May 16, 2025 • 26 mins
Advancing Orthopedic Surgery in Brazil with Dr. Leandro Ejnisman
Join host Joe Schwab on the AHF Podcast as he explores the advancements in orthopedic surgery in Sao Paulo, Brazil, with Dr. Leandro Ejnisman. Dr. Ejnisman shares his decade-long journey of introducing the anterior approach to hip replacement in his community, the role of technology and innovation in modern surgery, and his vision for a future where robots play a crucial role. Dr. Ejnisman's insights also cover the challenges and successes in adopting new techniques and the importance of mentorship and ongoing education. Tune in to hear about his experiences and the growing trend of anterior approach surgeries in Brazil.
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Episode Transcript
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Joseph M Schwab (00:24):
Hello again and welcome back to the AHF Podcast.
I'm your host, Joe Schwab.
This week we head to Sao Paulo,Brazil.
Where Dr.
Leandro Ejnisman has beenworking hard to introduce
anterior approach to hiscommunity for the past 10 years.
He shares his insights ontechnology, surgeon
(00:45):
entrepreneurship, and what thefuture of orthopedic surgery
just might look like.
And here's a hint.
He's betting it'll involverobots.
Let's join in on theconversation.
Leandro, welcome to the AHFPodcast.
Leandro Ejnisman (01:01):
Thank you very much Joe.
It's an honor for me to be here.
Thank you very much.
And especially being the firstone, I believe, from Latin
America.
Joseph M Schwab (01:08):
That's right.
So which, tell our listeners alittle bit about you and a
little bit about
Leandro Ejnisman (01:13):
I.
Sure.
So I'm from Sa Paulo Brazil, asyou mentioned.
I was born here and I did all mytraining here.
I went to medical school atUniversity of Sao Paulo, and for
those who don't know, it's avery prestigious university here
in, in South America.
It's considered, definitely oneof the best here in Brazil,
Latin America, but, but also itranks really well, in world
(01:35):
rankings.
a little thing that's differenthere in Brazil is that.
Usually if you are in a goodway, in a good place where you
did your medical school, peopletend to stay in the same place
for residency and fellowship.
So it's a little bit differentthan us.
What I see that most people goaround in different places.
so I did my, medical school atUniversity of Sao Paulo, my, my
(01:56):
residency and my fellowship,which was in hip surgery.
also our practice here is likejoint centered, so.
Most people like my practice as,as you asked, is basically hip
surgery.
I do both hip replacements andhip preservation surgery.
So after my, my fellowship herein Brazil, I went to the west to
(02:17):
do another fellowship.
I.
And in my, in my hospital, wedidn't have much hip
arthroscopy.
So I spent one year after myfellowship at, in Il, Colorado
with Dr.
Philippon at the StatemanClinic.
I went there as a, we have likea institution here that gives
scholarships to Brazilians thatwant to go abroad.
It's called Institu technology,the S, so I went there and I
(02:39):
have a wonderful year of Dr.
Philippon.
I learned a lot of laproscopy.
I did some research, which wasreally interesting, and then I
came back, When I started mypractice, I divided myself
between public system here inBrazil and my private practice,
the public system was at theUniversity of Sao Paulo where I
trained.
I also did my PhD there in, inhip surgery, especially
(03:04):
studying, the relationshipbetween labor affairs and, and,
Angle measurements in CT scans,which was a very interesting
study.
And after seven years, I decidedthat I wanted to study a little
bit more and, and actually hone,yeah, even more my, my research
skills.
So I spent one year, in 2018, I.
(03:25):
California with Dr.
Mark Saffron at Stanford, whichwas a really interesting year.
I was able to do more research.
Again, I studied basically a lotof hip micro instability.
but it was also very interestingto get in, in like the mindset
of the Silicon Valley.
Did a lot of courses oninnovation and a lot of stuff on
design thinking.
So it kind of changed my, mypractice a little bit when I
(03:47):
came back.
So I decided a lot to go.
I started to do a lot of stuffwith innovation.
I actually found that I startedup, I started doing some angel
investments in, in health tech,related, companies.
I also did, started doing a lotof stuff with, technology in,
in.
In medicine now we practice inorthopedics.
So I've been doing a lot ofstuff with robotics, navigation,
(04:09):
also some stuff with, augmentedreality and virtual reality.
So definitely my experience inCalifornia changed me a a lot.
Joseph M Schwab (04:16):
So were most of in the area of orthopedics or
more specifically in hip surgeryor were the, was it a kind of
across the gamut of medicine
Leandro Ejnisman (04:26):
I, I have a, I have vested in an engine
investment in a company thatdoes a lot of stuff with digital
health in orthopedics.
So they have like a softwarethat's nap, especially like for,
for like a company that has likethousands of employees and have
a lots of.
Problems with people gettingabsent because of back pain,
this kind of stuff.
So it helps monitor theirhealth.
(04:46):
And Oslo has some, like telephysiotherapy and
Teleconsultation helped by ai,so that's a very interesting
company.
I also helped a company that hadstuff with 3D printing, but
especially with Sprint, likefor, ortho Posis and this kind
of stuff.
And I also have, in a, I alsohave some investment in a
company that does stuff of.
(05:07):
Medical education, they do like,especially for medical students,
they do like clinical cases withactors.
So you have like a situationthat, like you have an actor
that presents himself with asymptom, let's say his coughing.
And then you have like, you haveto ask, what's the exam that you
want?
They show the exam.
Then you, you see the, you wannasee, tell what you're gonna do.
(05:29):
And it's a very interestingcompany actually going abroad as
well.
So it's very popular.
Yeah.
Joseph M Schwab (05:34):
I mean, you really have your hands in a lot
of different, areas of medicineit sounds like, as well as in
technology and innovation.
focusing a little bit onanterior approach, hip
replacement, tell me about howcommon it is, either in Sao
Paulo or, or in, you know,Brazil overall.
Leandro Ejnisman (05:53):
It is definitely growing.
So I don't have officialnumbers, but I would guess
around 5% of doctors here woulddo anterior approaches,
definitely less than US orEurope.
But I would say like until likefive years ago, it would be.
Probably less than 1%.
So it's definitely growingreally fast.
My, my first contact with theinterior approach was when I
(06:14):
still, when I was in, in Vailwith Dr.
Philippon.
I've seen talks of Dr.
Matta and doing the interiorapproach of the HA table, but
that was something that looked alittle bit far from me'cause.
Brazil.
It's an interesting country'cause it's a land of
disparities.
