October 17, 2025 • 38 mins
Innovating Orthopedics: Dr. Stefan Kreuzer's Journey
Join host Joe Schwab on the AHF Podcast as he interviews Dr. Stefan Kreuzer, an orthopedic hip and knee surgeon in Houston and founder of INOV8 Orthopedics. Dr. Kreuzer shares his fascinating journey from growing up in Switzerland to becoming a champion of minimally invasive techniques in the United States. They discuss his dyslexia diagnosis, his passion for technology in the operating room, and his innovative approaches to anterior approach hip replacement. Dr. Kreuzer also talks about his personal philosophy on continuous learning and the importance of optimizing surgeon performance. Don’t miss this insightful conversation that delves into the intersection of technology and healthcare, and how it can improve patient outcomes. 📈💼🦾 #AnteriorApproachTotalHip #AHF #InnovationInMedicine
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Joseph M. Schwab (00:22):
Hello, and welcome again to the AHF
Podcast.
I'm your host, Joe Schwab.
My guest today is Dr.
Stefan Kreuzer an orthopedic,hip and knee surgeon in Houston,
and founder of INOV8Orthopedics, a Houston based
orthopedics and sports medicinefacility.
He was born and raised inSwitzerland, but living in the
(00:44):
United States for the past 40years.
He's well known and wellrespected for with minimally
invasive approachesincorporating robotics
navigation technologies, andbeing a champion for outpatient
total joint arthroplasty.
Stefan, welcome to the AHFPodcast.
Stefan Kreuzer (01:06):
Thanks so much for including me.
Joseph M. Schwab (01:08):
So I gave a little bit of background to our
listeners, but I think they'dlike to hear from you directly a
little bit about how you endedup where you are.
Tell us your story.
Stefan Kreuzer (01:19):
Yeah, so it's an interesting journey.
Um, as you mentioned, I grew upin Switzerland.
I was actually born in Austria,and when I was 15, my, uh, dad
decided to, uh, explore otheroptions in his career, and we
moved to Vancouver, Canada.
I did, uh, high school there,finished my, uh, 12th grade in
high school and then wasfortunate enough to be recruited
(01:40):
as a, uh.
A tennis player to play collegetennis into Texas, then did four
years of college tennis.
Had a little bit of a hard timegetting into medical school at
the time because as you know,I'm a dyslexic and I didn't do
very well in the mcat, so I tooka little left-hand turn and
ended up going to graduateschool and then, uh uh, did four
(02:01):
years of molecular biology andbiochemistry.
And then improved my MCAT scorealso improved my, you know,
being a, uh, having a, aMaster's of Science and
biochemistry, and then got intomedical school in San Antonio.
Then, uh, got into residency todo orthopedics in Galveston.
Did for five years of, uh,orthopedics.
(02:22):
Then did my fellowship at BaylorCollege of Medicine, and then
started hanging a shingle andstarted swinging.
Joseph M. Schwab (02:29):
And you've been in practice, basically in
private practice ever since, isthat right?
Stefan Kreuzer (02:34):
No, actually I, I'm not, I was in private
practice for a long time, thenbecame employed.
About 15 years ago and did thatfor five or six years, and that
was clearly not for me.
And then made the very difficulttransition out of employment,
back into private practice, notjoining a group, just starting
(02:56):
from scratch.
So that was an interestingjourney.
I went from a, the fourthhighest paid employee in the UT
System, university of Texassystem.
To being leveraged to thehealth, borrow money from the
bank to, uh, build an outpatienttotal joint center, starting a
practice, you know, buyingcomputers, negotiating contracts
(03:17):
with payers, and, uh, you know,rolled up my sleeve, started
working very hard, and then itwas probably the hardest things
I, I ever did.
But now we're doing great.
Uh, we're doing great from aculture standpoint, from a
workflow standpoint, from apatient satisfaction standpoint,
and also financially, we'vedefinitely caught up in, in
doing quite well.
Joseph M. Schwab (03:37):
I want to get into your practice a little bit
more in a little bit, but youmentioned something in the
introduction about dyslexia andmy understanding is how you came
about your understanding ofbeing dyslexic.
It wasn't something you knew atthe time, is that right?
Stefan Kreuzer (03:53):
That's correct.
It was sort of interesting.
We, we were actually at ASChoolfunction, uh, of my daughter and
she went to a Montessori schooland there was, um, a handout
there that was written by NobelPrize Laureate about dyslexia,
and my wife picked it up.
And, uh, she read it and it sortof described me to a T.
So she actually came up with theidea, well, maybe, maybe the
(04:14):
reason why you can't read isbecause you're dyslexic.
And so she read it to me since Ican't read.
And um, it sort of reallydescribed sort of my.
My gifts and my challenges, andat the time I was already
successful, so I, I reallydidn't, didn't think more of it.
Um, a few years later I had apatient that had, I did both for
(04:35):
hip replacements and she's apsychologist who has, uh, uh.
A testing center for childrenwith learning disability.
And so we got into aconversation and asked her if
you can be tested as a, as anadult, because I didn't wanna
say that I'm a dyslexic, neverreally officially having been
tested.
And she says, oh, absolutely.
So I, I went to her testingcenter and it was.
(04:57):
Two tests and then sure enoughit came back.
Severe dyslexia, you know, mostpeople read around two 50 to
three 50 words a minute.
I clock that at 89 words aminute with a reading
comprehension of 51%, whichpretty much means you, you can't
read very well.
Joseph M. Schwab (05:14):
So tell me a little bit about how that was a
challenge for you.
it, it, it, obviously I canperceive how there might have
been challenges growing up, buthow did you deal with it before
you understood you were, youknow, trying to make your way
through this world with thiscondition of dyslexia?
Stefan Kreuzer (05:33):
Yeah, I mean, many ways the main challenge,
the main effort was, was just.
Working harder, right?
So I just had to work twice ashard to get things accomplished.
And I tried all kinds oftechniques.
I don't know if you remember allin the old days, the bubble
diagrams, um, on, on how tolearn stuff, right?
And so, because I'm more visualthan a linear thinker, I don't
(05:56):
know how many bubble diagrams Ihad put together in order to
study.
And I just put in more effort.
You know, on the one hand, whenit came to reading, I struggled.
But then on the other areawhere.
Where, like for example in math,that was extremely easy for me.
Calculus was easy.
Algebra was easy.
So I, I had to spend very littleeffort to understand those
concepts, which gave me the timeto spend more effort when I had
(06:18):
to read a book or write anessay.
And then I got a lot of helpfrom people around me.
'cause, um, I just, I justcouldn't write very well.
Joseph M. Schwab (06:27):
And when you came away with this diagnosis.
Um, how has your approach tolearning changed since then?
I mean, you're an adult learnerat this point, right?
Um, but how has your approach tolearning new information,
learning new skills,assimilating new medical
information, how has thatchanged?
Stefan Kreuzer (06:48):
Great question, and now that I think about it,
you asking that question, thereare probably two technologies
that have really been incrediblyinstrumental to me as a person.
One was audible books.
Um, you know that that startedprobably about 15 years ago and
I'm extremely interested inthings, but I just couldn't read
(07:09):
very well.
So it was very difficult for meto read a book.
And once Audible came out, I gotan account and I was just
inhaling books.
I mean, there wasn't a week thatdidn't go by where I didn't read
a listen to a book.
And it just opened up a new eraof, of knowledge to me that that
did not exist before.
Came to business, whether itcame to personal health.
(07:32):
Uh, so that was oneinstrumental, um, technology
that really helped me as adyslexic a great deal.
And now, uh, ai, AI is just forme, is amazing.
I mean, I'm on chat GBTconstantly, uh, writing
documents and, and, andcollecting thoughts and using
to, to brainstorm to really putmy ideas.
(07:55):
Down the words because that wasthe biggest challenge.
Um, you know, I'm not a texter.
I'm not an emailer.
Uh, I like to talk on the phone,but nowadays everybody texts,
you know, you call somebody theydon't pick up, but they'll send
you a text back.
Um, you know, I like havingconversations like, hence the
podcast today, which I really,uh, I know I enjoy.
But using chat GPT to kind oftake my thoughts and putting
(08:19):
them down the paper has beenreally amazing for me.
