're gonna see that thispatient who did lose some weight
(12:31):
and optimize their care does alittle bit better.
And, and the reason is thepsychological term for that is
called locus of control.
One has an external locus ofcontrol.
They want someone else to dosomething for them.
The other has an internal locusof control.
They are able to kind of takecontrol and do some things for
themselves to get them in abetter position to go that
surgery.
(12:52):
Thank you.
Joseph M. Schwab (12:52):
Thank you, gentlemen.
Excellent debate.
Excellent.
For all the humor in thisdebate, and there was a generous
amount, including a livedemonstration of anterior
approach coin retrieval throughtwo layers of pants.
Both Dr.
Webber and Dr.
Kelly were wrestling with thesame fundamental question.
(13:12):
How do we give high riskpatients the safest path forward
without judging, delaying orabandoning them?
Dr.
Webber reminded us that somepatients just need someone
willing to take on a hard case.
Dr.
Kelly reminded us that askingpatients to participate in their
own optimization is part ofcompassionate care.
(13:36):
Both of them reminded us thatpannus height apparently matters
more than any of us learned inresidency.
No matter which side you leantoward.
It all comes back to thepatient, their pain, their
goals, their effort, and yes,maybe even their sense of humor.
(13:56):
Thank you for listening to thisepisode of the AHF podcast.
As always, please take a momentto like and subscribe so we can
keep the lights on and keepsharing great content just like
this.
Please also drop any topic ideasor feedback in the comments
below.
You can find the AHF podcast onApple Podcasts, Spotify, or in
(14:21):
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation.
One word, episodes of the AHFPodcast come out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
(14:42):
and pannuses happy and healthy.
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