I would say, you know, becauseyou have like lots of wealth
here.
So the, the hospital that I dothat, that I work now, it's
(06:34):
called Albert Einstein Hospital.
It's a Jewish hospital.
I'm very proud of that here inSao Paulo.
And it's considered, the,definitely the best hospital in
Latin America, but it also ranksin as 22nd in the wards, a
really prime institution.
But they have lots of otherhospitals here that are not, so
there's not.
The infrastructure that Einsteinhas has, and even like being in
(06:57):
such a good place, like for meas a ledge surgeon, asking for
like a special table that costsso much, it looks like a far
thing, you know, for me.
So I decided to do the interiorapproach.
I, I saw Dr.
Christoph Carin from Belgiumdoing the interior approach off
table in a meeting.
And I went to him and I saidthat that's when something
clicked to me, you know, sayingthat's something that I can do
(07:17):
in my practice, you know?
So I went to visit him in 2016,and that's when my journey
began.
So almost 10 years now I havethe opportunity to visit him
again.
I think 2000.
2000 and.
In 22, I think he, I was thefirst visitor after the pandemic
with him'cause he had to, toblock his visitors for a while
because of the pandemic.
So since 2016 I started doinginterior approach off table and
(07:42):
it's been amazing.
You know, it's, I decided to,'cause I was listening to other,
other, other, orthopedicsurgeons here at the podcast
telling that some people decidedto go like, full, full.
Food directly to the anteriorapproach and do a hundred
percent of their cases.
Interior.
I took another, approach.
I started like changinggradually.
So at the beginning I was verypicky, like doing the easy
(08:04):
cases, like thin patients, veryvgo snacks.
And then I started slowlygrowing, like doing more
difficult cases.
And last year, 2024, I did, Ithink like 92% of my cases were
interior approach.
You know, so I'm, I'm basicallyconverted now.
I still don't feel likeconfident.
I don't, I don't say confident,but I, I still rather not do a
hundred percent of them.
(08:25):
'cause especially like the.
What I feel is that like as I'min an environment where, where
anterior approach is not thenorm yet, I feel like if I do a
patient that it's like morecomplicated.
Like if you do a really obesepatient that has a higher rate
of infection, independent of theapproach, if I do an anterior
approach and he gets infected,it's because of the approach.
If I do a posterior approach andgets infected, was was a tough
(08:47):
case.
You know?
So I think, I feel I have toprotect myself and the approach,
you know.
Joseph M Schwab (08:51):
So do you find that's one of the biggest
challenges you have in sort ofperforming or growing anterior
approach in your area?
Or what, what are the biggestchallenges you see of greater
adoption in Brazil?
I,
Leandro Ejnisman (09:07):
It is changing.
You know, like I, I would saythe, the first meeting I, I, I,
I think I heard of in Brazil ofinterior approach was in 2017.
It was, organized by mad.
So a, a lot of pe, a lot ofpeople that do interior approach
here in Brazil, they use the medsystem with their table.
'cause the HANA table, we aregetting some here in Brazil.
I know in Sao Paulo of twoplaces they have it, but not
(09:29):
many.
So.
I went there and like peoplewere telling about the interior
approach and, and me, so onething that's a problem here in
Brazil is because our healthsystem is a little bit different
and dependent, depending on theinsurance of the patient and the
hospital that are doing surgery,sometimes it's not easy for the
surgeon to choose the implantthat he wants.
(09:51):
So one thing that I, when Idecided to do an interior
approach, the, the thing thatconvinced me of doing it off
table was because I didn't wantto get, stuck.
To, to a table, because Ithought in, in Brazil, our
practice, even though I'm mostof the time at Albert Einstein
Hospital, I still do surgeriesin other places.
So I felt like if I'm, if I'm,I'm attached to the table and I
(10:12):
can only do the surgery with theHANA table, if I go to another
place that doesn't have it, Iwon't be able to do the approach
that I want.
And the same thing happenedwith, it was my, my, my mindset
with mea.
I felt like, well, if I can dolike most of my cases with mea,
that's good.
I can do the interior approach.
But if some insurance or somehospital.
Doesn't allow me to use theirimplant, that I'm gonna be not
able to do the approach.
(10:32):
You know?
And I feel like as some, a lotof surgeons here in Brazil still
linked the anterior approach, orto the MEA system or to the the
H table.
They're kind of like, whoa, Icannot do this because I wanna
be able to do in every case.
But I feel like, Now, especiallythe past three or four years, I
feel like the mindset ischanging and I've here, I feel
(10:54):
like two, five years ago, I knewevery surgeon here in Brazil
that do the interior approach.
And now I don't, like every oncein a while I get patients,
patients know.
I get surgeons that come talk tome in meetings.
Oh, I've been doing interiorapproach, I've been doing off
table.
I've been doing on table.
So it's spreading and I feellike the, the grow, it's been,
the growth, it's been leading bythe patients themselves, you
(11:15):
know?
So I was talking to you that,yeah, I, I feel like my
practice, when I began mypractice in 2011, that's when it
began.
It was like in the publicsystem, was mainly, hip
replacements.
I didn't do many.
Hip preservation there.
But in my private practice, Iwould say probably 70% was hip
preservation.
But since I started doing, theinterior approach, it's been
(11:37):
changing a lot.
So I would say probably now 20to 30% of my practice is, is,
hip preservation and the rest isinterior approach, because I've
been getting referrals.
by, by another, by patientsthemselves, by physiotherapists
to see a lot of difference.
The TER approach.
It's funny, you know, like acouple of years ago I operated
on, the mom of a physiotherapisthere.
(12:00):
She's really known here.
She has a great practice.
Like she, she, she treated oneof my patients like she was.
Pled by like the, the, therecovery and the speed recover.
So like two months after shesent me her mom to operate on
and she like, she knows a lot ofguys here and like I was very
honored.
But it shows to me how thephysiotherapist see the
difference.
Like when during your approach,you know.
Joseph M Schwab (12:21):
the growth has really been word of mouth
through the patients, it sounds
Leandro Ejnisman (12:24):
Word of mouth.
Yeah.
One other thing that's that'sbig in Brazil is social media.
So the, the, like many doctorshave like social media pages and
Instagram, YouTube, LinkedIn, inall the, you know, the, the
places.
And also I have one myself, andthere's lots of patient
education and it's somethinglike then when the patient
starts.
(12:45):
Studying, quote unquote, aboutthe, the procedure.