Joseph M. Schwab (08:23):
So you seem really comfortable with
technology and, and looking at,you know, your history, looking
at how you have grown as anorthopedic surgeon.
Clearly your cv.
You don't shy away fromtechnology in the operating room
either.
Um, I, I would like to talk toyou a little bit about how you
got involved in anteriorapproach, which I think was
(08:45):
around 20 years ago at thispoint, right?
Mm-hmm.
Stefan Kreuzer (08:48):
It was 2003.
So it's been, uh, 20, 21 years.
2 22 years.
Yeah.
Um, I think that's another oneof those things that I think
dyslexia helped me is, you know,when I learned about the
anterior approach from a visualstandpoint, from a a 3D
standpoint, it.
Made so much sense to me and ingeneral when it comes to
technology, I think I canassimilate fairly quickly
(09:10):
whether something makes senseand it's gonna work or if
something is not gonna makesense.
And so I think that has kind ofgiven me an edge on, in
orthopedics of.
Sort of figuring out what is thetechnology, what are the
approaches that makes sense.
And that's how I got into energyapproach, hip replacement.
Uh, I remember I watched JoelMatta give a talk on it, and
when he mentioned when he, whenhe gave the talk, I says, oh, I
(09:32):
need to learn how to do this.
And then, you know, a monthlater I was in his operating
room observing and then cameback home and, and started
swinging.
Uh, that was back before we hadany courses or anything.
In fact, I had the, I think Ihad the fourth OSI table that
came off the assembly line, uh,to, uh, to perform anterior
approach, hip replacement, um,and then other things like
(09:55):
robotics.
You know, I remember I wasmeeting with Martin Roche who
mentioned about the Mako robot,and I think I had the third Mako
robot in my operating room thatcame off the assembly line.
That made a lot of sense to me.
And so in that area, I think,um, I've excelled because of my
dyslexia more than anything.
Joseph M. Schwab (10:14):
And it sounds like you have gravitated towards
this technology early.
You don't ever seem to be fullysatisfied with one technology.
What I observe is that youcontinue to strive for bigger,
better, faster, stronger.
Uh, tell me a little bit aboutyour sort of central philosophy
around how you pick and chooseand grow with technology.
Stefan Kreuzer (10:37):
Yeah, I think when, when you adopt technology.
You.
You quickly learn of what is avalue add and what is a
challenge.
And I think by continuouslyrethinking on how you're doing
things, when you then getexposed to a new technology, you
immediately realize, oh, this isgonna fix the problem that I'm
(11:00):
currently facing.
And I think that's how I'veprogressed from one navigation
system to the next, from onerobotic system to the next.
Um, and I just continuously tryto push on how we can do a
little bit better, uh, for ourpatients.
Joseph M. Schwab (11:17):
You had a, a publication about, value of, of
introspection specifically in,in adopting new techniques,
early parts learning curve.
Was that something that youlearned from surgery and you,
uh, applied it to, uh, yourtechnology, robotics, things
(11:37):
like was it something that youhad inherent to yourself maybe
the way you, uh, grew up in youreducation?
That you brought to medicine,how, how did you develop that
philosophy?
Stefan Kreuzer (11:50):
It's a good question.
I'm not sure that I couldpinpoint to, to exactly one
event other than early on in mylife.
My father once told me an openmind is the highest form of
intelligence.
Hmm.
And so I've always tried to usethat and it's been part of my
email on the bottom for a long,long time.
Um, because you.
(12:14):
You think you know it all, butyou really don't.
And as you learn more, you'veactually realized how little you
know.
So I always feel like knowledgeis not.
It's not a, a pyramid, it's anupside down pyramid.
And so as, and, and to me thatwas very real when I started
(12:34):
reading a lot or listening toaudio books because that really
expanded my knowledge base.
And that sort of created,created this hunger for more and
more knowledge.
And so I think that may be partof the, the, the, uh, growth
that I went through in, in my.
Early forties, uh, by havingbeen exposed to that knowledge
(12:58):
base where I just got so hungryof learning more because I was
deprived of this for 40 years ofmy life because I couldn't read.
And, and maybe that's what sortof pushed me to always try to do
better and always try to learnmore.
Um, even now it's, I mean.
Today I've had three calls withstartup companies about new
stuff that could be incorporatedinto the workflow in our clinic.
(13:21):
So it's, it's just a reallyexciting time.
Joseph M. Schwab (13:24):
In a recent conversation you had.
Um, you had a quote, um, that,that I just thought I would, I
would ask you about.
You said a better tool will makea better person.
So you had three companies todaycontract, uh, contacting you in
theory, offering you a bettertool.
Um.
What tools may, uh, I'll askthis in sort of two parts.
(13:46):
What tools do you wish you had,um, back when you were in your
training that would make you abetter surgeon?
And what tools do you wish youhave now going forward to
deliver better for yourpatients?
Stefan Kreuzer (14:01):
It worked better to back then, um, I wish I had
audible books textbooks inschools because that was
torture.
Trying to read textbooks.
Uh, you know, I spent, Ibasically got my mail at the
library'cause I spent so muchtime at the library.
So back then, I think.
The educational process was notvery conducive to people with
(14:23):
dyslexia.
It just, we just sort of had tobear it and, and, and go through
it moving forwards.
Uh.
Just like Charlie DeCook whostarted the Anterior Hip
Foundation, I very much focus onefficiency and improving
workflow, and so I'm hoping thatAI tools, which is one of the
companies we have had aconversation with and virtual
(14:47):
reality tools from aneducational standpoint, which is
another company we had aconversation with, that this can
improve my efficiency in, indelivering.
Care to my patients because asI'm sure you know, he,
healthcare delivery system isnot optimal, especially in the
United States.
It's very scatterbrained.
It's very cumbersome.
It's, it's, it's, it's not a,there's so many different
(15:10):
technologies that don't talk toeach other.
You don't have, the EMRs, don'thave APIs.
It's very frustrating'causeyou're always putting bandaids
on trying to improve yourworkflow.
So I think moving forward withAI and with some of these newer
technologies of delivering.
Educational, uh, content will bevery instrumental in improving
patient care.
Joseph M. Schwab (15:32):
Focusing the technology conversation a little
bit more on anterior approach,hip replacement.
In your experience, becauseyou've been at this 20 years, if
you were to identify of thesingle biggest contribution or
greatest contribution oftechnology to the way we do
anterior hip replacement today,what would that be and why?
Stefan Kreuzer (15:56):
Yeah, so two technology that I think have
really made, uh, the anteriorapproach hip replacement more
predictable.
And, you know, just as a matterof disclosure, I obviously have
a biased view.
I think that.
A table, um, you know, I'm partof INOV8 Orthopedic Technology
and we make a table attachment.
OSI makes the HANA table.
(16:17):
So I think a, a positioningdevice that allows the, the leg
to be positioned in a certainway that it makes it easy to
access the femur has been veryinstrumental in reducing the
learning curve and probably alsoreducing the risk of, of
complications.
Now there are many surgeons todo without a table extremely
well.
(16:37):
I happened to be in the campthat I think at table was one of
the technologies that hasimproved that approach.
And to me.
Currently, uh, I use anavigation system that is CT
based.
Uh, and, uh, that to me, uh,called NaviSwiss and that to me
has been extremely, uh,instrumental in making the
surgery very predictable becausewe do the vast majority of the
(17:00):
surgeons in an ASC andambulatory surgery center, uh,
from an inventory management andfrom a predictability.
For us, that's extremelyimportant because we don't have
the resources a hospital does,and so.
Before I go to the operatingroom, I'm, I know what cup size,
what femur size.
I know what the leg length andoffset needs to be, what the cup
position needs to be.
Uh, and that has made it, uh,much less stressful of shifting
(17:24):
volume from inpatient tooutpatient.
Joseph M. Schwab (17:27):
Hmm.
And so speaking of technologylike navigation, like robotics,
uh, obviously you, you have hadextensive experience with
different, uh, roboticsplatforms, uh, several different
navigation platforms, you haveyour current set that you prefer
to use when you're talking orthinking about the distinct
(17:47):
benefits of each of theseplatforms.
For a surgeon who is maybestarting to look into those
sorts of things, what's youradvice about how they should
decide which technology suitsthem, their practice and their
patients?
Are there distinct benefits thatyou see, uh, of certain types of
platforms?
Stefan Kreuzer (18:09):
That's a good question.
And every surgeon has to sort ofdecide that for themselves.
Right?
where are my challenges?
And so if a surgeon has a higherdislocation rate, yeah, he may
want to use a technology thatimproves cup position.
Or if a surgeon had somepatients who are, the leg length
wasn't correct, um, and which iscan be quite.
(18:30):
Disturbing for certain patients,especially if they're younger,
if they're female, if they wannawear flip flops, you know, you
can't really adjust it with aninsert.
Um, that's another area whereprobably a a, an additional
technology can help make it amore predictable.
Uh, but every surgeon reallyhasn't decided for themselves,
you know, is good, good enough,or do they wanna do better?
(18:52):
Um.
You know, I'm in the camp.
I always try to do a little bitbetter and, and I look at
technology that makes me abetter surgeon.
I'm not arrogant enough to saythat I know it all and I know
how to do it perfect.
Uh, so I always look fortechnology that may give me a
little bit additionalinformation, whether that's
intraoperative or preoperative,that then, uh, results in a
(19:15):
better outcomes.
Joseph M. Schwab (19:17):
Have any of those insights that technology,
uh, has given you changed notonly your sort of intraoperative
mindset or decision makingduring the surgery?
But has any of it changed theway you approach surgery?
Completely sort of shifted yourmindset, uh, in the way you
think about hip replacement.
Stefan Kreuzer (19:37):
Uh, on the hip replacement, probably less
because, you know, hip is a verysimple joint and you get the cup
at the right place, you get thefem at the right place.
Uh, a hip will do well.
Well, um, a lot of my focus nowis on knee replacement.
Um, where there's an area, Ithink there's more room for
improvement.
Because, you know, hips can runmarathons, but knees cannot.
(19:59):
Um, and I'm hoping that one ofthese days, knees can run
marathons as well.
Um, and, but that's, I think, anarea where some of the soft
tissue measuring devices, uh,can improve outcome.
Uh, and so I, I, I do spendquite a bit of focus on the
development side and also on thethinking side in that area.
I think hips, hips do great.
(20:20):
I mean, you, you're a hipsurgeon, you, you know this as
well as I do.
Um, most of the time if you getthe stuff in the right place,
they're gonna do phenomenal.
Joseph M. Schwab (20:28):
Does the use of this technology affect your
confidence in the OR at all, oris that not really a is, is
there not really that sort ofmindset effect for you?
Stefan Kreuzer (20:38):
Oh, I think you hit the nail on the head.
It does impact my confidence.
I mean, I walk into a room, lookat the plan, and, and I know
where I'm going.
So it definitely improves my,reduces my stress level and, and
improves my confidence that I'mgonna do a great job with this
patient.
Joseph M. Schwab (20:57):
Are there additional sort of downstream
effects of these technologiesthat aren't necessarily the
exact thing that you're lookingfor?
So for instance, you know, youmay have a lower dislocation
rate because you're veryconfident in the position of
your cup and the position ofyour stem.
Um, but does your increasedconfidence translate to.
Maybe greater efficiency withinyour ASC setting or more
(21:20):
cost-effective use oftechnology, other technologies,
um, especially in somebody who'strying to maximize their
efficiency.
Stefan Kreuzer (21:29):
Yeah, great question.
And in, in the one area that.
A recent upgrade of thenavigation.
Just to be specific on, on oneparticular point, or to answer
your question, I wanna give anexample.
Uh, there's an upgrade on thenavigation system that allows
for navigated reaming.
And because it's a CT basednavigation system, so we collect
(21:50):
32 points in the acetabulum, andthen so you know exactly where
the acetabulum is.
And so that has allowed me togo.
To a single reamer.
So if it's a 52 cup, I put in a52 reamer and I ream the
acetabulum to the exact depth ofwhat the plan is, and then I put
(22:11):
in a 52 cup.
So my cup efficiency hasimproved significantly.
Um, you know, we put in a cup inless than three minutes.
Joseph M. Schwab (22:22):
How do you communicate these values, these
philosophies and, and how youuse technology to your patients?
Do your, do your patients seekyou out because they know you
use this, or is this somethingthat you have to convince them
is the right thing for them?
Stefan Kreuzer (22:39):
I think patients are very, have a very poor
understanding of the different.
In surgeon quality and, andsurgeons utilization of
technology.
And I've never been a bigmarketing guy.
I don't have billboards, I don'thave, you know, ads in the
paper.
(23:00):
I don't help what, what I do.
Um, I don't even mention to thepatient.
I use navigation unless theyask, uh, I could probably do a
better job in doing that.
Um, you know, it's, there's alsothe question, there's an
increased cost, right?
So should I charge patients morefor navigation?
(23:21):
Which you can, I mean, you canlegally tell the patient that
this is not a covered serviceand, and you pay extra for it.
And I've always been asked thequestion, well, if the patient
is not willing to pay for it,would I, would I not use it?
The answer is no, I'm gonna useit regardless.
And so it's really hard tocharge for something that you're
gonna use regardless.
(23:42):
And so that's probably an areawhere I could probably benefit a
little bit more if I spend alittle bit more time talking to
the patients.
Um, but in the scheme of things,I think at the end of the day,
the happy patients, probably themost satisfying part of my jobs.
Joseph M. Schwab (23:56):
So how do you approach the doctor-patient
conversation?
Is that, uh, you're, you'rereally just giving them the
facts of.
What you plan to do in theprocedure, or are there other
aspects to it that you find tobe important, especially in a
highly efficient ASC setting?
Stefan Kreuzer (24:12):
Yeah, so we, we definitely talk about the imp
importance of going to an ASC,what the benefits are, the lower
risk of infection, you know,the, the focus factory type
approach where the nurses, uh,know exactly what they're
supposed to do because that'sall we do in that surgery
center.
Uh, the efficiency that itcreates and that it translates
(24:33):
into, uh, a better outcome.
So we definitely focus on that.
And then we always focus ontechnology if, if the patient
asks, and a lot of that contentis out on the web and, you know,
I've had several patients nowthat go into chat GPT and say,
you know, who's the best surgeonin Houston?
And, and for some reason my namepopped up.
Uh, so which is, which is kindof, you know, interesting,
(24:53):
right.
Since I use chat, chat GPT much.
Joseph M. Schwab (24:56):
So one of the things that I saw, um, on one of
the recent posts you wereinvolved in was this idea of the
surgeon as an elite athlete, andI know you, you have.
Uh, I mean, you have yourathletic abilities, obviously
you, you, you know, you wererecruited for tennis, but you
continue to be an athlete now.
(25:17):
I'm interested in hearing yourthoughts and treating this
surgeon like an elite athlete
Stefan Kreuzer (25:27):
In fact, that's my next call at 10 o'clock.
So, um, there's an interestingconnection.
The, in fact, the navigationcompany that I work with, the,
um, the president, uh, one ofhis best friends is a physical
therapist from Australia who atHI think 23 or 24 decided to.
(25:48):
Become an Olympic athlete.
So and so, she, she moved to adifferent town where biking was
a lot, uh, easier to do andtrained and actually made it to
the Olympics in Brazil.
Uh, came in second at the Worldchampionship one year.
So obviously this lady has putan enormous amount of effort
trying to optimize because, youknow, most athletes they.
(26:12):
They retire at age 25.
They certainly don't start atage 25.
And so she came up with thatconcept.
Can, can you utilize thetechniques she used in order to
optimize her performance?
And in general, Olympic athletesor any athletes,'cause they have
lots of coaches and theyoptimize their performance and
translate that into, uh, tryingto optimize the performance of a
(26:36):
surgeon in the operating room.
'cause there are really twobenefits.
A, you know, you, you as asurgeon can go through a full
day of, of surgeries healthierand, and with less stress and
better performing and improveefficiency and hope for this
will also translate into patientbit better patient care because
(26:58):
we know we make better decisionsif we are in, in a good state of
mind.
And so.
I love that concept.
Um, it very much goes sort ofhand in hand with Charlie, the
cook's concept of 12 by 12, um,where you optimize the OR team.
But I realized after I sent myteam to Charlie, the cook, that
the limiting factor wasn't myteam.
(27:19):
It was me I was the biggestvariable.
You know, I would do a hip in 28minutes and then I would do a
hip in 45 minutes.
And why is that?