And they hear there's aprocedure that's muscle, more
muscle sparing, there's lessinvasive, they're, they're
really convinced, you know, solots of patients come to me,
they, they come to me and thefirst thing they, they ask is
like, you, you do interapproach.
Right?
Because that's what I want.
You know?
So that's something interesting.
Joseph M Schwab (13:02):
So, so you've been doing it for about 10
years, plus or minus.
And if, if you could go back tothe beginning, really, there one
thing that you wish you would'veknown, or you wish you would've
approached differently when youwere starting to learning
anterior approach?
Leandro Ejnisman (13:23):
I wish I had more, more structure than I had
in the beginning.
So like the companies, the, themedical companies wasn't,
weren't like too, too red,weren't ready for the interior
approach.
So when I started I didn't havelike offset handles.
I.
For doing the interior approachI had, to by myself, the
retractors that I used, youknow, so it was very, like,
(13:44):
sometimes when I think of thebeginning, I would think, I feel
like I was very brave doing it,you know?
'cause I was doing, like, Iwouldn't recommend people to do
it the way I did.
'cause like, I didn't have likethe, the right instrumentation.
I was in the public systemdoing, with residents, like
junior people to not help mevery much, you know?
So it was the, the beginningwas.
Tough, but I'm, I'm, I'm reallyhappy that I did it, you know?
(14:06):
'cause now I'm really happy withthe interior approach.
One thing that I did that somepeople do not recommend, but I
still think like it was a goodcall.
I did in the beginning many hipfractures.
'cause I do a lot of femoralneck fractures and I've seen
some people telling people liketo stay off of femoral femoral
fractures in the beginning.
And that's not my feelingbecause people are worried about
(14:26):
the femoral fracture, likegetting, doing like a, a calco
fracture or something.
That's something that I, Ididn't have.
In the beginning, and I feellike usually there are older
patients, like very, with verysoft tissues.
I very lax, so getting like theproper releases and getting the
femoral exposure, I feel likeit's very easy in, in femoral
fractures.
And I still do a lot of those.
(14:47):
And it's interesting, somepeople say, oh, but it's e
femoral fracture is an elderlypatient.
You don't need like to be lessinvasive.
But that's something that Itotally disagree.
I feel like they, they do reallywell.
They recover faster, they bleedless and they're really happy,
you know, so that's somethingthat I kind of disagree with
many people that I've heard of.
Joseph M Schwab (15:04):
No, I, I completely agree with you.
I think hip fractures are agreat place to learn anterior
approach, for the reasons thatyou mentioned and the fact that
you want to do everything youcan to get those patients
functional and minimize theiramount of.
Pain, so that they avoid thingslike dementia or delirium and
things like that.
(15:24):
So in your journey, I mean, youmentioned, for instance,
Kristoff Corten as a, as, as amentor.
What was it that you felt yougot from those sort of
mentorship relationships?
Was it really specific ways todo things or was it introduction
to different technologies, orwas it just sort of a, a, a
whole picture of efficiency?
(15:45):
What do you felt like youlearned from your mentors?
I.
Leandro Ejnisman (15:49):
I feel from him, I learned like the most
important thing definitely isthe, the technique itself.
You know?
'cause, like doing the properreleases, like being, when I
spent the first time I wentthere, I think like three days
with him in the, or the secondtime, two days.
He has a great volume.
So like being the, the firsttime I think I saw.
30 plus surgeries and I was ableto scrub in of him.
(16:13):
It's a big difference, like fromwhen we visit the us you know,
'cause I've did lots ofvisitation with surgeons, which
it's just a great way to, tolearn from people.
And usually when you go to theUS you cannot scrub in.
And especially if you're like,learning, the interior approach
is kind of deep, you know, it'sreally hard to see from the
outside, you know.
So being able to scrub in withhim was great.
(16:33):
He was also a mentor for me.
Like I, I remember like I had.
In the be beginning of mylearning curve, I had one case
of femoral nerve palsy, which I,I got really, really scared.
So I was able to, to send anemail to him like, did this ever
happen?
It's gonna get better.
And he's like, calm me down.
Say it gets better.
Just the pulse.
And actually it did get betterreally fast, so it was really
great.
And the technology also.
(16:54):
So like I have access to thegripper, the technology that he
developed.
It's great.
I still struggle in Brazilbecause of the cost, so I'm not
able to use it in every surgery.
It's a pity, I would love to useit, but I feel like he's a guy
that's kind of pushing like ourtechnology and everything, and I
really look up to him for thatand appreciate that, you know.
Joseph M Schwab (17:15):
based on your experience, based on your time
with mentors, your timestudying, have you made any
adjustments to yourinstrumentation, to your
positioning or to your teamcoordination, to work on
essentially efficiency in yourORs or how, how are things
working for you currently?
Leandro Ejnisman (17:34):
Unfortunately, efficiency is not the best thing
here.
You know, like our, I would saylike I've, I've visited some
places like in Belgium, in theus like the turn, the turnover
of the, the rooms, the time,like the amount of surgeries
that guys can do like in a day,something that, unfortunately
it's not my reality.
So most of the days I'll dolike.
Two cases, three at most, youknow, and, and I kind of mix
(17:56):
like in the morning or thesurgeries in the afternoon, or
the clinic or, or the other way,you know, so efficiency,
unfortunately it's not thatgreat here.
so like, I'm like, especiallylike, let's say I'm doing also a
lot of robotics now, and I talkto some people that say, oh,
doing robotics, like.
Gives you an extra time insurgery and it's, I don't wanna
do that because if I add likefive or 10 minutes to my case,
(18:19):
in the end of the day, I'm doingone less case.
And actually it's not myreality, you know, if I'm doing
like two cases and even I, Ifeel like the, the more in the
advanced learning curve you are,the less.
It, it take, it adds time to thesurgeon actually starts, lessen
the time.
But even if it does, for medoing two cases that in 10, 10
minutes not be like a greatdifference, I think the biggest
(18:40):
difference, inefficient that'shappening in my or now that
people are getting more used tointerior approach, you know,
because at the beginning I wouldget to the OR and every time
people would say, okay, so let'sturn the patient to the side.
And I'm like, no, I don't, I'mnot turning the patient to the
side.
I'll be asking for Flora andlike, why do you need flora for,
for a, for a hip replacement?
You know, so.
That's something that haschanged and I think that's a
(19:01):
bigger, efficiency that I added.
You know, like having a team andalso the people that scrubbing
with me.
It's not every time the samepeople, but most of the time,
most of the people you know.