And so can we apply some ofthose techniques to the surgeons
to try to improve theirefficiency?
Which, uh, and then also from amental health standpoint and
longevity standpoint, you know,I'm, I'm a big exerciser.
(27:39):
I exercise an hour every morningbefore I start surgery, and so
can we take that to the nextlevel?
I find that an interestingconcept.
Joseph M. Schwab (27:47):
Well, and it seems like you take, um, data,
you know, feedback.
On your performance too, both asan athlete and surgically.
And in fact, I heard in one ofyour recent interviews that one
of the first people you hired atyour practice was a data a
computer programmer, uh, to setup a database collecting
(28:07):
clinical data on your patients.
Um, and so you should have anexceptional amount of data at
your disposal about theiroutcomes.
Patient data.
Do you also collect surgeon andsurgical data, and can you tell
me a little bit about how youuse data in your practice?
Mm-hmm.
Stefan Kreuzer (28:27):
Great question, and I think that's what makes
this a perfect match for me and,and this this new consultant is
because we do collect so muchdata.
You know, David, my data guy,I've had him for almost 20 years
and so we've collect a lot ofdata.
So we have a lot ofretrospective data, um, and I
collect a lot of surgeon data.
I have a whoop on my right hand.
(28:48):
I have a Garmin watch nowconverted to a Kronos watch on
the left side.
Um, I wore a glucose monitor forat least two years, a continuous
glucose monitor.
Um, there is a device thatactually can measure, um, the
electrolytes in your sweat.
So we're gonna start using thatto, uh, collect, uh, data.
(29:11):
So the, the approach that we'regonna use is we'll collect.
Two months worth of data on mein every form that we possibly
can, and this next call willdefine that a little bit better.
And then see after that, whatkind of intervention can we
utilize?
Whether it's making sure youdrink enough fluid, whether you,
(29:32):
you know, take someelectrolytes, whether.
Take glucose around noon becauseyour glucose may be a little bit
lower to try to micromanage themetabolic health of me to see
whether that then translatesinto better performance.
Joseph M. Schwab (29:47):
So I, I don't know if you'll allow me to make
the, the analogy, but, so I dida traveling fellowship in, in
the UK and we, three and a halfweeks around the uk, and part of
which we spent at WrightingtonHospital where John Charnley
practiced.
And one of the things thatstruck.
Me about him his ability toexperiment on himself.
(30:10):
So when he was looking formaterials that were
biocompatible as he wasdeveloping his hip replacement,
one of the things that he woulddo was implant different
materials basically over hisshin, uh, and see how, how well
his body responded to him.
Would you accept the analogy?
(30:31):
The analogy of being the nextJohn Charnley, if that were the
basis for it.
Stefan Kreuzer (30:36):
Well, I mean, the next John, Charnley, that's,
that's a, that's a high order.
I, I love the analogy, you know,I'm not gonna have a skin
incision and implant somethinginto my shin to accomplish this.
Maybe if it gives you enoughdata to make a difference.
Sure.
Um, I think with the currentmonitoring devices, you can
collect an enormous amount ofdata, um, during surgery to, to
(30:59):
see whether that will, cantranslate into, into different
outcomes.
Joseph M. Schwab (31:04):
Is the surgeon the source of the data that
we're gonna be looking at in thenext round of innovative
technology?
Um, sort of along that lines ofthem like the and are our
biggest limitations in achievingour best outcomes.
Starting to be the surgeon.
Stefan Kreuzer (31:25):
I certainly think 100% that is a correct
statement and if you want toexpand a little bit on this, um,
I'm afraid that we're gonna havea massive shortage of physician
in the next five to 10 yearsbecause if you look at what has
occurred.
Number one, during COVID, a lotof physicians retired.
(31:48):
Uh, there was a recent surveythat showed that physicians that
are 40 years old, I think like40% plan on retiring.
And at age 55, were not trainingenough surgeon and the volume
required to take care of patientis gone up.
And finally, with the employedmodel.
(32:11):
Physicians are not nearly asproductive than in private
practice.
Uh, my wife says this all thetime, is the new physicians that
are coming on board, you know,it's their work life balance is
extremely important and theyreally believe in.
In work-life balance.
So they have as productive as weare.
(32:32):
So my prediction is in the nextfive to 10 years, we're gonna
have a massive shortage ofphysicians.
And so if we can optimizephysician output, uh, hopefully
we can combat some of that, uh,that uh, uh, shortage of
physician.
Joseph M. Schwab (32:47):
Hmm.
You had had also mentioned, Ithink in, in a recent interview,
um, one of the, uh, one of themost, um, influential or I, I
guess you mentioned it as abook.
I don't recall how influentialyou said it was, power of why,
um, creating that sense ofpurpose.
Um, in what you do, and thissort of speaks to this idea of
(33:11):
optimizing and, and, uh, uh,maximizing the output of the
surgeon.
Um, can you just tell me alittle bit about why, how that
book has influenced you?
Um, what is your why for howyou've gone about creating the
tools that you've created,building innovate, orthopedics,
for instance, um, and whypatients will continue to
(33:34):
benefit from your pursuit ofprogress?
Stefan Kreuzer (33:37):
Yeah, the book is called Start With Why, and
it's by Simon Sinek.
Yeah, and and I highly recommendanybody to read it to me.
It, it was transformationalbecause I was in a situation
where revenue and productivity.
To generate revenue.
Was the main focus.
That's the system that I was in,and that's, I was not part, I
(34:02):
didn't want to be part of thatsystem anymore.
And so my why was it have, itwasn't well defined at the time.
It just needed to be somethingdifferent.
Um, and.
I realized that in that systemwe didn't really provide a very
healthy environment.
And so my why was I wanted tocreate a healthcare delivery
(34:24):
system where the team workedbetter together.
It was a system with really goodculture where nurses wanted to
be there.
Uh, they wanted to to be part ofa team approach.
And the financial aspect was asecondary gain or.
Tertiary gain, that was not themain focus.
(34:44):
Uh, and so I exited the employedmodel.
And started innovate.
And Innovate was really, thereare four companies.
There's Innovate Orthopedics,which is the practice, innovate
Surgical, which is the SurgeryCenter.
Then Innovate Research becauseof the research component, and
then Innovate Healthcare, whichis the value-based care
contracting, uh, company.
(35:06):
Uh, and so the focus was tocreate a very happy environment
for employees.
Which then translates into ahappy patient.
And the destruction needs to beefficient in order to reduce
healthcare cost.
Um, because.
We're, you know, healthcarecosts in the United States is
outta control.
(35:26):
And, and I think we'veaccomplished that.
I think we are not relevant yetbecause we're just one.
And if we can make, you know, 10centers or 20 centers or 30
centers to create that, then,then we do become relevant for
the healthcare cost, uh,challenge in the United States.
Joseph M. Schwab (35:43):
If you've reached those goals, has your
why changed?
And if so, what's your new why?
Stefan Kreuzer (35:50):
It has changed.
It has evolved.
Um, you know, probably two orthree years ago, or maybe a
little bit more than five yearsago, um, I also started having a
much stronger focus on personalhealth, uh,'cause and I felt
that I didn't wanna work.
Like a dog and then die, youknow, of a heart attack.
So, um, I really sort of focusedmy why to also improve my
(36:12):
personal health and startedexercising more and eating
better and sleeping better.
And, and, you know, one of thebooks there that really sort of
impacted my, my Personal Healthjourney is by Peter Atia, the
book called Outlive and hispodcast, the Drive.
Yeah, both of which, uh, thebook is an audible book and the
(36:33):
podcast is obviously audible aswell.
So very good for me.
Uh, but that has really sort of,um, evolved my, my why on a
personal level, not just on abusiness level.
Joseph M. Schwab (36:46):
Well, Stefan, I really taking the time to be
with us today.
I want to be mindful of yourtime, but, uh, my producer,
Lila, uh, she described youafter her initial conversations
as it's like talking with chatGPT and I, I'm gonna take the
kindest interpretation of that,uh, in that you are a wealth of
(37:09):
knowledge.
You're exceptionally thoughtful.
You're very well spoken.
And, um, it's just really been apleasure talking to you today.
Thank you for being on thepodcast.
Stefan Kreuzer (37:18):
Yeah.
Thank you so much for includingme.
It's been a, it's been, it'sbeen a great conversation.