So now I feel like you'regetting like a proper protocol
that you're doing like thethings basically the same, same
way every time.
You know?
So having the numbered retractoris something that, it's so
(19:22):
simple, but it adds, you know,like giving the refactor number
one, number two, number three,and people start getting used to
it.
Definitely add adds efficiencyto the surgery.
Joseph M Schwab (19:29):
are there other surgeons in your practice who
are doing anterior approach, oris it just you?
Leandro Ejnisman (19:37):
no, there's not, there's there, there are
more people there.
One, more senior guy thatactually he's doing interior
approach, but it's a WatsonJones, not a direct interior.
and as I said, like in in, in,in Sao Paulo people we are not
like, I think it's differentlike from Europe and US or
patients, but people, surgeonsmainly go like to one hospital.
(19:57):
So like people go around indifferent hospitals.
So I say that, that the doctorsthat like operate mainly at my
hospital, I would say this, meand this other guy that does
Watson Jones are the only two.
But like people that will comefrom time to time there, there
are more people that do anteriorapproach as well.
Joseph M Schwab (20:13):
So I, I mean, you have this perspective of
the, you know, the possibilityof growth of anterior approach
specifically in Brazil.
If you were to give advice, tosome surgeons who are
considering switching toanterior approach, but are
hesitant, what advice would yougive them?
Leandro Ejnisman (20:34):
look for proper education.
Definitely.
So that's something that'sgrowing in Brazil.
So one thing that I think reallychanged in the past year is that
we're starting to get more,more, more support from the
industry.
You know, so like our, ourBrazilian hip meeting from our
society happens every two years.
So the last one was in 2023, andit was amazing'cause I saw like
(20:54):
most of the symposiums of the,the companies were.
About interior approach.
So they brought a lot of,foreigners that do interior
approach.
I participated in one.
I work a lot of the, I work alot with the Pew Johnson, so I,
we had a symposium aboutinterior approach.
So I always tell, don't be like,I think I was probably a little
bit too brave.
I tell patients, like, I tellanother surgeons, like, go to a
(21:17):
lab, you're gonna, I know you'regonna have a great lab in, in
Nashville this year.
visit a surgeon if possible.
Ask to have like a reverse.
Visitation when you can, youknow, really pick your cases in
the beginning.
You know, like something thathappened with me that I don't
hear very often from people, asI told you that I, I had like a,
I was very picky in thebeginning of my patients.
(21:39):
I almost feel like I have adoubled curved learning curve.
What I mean is that like, I waslike, I think I did like a
hundred cases, like reallypicking the, the easy ones.
Then I decided, okay, let's moveto the harder ones.
And then almost felt like I waslearning again, you know?
So I started to have like alittle bit more complications.
The cases were difficult again.
So I really understood thedifference between doing an easy
(22:00):
case and a tough case.
So I usually tell tell peoplelike start easy cases and don't
be in a rush to turn yourpractice to a hundred percent
interior approach.
You know, take your time.
That's something that I did andI'm really thinking, I'm glad I
did that.
Joseph M Schwab (22:12):
I almost feel like publishing about the double
learning curve is somethingworthwhile.
That that's such a,
Leandro Ejnisman (22:19):
That'd be interesting.
Joseph M Schwab (22:20):
That is such an interesting observation that
I've never heard anyone saybefore.
But you're absolutely right.
If you start out with that sortof, narrowed set of patients,
you get really comfortable withit, and then you expand your
indications.
Yeah, absolutely.
You can hit a whole notherlearning curve.
Right.
I mean, you, you have thistremendous perspective.
(22:40):
you've seen the growth whereyou're at.
You're, you're clearly you'reinterested in innovation and
technology.
What do you see for the futureof, of hip surgery, hip
replacement surgery?
You mentioned robotics.
Where do you see this going?
Leandro Ejnisman (22:56):
I feel like if it, I don't know the number,
it's gonna be 10 years, 20years, or 50 years, but I feel
like we're gonna move to ahundred percent robotics and
technology.
That's something that I'mreally, really be believing.
Joseph M Schwab (23:06):
Mo
Leandro Ejnisman (23:07):
not sure it's gonna be some.
Joseph M Schwab (23:08):
out of the operating room and everything's
or what?
Leandro Ejnisman (23:11):
If you go like farther far, yeah, I think if
you go further away, probably atsome point I think like it's
gonna be like in a Star Warswhere the robots like the rain
plant, like the looks hand.
But I think that's definitelyfarther away.
But I would say like in.
Not so long, not in so longtime, like 10 to 20 years we're
gonna move.
Like every case is gonna havetechnology with it, you know,
(23:34):
which the thing that I'm notsure is which technology will
quote unquote win.
You know, if it's gonna be 3Dprinted guides, if it's gonna be
help with, augmented reality, ifit's gonna be a robot itself.
Navigation, that's something Ithink it's open for, for
discussion.
You know, at this point I'vebeen using mainly the valve
system from the pew, which Ireally like.
And the Mako from, from Stryker.
(23:56):
I've been using both and I feellike both has have their adv
advantages and disadvantages.
But like as I told you, likeI'm, I'm, I'm not able every
time to pick the implant thatI'm using.
So I still do a lot of surgerieswith other implants without the
help of technology.
And definitely like when I'mdoing without technology now I'm
kind of, I'm not sure if I'mdoing like the best treatment
(24:18):
that I can do to this patient.
You know, that's something that,that's a feeling that I have at
this point.
Joseph M Schwab (24:22):
I mean, I, I feel, I, I, I absolutely hear
what you're saying and I feellike, I mean, that's almost the
goal of every surgeon, right?
Is to feel like what do we needto be doing better?
it's that, that, desire to becontent with what you've done,
but also to be, even morecontent with what you can do in
the future.
boy, I, I Leandro, I, I reallyappreciate the opportunity of
(24:45):
talking with you.
I, I really love hearing yourperspective on this, and I, and
I love that you are, bringingthis approach and this
enthusiasm for innovation, toBrazil and, you know, bringing
it all around the world At thispoint, you know, we've been to,
to Belgium, you're coming to, toNashville, and, you're gonna be,
(25:07):
giving us some of yourperspective there.
So.
I really appreciate you beingwith me today on the podcast.
Leandro Ejnisman (25:13):
Thank you very much and, thank you for the
opportunity to be here and Ilook forward to seeing you in
Nashville and every othersurgeon that, really, eager to
talk to everyone and learn frompeople from all over the world.
Joseph M Schwab (25:24):
Thank you for listening to this episode of the
AHF podcast.
Remember to like and subscribeso we can reach a wider
audience.
If you have an idea for a topic,leave it in the comments.
Remember.
You can find us in audio podcastform in your favorite podcast
app, as well as in video form onYouTube slash at anterior hip
(25:45):
foundation, all one word.
New episodes of the AHF podcastcome out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
happy and healthy.
Hello again and welcome back to the AHF Podcast.
I'm your host, Joe Schwab.
This week we head to Sao Paulo,Brazil.
Where Dr.
Leandro Ejnisman has beenworking hard to introduce
anterior approach to hiscommunity for the past 10 years.
He shares his insights ontechnology, surgeon
(00:45):
entrepreneurship, and what thefuture of orthopedic surgery
just might look like.
And here's a hint.
He's betting it'll involverobots.
Let's join in on theconversation.
Leandro, welcome to the AHFPodcast.
Leandro Ejnisman (01:01):
Thank you very much Joe.
It's an honor for me to be here.
Thank you very much.
And especially being the firstone, I believe, from Latin
America.
Joseph M Schwab (01:08):
That's right.
So which, tell our listeners alittle bit about you and a
little bit about
Leandro Ejnisman (01:13):
I.
Sure.
So I'm from Sa Paulo Brazil, asyou mentioned.
I was born here and I did all mytraining here.
I went to medical school atUniversity of Sao Paulo, and for
those who don't know, it's avery prestigious university here
in, in South America.
It's considered, definitely oneof the best here in Brazil,
Latin America, but, but also itranks really well, in world
(01:35):
rankings.
a little thing that's differenthere in Brazil is that.
Usually if you are in a goodway, in a good place where you
did your medical school, peopletend to stay in the same place
for residency and fellowship.
So it's a little bit differentthan us.
What I see that most people goaround in different places.
so I did my, medical school atUniversity of Sao Paulo, my, my
(01:56):
residency and my fellowship,which was in hip surgery.
also our practice here is likejoint centered, so.
Most people like my practice as,as you asked, is basically hip
surgery.
I do both hip replacements andhip preservation surgery.
So after my, my fellowship herein Brazil, I went to the west to
(02:17):
do another fellowship.
I.
And in my, in my hospital, wedidn't have much hip
arthroscopy.
So I spent one year after myfellowship at, in Il, Colorado
with Dr.
Philippon at the StatemanClinic.
I went there as a, we have likea institution here that gives
scholarships to Brazilians thatwant to go abroad.
It's called Institu technology,the S, so I went there and I
(02:39):
have a wonderful year of Dr.
Philippon.
I learned a lot of laproscopy.
I did some research, which wasreally interesting, and then I
came back, When I started mypractice, I divided myself
between public system here inBrazil and my private practice,
the public system was at theUniversity of Sao Paulo where I
trained.
I also did my PhD there in, inhip surgery, especially
(03:04):
studying, the relationshipbetween labor affairs and, and,
Angle measurements in CT scans,which was a very interesting
study.
And after seven years, I decidedthat I wanted to study a little
bit more and, and actually hone,yeah, even more my, my research
skills.
So I spent one year, in 2018, I.
(03:25):
California with Dr.
Mark Saffron at Stanford, whichwas a really interesting year.
I was able to do more research.
Again, I studied basically a lotof hip micro instability.
but it was also very interestingto get in, in like the mindset
of the Silicon Valley.
Did a lot of courses oninnovation and a lot of stuff on
design thinking.
So it kind of changed my, mypractice a little bit when I
(03:47):
came back.
So I decided a lot to go.
I started to do a lot of stuffwith innovation.
I actually found that I startedup, I started doing some angel
investments in, in health tech,related, companies.
I also did, started doing a lotof stuff with, technology in,
in.
In medicine now we practice inorthopedics.
So I've been doing a lot ofstuff with robotics, navigation,
(04:09):
also some stuff with, augmentedreality and virtual reality.
So definitely my experience inCalifornia changed me a a lot.
Joseph M Schwab (04:16):
So were most of in the area of orthopedics or
more specifically in hip surgeryor were the, was it a kind of
across the gamut of medicine
Leandro Ejnisman (04:26):
I, I have a, I have vested in an engine
investment in a company thatdoes a lot of stuff with digital
health in orthopedics.
So they have like a softwarethat's nap, especially like for,
for like a company that has likethousands of employees and have
a lots of.
Problems with people gettingabsent because of back pain,
this kind of stuff.
So it helps monitor theirhealth.
(04:46):
And Oslo has some, like telephysiotherapy and
Teleconsultation helped by ai,so that's a very interesting
company.
I also helped a company that hadstuff with 3D printing, but
especially with Sprint, likefor, ortho Posis and this kind
of stuff.
And I also have, in a, I alsohave some investment in a
company that does stuff of.
(05:07):
Medical education, they do like,especially for medical students,
they do like clinical cases withactors.
So you have like a situationthat, like you have an actor
that presents himself with asymptom, let's say his coughing.
And then you have like, you haveto ask, what's the exam that you
want?
They show the exam.
Then you, you see the, you wannasee, tell what you're gonna do.
(05:29):
And it's a very interestingcompany actually going abroad as
well.
So it's very popular.
Yeah.
Joseph M Schwab (05:34):
I mean, you really have your hands in a lot
of different, areas of medicineit sounds like, as well as in
technology and innovation.
focusing a little bit onanterior approach, hip
replacement, tell me about howcommon it is, either in Sao
Paulo or, or in, you know,Brazil overall.
Leandro Ejnisman (05:53):
It is definitely growing.
So I don't have officialnumbers, but I would guess
around 5% of doctors here woulddo anterior approaches,
definitely less than US orEurope.
But I would say like until likefive years ago, it would be.
Probably less than 1%.
So it's definitely growingreally fast.
My, my first contact with theinterior approach was when I
(06:14):
still, when I was in, in Vailwith Dr.
Philippon.
I've seen talks of Dr.
Matta and doing the interiorapproach of the HA table, but
that was something that looked alittle bit far from me'cause.
Brazil.
It's an interesting country'cause it's a land of
disparities.
I would say, you know, becauseyou have like lots of wealth
here.
So the, the hospital that I dothat, that I work now, it's
(06:34):
called Albert Einstein Hospital.
It's a Jewish hospital.
I'm very proud of that here inSao Paulo.
And it's considered, the,definitely the best hospital in
Latin America, but it also ranksin as 22nd in the wards, a
really prime institution.