Joseph M. Schwab (37:23):
Thank you for joining me for this of AHF
podcast.
As always, please take a momentto like and subscribe so we can
keep the lights on.
Keep sharing great content justlike this.
Please also drop any topic ideasor feedback in the comments
below.
You can find the AHF podcast onApple Podcasts, Spotify, or in
(37:47):
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation.
All one word, episodes of theAHF Podcast come out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
happy, healthy, and intelligent.
Hello, and welcome again to the AHF
Podcast.
I'm your host, Joe Schwab.
My guest today is Dr.
Stefan Kreuzer an orthopedic,hip and knee surgeon in Houston,
and founder of INOV8Orthopedics, a Houston based
orthopedics and sports medicinefacility.
He was born and raised inSwitzerland, but living in the
(00:44):
United States for the past 40years.
He's well known and wellrespected for with minimally
invasive approachesincorporating robotics
navigation technologies, andbeing a champion for outpatient
total joint arthroplasty.
Stefan, welcome to the AHFPodcast.
Stefan Kreuzer (01:06):
Thanks so much for including me.
Joseph M. Schwab (01:08):
So I gave a little bit of background to our
listeners, but I think they'dlike to hear from you directly a
little bit about how you endedup where you are.
Tell us your story.
Stefan Kreuzer (01:19):
Yeah, so it's an interesting journey.
Um, as you mentioned, I grew upin Switzerland.
I was actually born in Austria,and when I was 15, my, uh, dad
decided to, uh, explore otheroptions in his career, and we
moved to Vancouver, Canada.
I did, uh, high school there,finished my, uh, 12th grade in
high school and then wasfortunate enough to be recruited
(01:40):
as a, uh.
A tennis player to play collegetennis into Texas, then did four
years of college tennis.
Had a little bit of a hard timegetting into medical school at
the time because as you know,I'm a dyslexic and I didn't do
very well in the mcat, so I tooka little left-hand turn and
ended up going to graduateschool and then, uh uh, did four
(02:01):
years of molecular biology andbiochemistry.
And then improved my MCAT scorealso improved my, you know,
being a, uh, having a, aMaster's of Science and
biochemistry, and then got intomedical school in San Antonio.
Then, uh, got into residency todo orthopedics in Galveston.
Did for five years of, uh,orthopedics.
(02:22):
Then did my fellowship at BaylorCollege of Medicine, and then
started hanging a shingle andstarted swinging.
Joseph M. Schwab (02:29):
And you've been in practice, basically in
private practice ever since, isthat right?
Stefan Kreuzer (02:34):
No, actually I, I'm not, I was in private
practice for a long time, thenbecame employed.
About 15 years ago and did thatfor five or six years, and that
was clearly not for me.
And then made the very difficulttransition out of employment,
back into private practice, notjoining a group, just starting
(02:56):
from scratch.
So that was an interestingjourney.
I went from a, the fourthhighest paid employee in the UT
System, university of Texassystem.
To being leveraged to thehealth, borrow money from the
bank to, uh, build an outpatienttotal joint center, starting a
practice, you know, buyingcomputers, negotiating contracts
(03:17):
with payers, and, uh, you know,rolled up my sleeve, started
working very hard, and then itwas probably the hardest things
I, I ever did.
But now we're doing great.
Uh, we're doing great from aculture standpoint, from a
workflow standpoint, from apatient satisfaction standpoint,
and also financially, we'vedefinitely caught up in, in
doing quite well.
Joseph M. Schwab (03:37):
I want to get into your practice a little bit
more in a little bit, but youmentioned something in the
introduction about dyslexia andmy understanding is how you came
about your understanding ofbeing dyslexic.
It wasn't something you knew atthe time, is that right?
Stefan Kreuzer (03:53):
That's correct.
It was sort of interesting.
We, we were actually at ASChoolfunction, uh, of my daughter and
she went to a Montessori schooland there was, um, a handout
there that was written by NobelPrize Laureate about dyslexia,
and my wife picked it up.
And, uh, she read it and it sortof described me to a T.
So she actually came up with theidea, well, maybe, maybe the
(04:14):
reason why you can't read isbecause you're dyslexic.
And so she read it to me since Ican't read.
And um, it sort of reallydescribed sort of my.
My gifts and my challenges, andat the time I was already
successful, so I, I reallydidn't, didn't think more of it.
Um, a few years later I had apatient that had, I did both for
(04:35):
hip replacements and she's apsychologist who has, uh, uh.
A testing center for childrenwith learning disability.
And so we got into aconversation and asked her if
you can be tested as a, as anadult, because I didn't wanna
say that I'm a dyslexic, neverreally officially having been
tested.
And she says, oh, absolutely.
So I, I went to her testingcenter and it was.
(04:57):
Two tests and then sure enoughit came back.
Severe dyslexia, you know, mostpeople read around two 50 to
three 50 words a minute.
I clock that at 89 words aminute with a reading
comprehension of 51%, whichpretty much means you, you can't
read very well.
Joseph M. Schwab (05:14):
So tell me a little bit about how that was a
challenge for you.
it, it, it, obviously I canperceive how there might have
been challenges growing up, buthow did you deal with it before
you understood you were, youknow, trying to make your way
through this world with thiscondition of dyslexia?
Stefan Kreuzer (05:33):
Yeah, I mean, many ways the main challenge,
the main effort was, was just.
Working harder, right?
So I just had to work twice ashard to get things accomplished.
And I tried all kinds oftechniques.
I don't know if you remember allin the old days, the bubble
diagrams, um, on, on how tolearn stuff, right?
And so, because I'm more visualthan a linear thinker, I don't
(05:56):
know how many bubble diagrams Ihad put together in order to
study.
And I just put in more effort.
You know, on the one hand, whenit came to reading, I struggled.
But then on the other areawhere.
Where, like for example in math,that was extremely easy for me.
Calculus was easy.
Algebra was easy.
So I, I had to spend very littleeffort to understand those
concepts, which gave me the timeto spend more effort when I had
(06:18):
to read a book or write anessay.
And then I got a lot of helpfrom people around me.
'cause, um, I just, I justcouldn't write very well.
Joseph M. Schwab (06:27):
And when you came away with this diagnosis.
Um, how has your approach tolearning changed since then?
I mean, you're an adult learnerat this point, right?
Um, but how has your approach tolearning new information,
learning new skills,assimilating new medical
information, how has thatchanged?
Stefan Kreuzer (06:48):
Great question, and now that I think about it,
you asking that question, thereare probably two technologies
that have really been incrediblyinstrumental to me as a person.
One was audible books.
Um, you know that that startedprobably about 15 years ago and
I'm extremely interested inthings, but I just couldn't read
(07:09):
very well.
So it was very difficult for meto read a book.
And once Audible came out, I gotan account and I was just
inhaling books.
I mean, there wasn't a week thatdidn't go by where I didn't read
a listen to a book.
And it just opened up a new eraof, of knowledge to me that that
did not exist before.
Came to business, whether itcame to personal health.
(07:32):
Uh, so that was oneinstrumental, um, technology
that really helped me as adyslexic a great deal.
And now, uh, ai, AI is just forme, is amazing.
I mean, I'm on chat GBTconstantly, uh, writing
documents and, and, andcollecting thoughts and using
to, to brainstorm to really putmy ideas.
(07:55):
Down the words because that wasthe biggest challenge.
Um, you know, I'm not a texter.
I'm not an emailer.
Uh, I like to talk on the phone,but nowadays everybody texts,
you know, you call somebody theydon't pick up, but they'll send
you a text back.
Um, you know, I like havingconversations like, hence the
podcast today, which I really,uh, I know I enjoy.
But using chat GPT to kind oftake my thoughts and putting
(08:19):
them down the paper has beenreally amazing for me.
Joseph M. Schwab (08:23):
So you seem really comfortable with
technology and, and looking at,you know, your history, looking
at how you have grown as anorthopedic surgeon.
Clearly your cv.
You don't shy away fromtechnology in the operating room
either.
Um, I, I would like to talk toyou a little bit about how you
got involved in anteriorapproach, which I think was
(08:45):
around 20 years ago at thispoint, right?
Mm-hmm.
Stefan Kreuzer (08:48):
It was 2003.
So it's been, uh, 20, 21 years.
2 22 years.
Yeah.
Um, I think that's another oneof those things that I think
dyslexia helped me is, you know,when I learned about the
anterior approach from a visualstandpoint, from a a 3D
standpoint, it.
Made so much sense to me and ingeneral when it comes to
technology, I think I canassimilate fairly quickly
(09:10):
whether something makes senseand it's gonna work or if
something is not gonna makesense.
And so I think that has kind ofgiven me an edge on, in
orthopedics of.
Sort of figuring out what is thetechnology, what are the
approaches that makes sense.
And that's how I got into energyapproach, hip replacement.
Uh, I remember I watched JoelMatta give a talk on it, and
when he mentioned when he, whenhe gave the talk, I says, oh, I
(09:32):
need to learn how to do this.
And then, you know, a monthlater I was in his operating
room observing and then cameback home and, and started
swinging.
Uh, that was back before we hadany courses or anything.
In fact, I had the, I think Ihad the fourth OSI table that
came off the assembly line, uh,to, uh, to perform anterior
approach, hip replacement, um,and then other things like
(09:55):
robotics.
You know, I remember I wasmeeting with Martin Roche who
mentioned about the Mako robot,and I think I had the third Mako
robot in my operating room thatcame off the assembly line.
That made a lot of sense to me.
And so in that area, I think,um, I've excelled because of my
dyslexia more than anything.
Joseph M. Schwab (10:14):
And it sounds like you have gravitated towards
this technology early.
You don't ever seem to be fullysatisfied with one technology.
What I observe is that youcontinue to strive for bigger,
better, faster, stronger.
Uh, tell me a little bit aboutyour sort of central philosophy
around how you pick and chooseand grow with technology.
Stefan Kreuzer (10:37):
Yeah, I think when, when you adopt technology.
You.
You quickly learn of what is avalue add and what is a
challenge.
And I think by continuouslyrethinking on how you're doing
things, when you then getexposed to a new technology, you
immediately realize, oh, this isgonna fix the problem that I'm
(11:00):
currently facing.
And I think that's how I'veprogressed from one navigation
system to the next, from onerobotic system to the next.
Um, and I just continuously tryto push on how we can do a
little bit better, uh, for ourpatients.
Joseph M. Schwab (11:17):
You had a, a publication about, value of, of
introspection specifically in,in adopting new techniques,
early parts learning curve.
Was that something that youlearned from surgery and you,
uh, applied it to, uh, yourtechnology, robotics, things
(11:37):
like was it something that youhad inherent to yourself maybe
the way you, uh, grew up in youreducation?
That you brought to medicine,how, how did you develop that
philosophy?
Stefan Kreuzer (11:50):
It's a good question.
I'm not sure that I couldpinpoint to, to exactly one
event other than early on in mylife.
My father once told me an openmind is the highest form of
intelligence.
Hmm.
And so I've always tried to usethat and it's been part of my
email on the bottom for a long,long time.
Um, because you.
(12:14):
You think you know it all, butyou really don't.
And as you learn more, you'veactually realized how little you
know.
So I always feel like knowledgeis not.
It's not a, a pyramid, it's anupside down pyramid.
And so as, and, and to me thatwas very real when I started
(12:34):
reading a lot or listening toaudio books because that really
expanded my knowledge base.
And that sort of created,created this hunger for more and
more knowledge.
And so I think that may be partof the, the, the, uh, growth
that I went through in, in my.
Early forties, uh, by havingbeen exposed to that knowledge
(12:58):
base where I just got so hungryof learning more because I was
deprived of this for 40 years ofmy life because I couldn't read.
And, and maybe that's what sortof pushed me to always try to do
better and always try to learnmore.
Um, even now it's, I mean.
Today I've had three calls withstartup companies about new
stuff that could be incorporatedinto the workflow in our clinic.
(13:21):
So it's, it's just a reallyexciting time.
Joseph M. Schwab (13:24):
In a recent conversation you had.
Um, you had a quote, um, that,that I just thought I would, I
would ask you about.
You said a better tool will makea better person.
So you had three companies todaycontract, uh, contacting you in
theory, offering you a bettertool.
Um.
What tools may, uh, I'll askthis in sort of two parts.
(13:46):
What tools do you wish you had,um, back when you were in your
training that would make you abetter surgeon?
And what tools do you wish youhave now going forward to
deliver better for yourpatients?
Stefan Kreuzer (14:01):
It worked better to back then, um, I wish I had
audible books textbooks inschools because that was
torture.
Trying to read textbooks.
Uh, you know, I spent, Ibasically got my mail at the
library'cause I spent so muchtime at the library.
So back then, I think.
The educational process was notvery conducive to people with
(14:23):
dyslexia.
It just, we just sort of had tobear it and, and, and go through
it moving forwards.
Uh.
Just like Charlie DeCook whostarted the Anterior Hip
Foundation, I very much focus onefficiency and improving
workflow, and so I'm hoping thatAI tools, which is one of the
companies we have had aconversation with and virtual
(14:47):
reality tools from aneducational standpoint, which is
another company we had aconversation with, that this can
improve my efficiency in, indelivering.
Care to my patients because asI'm sure you know, he,
healthcare delivery system isnot optimal, especially in the
United States.
It's very scatterbrained.
It's very cumbersome.
It's, it's, it's, it's not a,there's so many different
(15:10):
technologies that don't talk toeach other.
You don't have, the EMRs, don'thave APIs.
It's very frustrating'causeyou're always putting bandaids
on trying to improve yourworkflow.
So I think moving forward withAI and with some of these newer
technologies of delivering.
Educational, uh, content will bevery instrumental in improving
patient care.
Joseph M. Schwab (15:32):
Focusing the technology conversation a little
bit more on anterior approach,hip replacement.
In your experience, becauseyou've been at this 20 years, if
you were to identify of thesingle biggest contribution or
greatest contribution oftechnology to the way we do
anterior hip replacement today,what would that be and why?
Stefan Kreuzer (15:56):
Yeah, so two technology that I think have
really made, uh, the anteriorapproach hip replacement more
predictable.
And, you know, just as a matterof disclosure, I obviously have
a biased view.
I think that.
A table, um, you know, I'm partof INOV8 Orthopedic Technology
and we make a table attachment.
OSI makes the HANA table.
(16:17):
So I think a, a positioningdevice that allows the, the leg
to be positioned in a certainway that it makes it easy to
access the femur has been veryinstrumental in reducing the
learning curve and probably alsoreducing the risk of, of
complications.
Now there are many surgeons todo without a table extremely
well.
(16:37):
I happened to be in the campthat I think at table was one of
the technologies that hasimproved that approach.
And to me.
Currently, uh, I use anavigation system that is CT
based.
Uh, and, uh, that to me, uh,called NaviSwiss and that to me
has been extremely, uh,instrumental in making the
surgery very predictable becausewe do the vast majority of the
(17:00):
surgeons in an ASC andambulatory surgery center, uh,
from an inventory management andfrom a predictability.
For us, that's extremelyimportant because we don't have
the resources a hospital does,and so.
Before I go to the operatingroom, I'm, I know what cup size,
what femur size.
I know what the leg length andoffset needs to be, what the cup
position needs to be.
Uh, and that has made it, uh,much less stressful of shifting
(17:24):
volume from inpatient tooutpatient.
Joseph M. Schwab (17:27):
Hmm.
And so speaking of technologylike navigation, like robotics,
uh, obviously you, you have hadextensive experience with
different, uh, roboticsplatforms, uh, several different
navigation platforms, you haveyour current set that you prefer
to use when you're talking orthinking about the distinct
(17:47):
benefits of each of theseplatforms.
For a surgeon who is maybestarting to look into those
sorts of things, what's youradvice about how they should
decide which technology suitsthem, their practice and their
patients?
Are there distinct benefits thatyou see, uh, of certain types of
platforms?
Stefan Kreuzer (18:09):
That's a good question.
And every surgeon has to sort ofdecide that for themselves.
Right?
where are my challenges?
And so if a surgeon has a higherdislocation rate, yeah, he may
want to use a technology thatimproves cup position.
Or if a surgeon had somepatients who are, the leg length
wasn't correct, um, and which iscan be quite.
(18:30):
Disturbing for certain patients,especially if they're younger,
if they're female, if they wannawear flip flops, you know, you
can't really adjust it with aninsert.