But they have lots of otherhospitals here that are not, so
there's not.
The infrastructure that Einsteinhas has, and even like being in
(06:57):
such a good place, like for meas a ledge surgeon, asking for
like a special table that costsso much, it looks like a far
thing, you know, for me.
So I decided to do the interiorapproach.
I, I saw Dr.
Christoph Carin from Belgiumdoing the interior approach off
table in a meeting.
And I went to him and I saidthat that's when something
clicked to me, you know, sayingthat's something that I can do
(07:17):
in my practice, you know?
So I went to visit him in 2016,and that's when my journey
began.
So almost 10 years now I havethe opportunity to visit him
again.
I think 2000.
2000 and.
In 22, I think he, I was thefirst visitor after the pandemic
with him'cause he had to, toblock his visitors for a while
because of the pandemic.
So since 2016 I started doinginterior approach off table and
(07:42):
it's been amazing.
You know, it's, I decided to,'cause I was listening to other,
other, other, orthopedicsurgeons here at the podcast
telling that some people decidedto go like, full, full.
Food directly to the anteriorapproach and do a hundred
percent of their cases.
Interior.
I took another, approach.
I started like changinggradually.
So at the beginning I was verypicky, like doing the easy
(08:04):
cases, like thin patients, veryvgo snacks.
And then I started slowlygrowing, like doing more
difficult cases.
And last year, 2024, I did, Ithink like 92% of my cases were
interior approach.
You know, so I'm, I'm basicallyconverted now.
I still don't feel likeconfident.
I don't, I don't say confident,but I, I still rather not do a
hundred percent of them.
(08:25):
'cause especially like the.
What I feel is that like as I'min an environment where, where
anterior approach is not thenorm yet, I feel like if I do a
patient that it's like morecomplicated.
Like if you do a really obesepatient that has a higher rate
of infection, independent of theapproach, if I do an anterior
approach and he gets infected,it's because of the approach.
If I do a posterior approach andgets infected, was was a tough
(08:47):
case.
You know?
So I think, I feel I have toprotect myself and the approach,
you know.
Joseph M Schwab (08:51):
So do you find that's one of the biggest
challenges you have in sort ofperforming or growing anterior
approach in your area?
Or what, what are the biggestchallenges you see of greater
adoption in Brazil?
I,
Leandro Ejnisman (09:07):
It is changing.
You know, like I, I would saythe, the first meeting I, I, I,
I think I heard of in Brazil ofinterior approach was in 2017.
It was, organized by mad.
So a, a lot of pe, a lot ofpeople that do interior approach
here in Brazil, they use the medsystem with their table.
'cause the HANA table, we aregetting some here in Brazil.
I know in Sao Paulo of twoplaces they have it, but not
(09:29):
many.
So.
I went there and like peoplewere telling about the interior
approach and, and me, so onething that's a problem here in
Brazil is because our healthsystem is a little bit different
and dependent, depending on theinsurance of the patient and the
hospital that are doing surgery,sometimes it's not easy for the
surgeon to choose the implantthat he wants.
(09:51):
So one thing that I, when Idecided to do an interior
approach, the, the thing thatconvinced me of doing it off
table was because I didn't wantto get, stuck.
To, to a table, because Ithought in, in Brazil, our
practice, even though I'm mostof the time at Albert Einstein
Hospital, I still do surgeriesin other places.
So I felt like if I'm, if I'm,I'm attached to the table and I
(10:12):
can only do the surgery with theHANA table, if I go to another
place that doesn't have it, Iwon't be able to do the approach
that I want.
And the same thing happenedwith, it was my, my, my mindset
with mea.
I felt like, well, if I can dolike most of my cases with mea,
that's good.
I can do the interior approach.
But if some insurance or somehospital.
Doesn't allow me to use theirimplant, that I'm gonna be not
able to do the approach.
(10:32):
You know?
And I feel like as some, a lotof surgeons here in Brazil still
linked the anterior approach, orto the MEA system or to the the
H table.
They're kind of like, whoa, Icannot do this because I wanna
be able to do in every case.
But I feel like, Now, especiallythe past three or four years, I
feel like the mindset ischanging and I've here, I feel
(10:54):
like two, five years ago, I knewevery surgeon here in Brazil
that do the interior approach.
And now I don't, like every oncein a while I get patients,
patients know.
I get surgeons that come talk tome in meetings.
Oh, I've been doing interiorapproach, I've been doing off
table.
I've been doing on table.
So it's spreading and I feellike the, the grow, it's been,
the growth, it's been leading bythe patients themselves, you
(11:15):
know?
So I was talking to you that,yeah, I, I feel like my
practice, when I began mypractice in 2011, that's when it
began.
It was like in the publicsystem, was mainly, hip
replacements.
I didn't do many.
Hip preservation there.
But in my private practice, Iwould say probably 70% was hip
preservation.
But since I started doing, theinterior approach, it's been
(11:37):
changing a lot.
So I would say probably now 20to 30% of my practice is, is,
hip preservation and the rest isinterior approach, because I've
been getting referrals.
by, by another, by patientsthemselves, by physiotherapists
to see a lot of difference.
The TER approach.
It's funny, you know, like acouple of years ago I operated
on, the mom of a physiotherapisthere.
(12:00):
She's really known here.
She has a great practice.
Like she, she, she treated oneof my patients like she was.
Pled by like the, the, therecovery and the speed recover.
So like two months after shesent me her mom to operate on
and she like, she knows a lot ofguys here and like I was very
honored.
But it shows to me how thephysiotherapist see the
difference.
Like when during your approach,you know.
Joseph M Schwab (12:21):
the growth has really been word of mouth
through the patients, it sounds
Leandro Ejnisman (12:24):
Word of mouth.
Yeah.
One other thing that's that'sbig in Brazil is social media.
So the, the, like many doctorshave like social media pages and
Instagram, YouTube, LinkedIn, inall the, you know, the, the
places.
And also I have one myself, andthere's lots of patient
education and it's somethinglike then when the patient
starts.
(12:45):
Studying, quote unquote, aboutthe, the procedure.
And they hear there's aprocedure that's muscle, more
muscle sparing, there's lessinvasive, they're, they're
really convinced, you know, solots of patients come to me,
they, they come to me and thefirst thing they, they ask is
like, you, you do interapproach.
Right?
Because that's what I want.
You know?
So that's something interesting.
Joseph M Schwab (13:02):
So, so you've been doing it for about 10
years, plus or minus.
And if, if you could go back tothe beginning, really, there one
thing that you wish you would'veknown, or you wish you would've
approached differently when youwere starting to learning
anterior approach?
Leandro Ejnisman (13:23):
I wish I had more, more structure than I had
in the beginning.
So like the companies, the, themedical companies wasn't,
weren't like too, too red,weren't ready for the interior
approach.
So when I started I didn't havelike offset handles.
I.
For doing the interior approachI had, to by myself, the
retractors that I used, youknow, so it was very, like,
(13:44):
sometimes when I think of thebeginning, I would think, I feel
like I was very brave doing it,you know?
'cause I was doing, like, Iwouldn't recommend people to do
it the way I did.
'cause like, I didn't have likethe, the right instrumentation.
I was in the public systemdoing, with residents, like
junior people to not help mevery much, you know?
So it was the, the beginningwas.
Tough, but I'm, I'm, I'm reallyhappy that I did it, you know?
(14:06):
'cause now I'm really happy withthe interior approach.
One thing that I did that somepeople do not recommend, but I
still think like it was a goodcall.
I did in the beginning many hipfractures.
'cause I do a lot of femoralneck fractures and I've seen
some people telling people liketo stay off of femoral femoral
fractures in the beginning.
And that's not my feelingbecause people are worried about
(14:26):
the femoral fracture, likegetting, doing like a, a calco
fracture or something.
That's something that I, Ididn't have.
In the beginning, and I feellike usually there are older
patients, like very, with verysoft tissues.
I very lax, so getting like theproper releases and getting the
femoral exposure, I feel likeit's very easy in, in femoral
fractures.
And I still do a lot of those.
(14:47):
And it's interesting, somepeople say, oh, but it's e
femoral fracture is an elderlypatient.
You don't need like to be lessinvasive.
But that's something that Itotally disagree.
I feel like they, they do reallywell.
They recover faster, they bleedless and they're really happy,
you know, so that's somethingthat I kind of disagree with
many people that I've heard of.
Joseph M Schwab (15:04):
No, I, I completely agree with you.
I think hip fractures are agreat place to learn anterior
approach, for the reasons thatyou mentioned and the fact that
you want to do everything youcan to get those patients
functional and minimize theiramount of.
Pain, so that they avoid thingslike dementia or delirium and
things like that.
(15:24):
So in your journey, I mean, youmentioned, for instance,
Kristoff Corten as a, as, as amentor.
What was it that you felt yougot from those sort of
mentorship relationships?
Was it really specific ways todo things or was it introduction
to different technologies, orwas it just sort of a, a, a
whole picture of efficiency?
(15:45):
What do you felt like youlearned from your mentors?
I.
Leandro Ejnisman (15:49):
I feel from him, I learned like the most
important thing definitely isthe, the technique itself.
You know?
'cause, like doing the properreleases, like being, when I
spent the first time I wentthere, I think like three days
with him in the, or the secondtime, two days.
He has a great volume.
So like being the, the firsttime I think I saw.
30 plus surgeries and I was ableto scrub in of him.
(16:13):
It's a big difference, like fromwhen we visit the us you know,
'cause I've did lots ofvisitation with surgeons, which
it's just a great way to, tolearn from people.
And usually when you go to theUS you cannot scrub in.
And especially if you're like,learning, the interior approach
is kind of deep, you know, it'sreally hard to see from the
outside, you know.
So being able to scrub in withhim was great.
(16:33):
He was also a mentor for me.
Like I, I remember like I had.
In the be beginning of mylearning curve, I had one case
of femoral nerve palsy, which I,I got really, really scared.
So I was able to, to send anemail to him like, did this ever
happen?
It's gonna get better.
And he's like, calm me down.
Say it gets better.
Just the pulse.
And actually it did get betterreally fast, so it was really
great.
And the technology also.
(16:54):
So like I have access to thegripper, the technology that he
developed.
It's great.
I still struggle in Brazilbecause of the cost, so I'm not
able to use it in every surgery.
It's a pity, I would love to useit, but I feel like he's a guy
that's kind of pushing like ourtechnology and everything, and I
really look up to him for thatand appreciate that, you know.
Joseph M Schwab (17:15):
based on your experience, based on your time
with mentors, your timestudying, have you made any
adjustments to yourinstrumentation, to your
positioning or to your teamcoordination, to work on
essentially efficiency in yourORs or how, how are things
working for you currently?
Leandro Ejnisman (17:34):
Unfortunately, efficiency is not the best thing
here.
You know, like our, I would saylike I've, I've visited some
places like in Belgium, in theus like the turn, the turnover
of the, the rooms, the time,like the amount of surgeries
that guys can do like in a day,something that, unfortunately
it's not my reality.
So most of the days I'll dolike.
Two cases, three at most, youknow, and, and I kind of mix
(17:56):
like in the morning or thesurgeries in the afternoon, or
the clinic or, or the other way,you know, so efficiency,
unfortunately it's not thatgreat here.
so like, I'm like, especiallylike, let's say I'm doing also a
lot of robotics now, and I talkto some people that say, oh,
doing robotics, like.
Gives you an extra time insurgery and it's, I don't wanna
do that because if I add likefive or 10 minutes to my case,
(18:19):
in the end of the day, I'm doingone less case.
And actually it's not myreality, you know, if I'm doing
like two cases and even I, Ifeel like the, the more in the
advanced learning curve you are,the less.
It, it take, it adds time to thesurgeon actually starts, lessen
the time.
But even if it does, for medoing two cases that in 10, 10
minutes not be like a greatdifference, I think the biggest
(18:40):
difference, inefficient that'shappening in my or now that
people are getting more used tointerior approach, you know,
because at the beginning I wouldget to the OR and every time
people would say, okay, so let'sturn the patient to the side.
And I'm like, no, I don't, I'mnot turning the patient to the
side.
I'll be asking for Flora andlike, why do you need flora for,
for a, for a hip replacement?
You know, so.
That's something that haschanged and I think that's a
(19:01):
bigger, efficiency that I added.
You know, like having a team andalso the people that scrubbing
with me.
It's not every time the samepeople, but most of the time,
most of the people you know.
So now I feel like you'regetting like a proper protocol
that you're doing like thethings basically the same, same
way every time.
You know?
So having the numbered retractoris something that, it's so
(19:22):
simple, but it adds, you know,like giving the refactor number
one, number two, number three,and people start getting used to
it.
Definitely add adds efficiencyto the surgery.
Joseph M Schwab (19:29):
are there other surgeons in your practice who
are doing anterior approach, oris it just you?