Um, that's another area whereprobably a a, an additional
technology can help make it amore predictable.
Uh, but every surgeon reallyhasn't decided for themselves,
you know, is good, good enough,or do they wanna do better?
(18:52):
Um.
You know, I'm in the camp.
I always try to do a little bitbetter and, and I look at
technology that makes me abetter surgeon.
I'm not arrogant enough to saythat I know it all and I know
how to do it perfect.
Uh, so I always look fortechnology that may give me a
little bit additionalinformation, whether that's
intraoperative or preoperative,that then, uh, results in a
(19:15):
better outcomes.
Joseph M. Schwab (19:17):
Have any of those insights that technology,
uh, has given you changed notonly your sort of intraoperative
mindset or decision makingduring the surgery?
But has any of it changed theway you approach surgery?
Completely sort of shifted yourmindset, uh, in the way you
think about hip replacement.
Stefan Kreuzer (19:37):
Uh, on the hip replacement, probably less
because, you know, hip is a verysimple joint and you get the cup
at the right place, you get thefem at the right place.
Uh, a hip will do well.
Well, um, a lot of my focus nowis on knee replacement.
Um, where there's an area, Ithink there's more room for
improvement.
Because, you know, hips can runmarathons, but knees cannot.
(19:59):
Um, and I'm hoping that one ofthese days, knees can run
marathons as well.
Um, and, but that's, I think, anarea where some of the soft
tissue measuring devices, uh,can improve outcome.
Uh, and so I, I, I do spendquite a bit of focus on the
development side and also on thethinking side in that area.
I think hips, hips do great.
(20:20):
I mean, you, you're a hipsurgeon, you, you know this as
well as I do.
Um, most of the time if you getthe stuff in the right place,
they're gonna do phenomenal.
Joseph M. Schwab (20:28):
Does the use of this technology affect your
confidence in the OR at all, oris that not really a is, is
there not really that sort ofmindset effect for you?
Stefan Kreuzer (20:38):
Oh, I think you hit the nail on the head.
It does impact my confidence.
I mean, I walk into a room, lookat the plan, and, and I know
where I'm going.
So it definitely improves my,reduces my stress level and, and
improves my confidence that I'mgonna do a great job with this
patient.
Joseph M. Schwab (20:57):
Are there additional sort of downstream
effects of these technologiesthat aren't necessarily the
exact thing that you're lookingfor?
So for instance, you know, youmay have a lower dislocation
rate because you're veryconfident in the position of
your cup and the position ofyour stem.
Um, but does your increasedconfidence translate to.
Maybe greater efficiency withinyour ASC setting or more
(21:20):
cost-effective use oftechnology, other technologies,
um, especially in somebody who'strying to maximize their
efficiency.
Stefan Kreuzer (21:29):
Yeah, great question.
And in, in the one area that.
A recent upgrade of thenavigation.
Just to be specific on, on oneparticular point, or to answer
your question, I wanna give anexample.
Uh, there's an upgrade on thenavigation system that allows
for navigated reaming.
And because it's a CT basednavigation system, so we collect
(21:50):
32 points in the acetabulum, andthen so you know exactly where
the acetabulum is.
And so that has allowed me togo.
To a single reamer.
So if it's a 52 cup, I put in a52 reamer and I ream the
acetabulum to the exact depth ofwhat the plan is, and then I put
(22:11):
in a 52 cup.
So my cup efficiency hasimproved significantly.
Um, you know, we put in a cup inless than three minutes.
Joseph M. Schwab (22:22):
How do you communicate these values, these
philosophies and, and how youuse technology to your patients?
Do your, do your patients seekyou out because they know you
use this, or is this somethingthat you have to convince them
is the right thing for them?
Stefan Kreuzer (22:39):
I think patients are very, have a very poor
understanding of the different.
In surgeon quality and, andsurgeons utilization of
technology.
And I've never been a bigmarketing guy.
I don't have billboards, I don'thave, you know, ads in the
paper.
(23:00):
I don't help what, what I do.
Um, I don't even mention to thepatient.
I use navigation unless theyask, uh, I could probably do a
better job in doing that.
Um, you know, it's, there's alsothe question, there's an
increased cost, right?
So should I charge patients morefor navigation?
(23:21):
Which you can, I mean, you canlegally tell the patient that
this is not a covered serviceand, and you pay extra for it.
And I've always been asked thequestion, well, if the patient
is not willing to pay for it,would I, would I not use it?
The answer is no, I'm gonna useit regardless.
And so it's really hard tocharge for something that you're
gonna use regardless.
(23:42):
And so that's probably an areawhere I could probably benefit a
little bit more if I spend alittle bit more time talking to
the patients.
Um, but in the scheme of things,I think at the end of the day,
the happy patients, probably themost satisfying part of my jobs.
Joseph M. Schwab (23:56):
So how do you approach the doctor-patient
conversation?
Is that, uh, you're, you'rereally just giving them the
facts of.
What you plan to do in theprocedure, or are there other
aspects to it that you find tobe important, especially in a
highly efficient ASC setting?
Stefan Kreuzer (24:12):
Yeah, so we, we definitely talk about the imp
importance of going to an ASC,what the benefits are, the lower
risk of infection, you know,the, the focus factory type
approach where the nurses, uh,know exactly what they're
supposed to do because that'sall we do in that surgery
center.
Uh, the efficiency that itcreates and that it translates
(24:33):
into, uh, a better outcome.
So we definitely focus on that.
And then we always focus ontechnology if, if the patient
asks, and a lot of that contentis out on the web and, you know,
I've had several patients nowthat go into chat GPT and say,
you know, who's the best surgeonin Houston?
And, and for some reason my namepopped up.
Uh, so which is, which is kindof, you know, interesting,
(24:53):
right.
Since I use chat, chat GPT much.
Joseph M. Schwab (24:56):
So one of the things that I saw, um, on one of
the recent posts you wereinvolved in was this idea of the
surgeon as an elite athlete, andI know you, you have.
Uh, I mean, you have yourathletic abilities, obviously
you, you, you know, you wererecruited for tennis, but you
continue to be an athlete now.
(25:17):
I'm interested in hearing yourthoughts and treating this
surgeon like an elite athlete
Stefan Kreuzer (25:27):
In fact, that's my next call at 10 o'clock.
So, um, there's an interestingconnection.
The, in fact, the navigationcompany that I work with, the,
um, the president, uh, one ofhis best friends is a physical
therapist from Australia who atHI think 23 or 24 decided to.
(25:48):
Become an Olympic athlete.
So and so, she, she moved to adifferent town where biking was
a lot, uh, easier to do andtrained and actually made it to
the Olympics in Brazil.
Uh, came in second at the Worldchampionship one year.
So obviously this lady has putan enormous amount of effort
trying to optimize because, youknow, most athletes they.
(26:12):
They retire at age 25.
They certainly don't start atage 25.
And so she came up with thatconcept.
Can, can you utilize thetechniques she used in order to
optimize her performance?
And in general, Olympic athletesor any athletes,'cause they have
lots of coaches and theyoptimize their performance and
translate that into, uh, tryingto optimize the performance of a
(26:36):
surgeon in the operating room.
'cause there are really twobenefits.
A, you know, you, you as asurgeon can go through a full
day of, of surgeries healthierand, and with less stress and
better performing and improveefficiency and hope for this
will also translate into patientbit better patient care because
(26:58):
we know we make better decisionsif we are in, in a good state of
mind.
And so.
I love that concept.
Um, it very much goes sort ofhand in hand with Charlie, the
cook's concept of 12 by 12, um,where you optimize the OR team.
But I realized after I sent myteam to Charlie, the cook, that
the limiting factor wasn't myteam.
(27:19):
It was me I was the biggestvariable.
You know, I would do a hip in 28minutes and then I would do a
hip in 45 minutes.
And why is that?
And so can we apply some ofthose techniques to the surgeons
to try to improve theirefficiency?
Which, uh, and then also from amental health standpoint and
longevity standpoint, you know,I'm, I'm a big exerciser.
(27:39):
I exercise an hour every morningbefore I start surgery, and so
can we take that to the nextlevel?
I find that an interestingconcept.
Joseph M. Schwab (27:47):
Well, and it seems like you take, um, data,
you know, feedback.
On your performance too, both asan athlete and surgically.
And in fact, I heard in one ofyour recent interviews that one
of the first people you hired atyour practice was a data a
computer programmer, uh, to setup a database collecting
(28:07):
clinical data on your patients.
Um, and so you should have anexceptional amount of data at
your disposal about theiroutcomes.
Patient data.
Do you also collect surgeon andsurgical data, and can you tell
me a little bit about how youuse data in your practice?
Mm-hmm.
Stefan Kreuzer (28:27):
Great question, and I think that's what makes
this a perfect match for me and,and this this new consultant is
because we do collect so muchdata.
You know, David, my data guy,I've had him for almost 20 years
and so we've collect a lot ofdata.
So we have a lot ofretrospective data, um, and I
collect a lot of surgeon data.
I have a whoop on my right hand.
(28:48):
I have a Garmin watch nowconverted to a Kronos watch on
the left side.
Um, I wore a glucose monitor forat least two years, a continuous
glucose monitor.
Um, there is a device thatactually can measure, um, the
electrolytes in your sweat.
So we're gonna start using thatto, uh, collect, uh, data.
(29:11):
So the, the approach that we'regonna use is we'll collect.
Two months worth of data on mein every form that we possibly
can, and this next call willdefine that a little bit better.
And then see after that, whatkind of intervention can we
utilize?
Whether it's making sure youdrink enough fluid, whether you,
(29:32):
you know, take someelectrolytes, whether.
Take glucose around noon becauseyour glucose may be a little bit
lower to try to micromanage themetabolic health of me to see
whether that then translatesinto better performance.
Joseph M. Schwab (29:47):
So I, I don't know if you'll allow me to make
the, the analogy, but, so I dida traveling fellowship in, in
the UK and we, three and a halfweeks around the uk, and part of
which we spent at WrightingtonHospital where John Charnley
practiced.
And one of the things thatstruck.
Me about him his ability toexperiment on himself.
(30:10):
So when he was looking formaterials that were
biocompatible as he wasdeveloping his hip replacement,
one of the things that he woulddo was implant different
materials basically over hisshin, uh, and see how, how well
his body responded to him.
Would you accept the analogy?
(30:31):
The analogy of being the nextJohn Charnley, if that were the
basis for it.
Stefan Kreuzer (30:36):
Well, I mean, the next John, Charnley, that's,
that's a, that's a high order.
I, I love the analogy, you know,I'm not gonna have a skin
incision and implant somethinginto my shin to accomplish this.
Maybe if it gives you enoughdata to make a difference.
Sure.
Um, I think with the currentmonitoring devices, you can
collect an enormous amount ofdata, um, during surgery to, to
(30:59):
see whether that will, cantranslate into, into different
outcomes.
Joseph M. Schwab (31:04):
Is the surgeon the source of the data that
we're gonna be looking at in thenext round of innovative
technology?
Um, sort of along that lines ofthem like the and are our
biggest limitations in achievingour best outcomes.
Starting to be the surgeon.
Stefan Kreuzer (31:25):
I certainly think 100% that is a correct
statement and if you want toexpand a little bit on this, um,
I'm afraid that we're gonna havea massive shortage of physician
in the next five to 10 yearsbecause if you look at what has
occurred.
Number one, during COVID, a lotof physicians retired.
(31:48):
Uh, there was a recent surveythat showed that physicians that
are 40 years old, I think like40% plan on retiring.
And at age 55, were not trainingenough surgeon and the volume
required to take care of patientis gone up.
And finally, with the employedmodel.
(32:11):
Physicians are not nearly asproductive than in private
practice.
Uh, my wife says this all thetime, is the new physicians that
are coming on board, you know,it's their work life balance is
extremely important and theyreally believe in.
In work-life balance.
So they have as productive as weare.
(32:32):
So my prediction is in the nextfive to 10 years, we're gonna
have a massive shortage ofphysicians.
And so if we can optimizephysician output, uh, hopefully
we can combat some of that, uh,that uh, uh, shortage of
physician.
Joseph M. Schwab (32:47):
Hmm.
You had had also mentioned, Ithink in, in a recent interview,
um, one of the, uh, one of themost, um, influential or I, I
guess you mentioned it as abook.
I don't recall how influentialyou said it was, power of why,
um, creating that sense ofpurpose.
Um, in what you do, and thissort of speaks to this idea of
(33:11):
optimizing and, and, uh, uh,maximizing the output of the
surgeon.
Um, can you just tell me alittle bit about why, how that
book has influenced you?
Um, what is your why for howyou've gone about creating the
tools that you've created,building innovate, orthopedics,
for instance, um, and whypatients will continue to
(33:34):
benefit from your pursuit ofprogress?
Stefan Kreuzer (33:37):
Yeah, the book is called Start With Why, and
it's by Simon Sinek.
Yeah, and and I highly recommendanybody to read it to me.
It, it was transformationalbecause I was in a situation
where revenue and productivity.
To generate revenue.
Was the main focus.
That's the system that I was in,and that's, I was not part, I
(34:02):
didn't want to be part of thatsystem anymore.
And so my why was it have, itwasn't well defined at the time.
It just needed to be somethingdifferent.
Um, and.
I realized that in that systemwe didn't really provide a very
healthy environment.
And so my why was I wanted tocreate a healthcare delivery
(34:24):
system where the team workedbetter together.
It was a system with really goodculture where nurses wanted to
be there.
Uh, they wanted to to be part ofa team approach.
And the financial aspect was asecondary gain or.
Tertiary gain, that was not themain focus.
(34:44):
Uh, and so I exited the employedmodel.
And started innovate.
And Innovate was really, thereare four companies.
There's Innovate Orthopedics,which is the practice, innovate
Surgical, which is the SurgeryCenter.
Then Innovate Research becauseof the research component, and
then Innovate Healthcare, whichis the value-based care
contracting, uh, company.
(35:06):
Uh, and so the focus was tocreate a very happy environment
for employees.
Which then translates into ahappy patient.
And the destruction needs to beefficient in order to reduce
healthcare cost.
Um, because.
We're, you know, healthcarecosts in the United States is
outta control.
(35:26):
And, and I think we'veaccomplished that.
I think we are not relevant yetbecause we're just one.
And if we can make, you know, 10centers or 20 centers or 30
centers to create that, then,then we do become relevant for
the healthcare cost, uh,challenge in the United States.
Joseph M. Schwab (35:43):
If you've reached those goals, has your
why changed?
And if so, what's your new why?
Stefan Kreuzer (35:50):
It has changed.
It has evolved.
Um, you know, probably two orthree years ago, or maybe a
little bit more than five yearsago, um, I also started having a
much stronger focus on personalhealth, uh,'cause and I felt
that I didn't wanna work.
Like a dog and then die, youknow, of a heart attack.
So, um, I really sort of focusedmy why to also improve my
(36:12):
personal health and startedexercising more and eating
better and sleeping better.
And, and, you know, one of thebooks there that really sort of
impacted my, my Personal Healthjourney is by Peter Atia, the
book called Outlive and hispodcast, the Drive.
Yeah, both of which, uh, thebook is an audible book and the
(36:33):
podcast is obviously audible aswell.
So very good for me.
Uh, but that has really sort of,um, evolved my, my why on a
personal level, not just on abusiness level.
Joseph M. Schwab (36:46):
Well, Stefan, I really taking the time to be
with us today.
I want to be mindful of yourtime, but, uh, my producer,
Lila, uh, she described youafter her initial conversations
as it's like talking with chatGPT and I, I'm gonna take the
kindest interpretation of that,uh, in that you are a wealth of
(37:09):
knowledge.
You're exceptionally thoughtful.
You're very well spoken.
And, um, it's just really been apleasure talking to you today.
Thank you for being on thepodcast.
Stefan Kreuzer (37:18):
Yeah.
Thank you so much for includingme.
It's been a, it's been, it'sbeen a great conversation.
Joseph M. Schwab (37:23):
Thank you for joining me for this of AHF
podcast.
As always, please take a momentto like and subscribe so we can
keep the lights on.
Keep sharing great content justlike this.
Please also drop any topic ideasor feedback in the comments
below.
You can find the AHF podcast onApple Podcasts, Spotify, or in
(37:47):
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation.
All one word, episodes of theAHF Podcast come out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
happy, healthy, and intelligent.
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