Leandro Ejnisman (19:37):
no, there's not, there's there, there are
more people there.
One, more senior guy thatactually he's doing interior
approach, but it's a WatsonJones, not a direct interior.
and as I said, like in in, in,in Sao Paulo people we are not
like, I think it's differentlike from Europe and US or
patients, but people, surgeonsmainly go like to one hospital.
(19:57):
So like people go around indifferent hospitals.
So I say that, that the doctorsthat like operate mainly at my
hospital, I would say this, meand this other guy that does
Watson Jones are the only two.
But like people that will comefrom time to time there, there
are more people that do anteriorapproach as well.
Joseph M Schwab (20:13):
So I, I mean, you have this perspective of
the, you know, the possibilityof growth of anterior approach
specifically in Brazil.
If you were to give advice, tosome surgeons who are
considering switching toanterior approach, but are
hesitant, what advice would yougive them?
Leandro Ejnisman (20:34):
look for proper education.
Definitely.
So that's something that'sgrowing in Brazil.
So one thing that I think reallychanged in the past year is that
we're starting to get more,more, more support from the
industry.
You know, so like our, ourBrazilian hip meeting from our
society happens every two years.
So the last one was in 2023, andit was amazing'cause I saw like
(20:54):
most of the symposiums of the,the companies were.
About interior approach.
So they brought a lot of,foreigners that do interior
approach.
I participated in one.
I work a lot of the, I work alot with the Pew Johnson, so I,
we had a symposium aboutinterior approach.
So I always tell, don't be like,I think I was probably a little
bit too brave.
I tell patients, like, I tellanother surgeons, like, go to a
(21:17):
lab, you're gonna, I know you'regonna have a great lab in, in
Nashville this year.
visit a surgeon if possible.
Ask to have like a reverse.
Visitation when you can, youknow, really pick your cases in
the beginning.
You know, like something thathappened with me that I don't
hear very often from people, asI told you that I, I had like a,
I was very picky in thebeginning of my patients.
(21:39):
I almost feel like I have adoubled curved learning curve.
What I mean is that like, I waslike, I think I did like a
hundred cases, like reallypicking the, the easy ones.
Then I decided, okay, let's moveto the harder ones.
And then almost felt like I waslearning again, you know?
So I started to have like alittle bit more complications.
The cases were difficult again.
So I really understood thedifference between doing an easy
(22:00):
case and a tough case.
So I usually tell tell peoplelike start easy cases and don't
be in a rush to turn yourpractice to a hundred percent
interior approach.
You know, take your time.
That's something that I did andI'm really thinking, I'm glad I
did that.
Joseph M Schwab (22:12):
I almost feel like publishing about the double
learning curve is somethingworthwhile.
That that's such a,
Leandro Ejnisman (22:19):
That'd be interesting.
Joseph M Schwab (22:20):
That is such an interesting observation that
I've never heard anyone saybefore.
But you're absolutely right.
If you start out with that sortof, narrowed set of patients,
you get really comfortable withit, and then you expand your
indications.
Yeah, absolutely.
You can hit a whole notherlearning curve.
Right.
I mean, you, you have thistremendous perspective.
(22:40):
you've seen the growth whereyou're at.
You're, you're clearly you'reinterested in innovation and
technology.
What do you see for the futureof, of hip surgery, hip
replacement surgery?
You mentioned robotics.
Where do you see this going?
Leandro Ejnisman (22:56):
I feel like if it, I don't know the number,
it's gonna be 10 years, 20years, or 50 years, but I feel
like we're gonna move to ahundred percent robotics and
technology.
That's something that I'mreally, really be believing.
Joseph M Schwab (23:06):
Mo
Leandro Ejnisman (23:07):
not sure it's gonna be some.
Joseph M Schwab (23:08):
out of the operating room and everything's
or what?
Leandro Ejnisman (23:11):
If you go like farther far, yeah, I think if
you go further away, probably atsome point I think like it's
gonna be like in a Star Warswhere the robots like the rain
plant, like the looks hand.
But I think that's definitelyfarther away.
But I would say like in.
Not so long, not in so longtime, like 10 to 20 years we're
gonna move.
Like every case is gonna havetechnology with it, you know,
(23:34):
which the thing that I'm notsure is which technology will
quote unquote win.
You know, if it's gonna be 3Dprinted guides, if it's gonna be
help with, augmented reality, ifit's gonna be a robot itself.
Navigation, that's something Ithink it's open for, for
discussion.
You know, at this point I'vebeen using mainly the valve
system from the pew, which Ireally like.
And the Mako from, from Stryker.
(23:56):
I've been using both and I feellike both has have their adv
advantages and disadvantages.
But like as I told you, likeI'm, I'm, I'm not able every
time to pick the implant thatI'm using.
So I still do a lot of surgerieswith other implants without the
help of technology.
And definitely like when I'mdoing without technology now I'm
kind of, I'm not sure if I'mdoing like the best treatment
(24:18):
that I can do to this patient.
You know, that's something that,that's a feeling that I have at
this point.
Joseph M Schwab (24:22):
I mean, I, I feel, I, I, I absolutely hear
what you're saying and I feellike, I mean, that's almost the
goal of every surgeon, right?
Is to feel like what do we needto be doing better?
it's that, that, desire to becontent with what you've done,
but also to be, even morecontent with what you can do in
the future.
boy, I, I Leandro, I, I reallyappreciate the opportunity of
(24:45):
talking with you.
I, I really love hearing yourperspective on this, and I, and
I love that you are, bringingthis approach and this
enthusiasm for innovation, toBrazil and, you know, bringing
it all around the world At thispoint, you know, we've been to,
to Belgium, you're coming to, toNashville, and, you're gonna be,
(25:07):
giving us some of yourperspective there.
So.
I really appreciate you beingwith me today on the podcast.
Leandro Ejnisman (25:13):
Thank you very much and, thank you for the
opportunity to be here and Ilook forward to seeing you in
Nashville and every othersurgeon that, really, eager to
talk to everyone and learn frompeople from all over the world.
Joseph M Schwab (25:24):
Thank you for listening to this episode of the
AHF podcast.
Remember to like and subscribeso we can reach a wider
audience.
If you have an idea for a topic,leave it in the comments.
Remember.
You can find us in audio podcastform in your favorite podcast
app, as well as in video form onYouTube slash at anterior hip
(25:45):
foundation, all one word.
New episodes of the AHF podcastcome out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
happy and healthy.
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