December 6, 2024 • 17 mins
In this episode, Joseph M. Schwab delves into the reasons behind the increasing favorability of the anterior approach in total hip arthroplasties in Australia. Featuring insights from hip surgeons Patrick Weinrauch, Jit Balakumar, Ilan Freedman, and Joe Scerri of Applied Medical.
Meet our guests:
Mr. Patrick Weinrauch - https://brisbanehipclinic.com.au/about-us/a-prof-weinrauch-orthopaedic-surgeon.html
Mr. Jit Balakumar - https://jitbalakumar.com.au/
Mr. Ilan Freedman - https://melbournehipsurgeon.com.au/
Joe Scerri - https://au.linkedin.com/in/joe-scerri-45a003254
Register now for AHF 2025 in Nashville, TN! https://anteriorhipfoundation.com/ahf2025-nashville/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Joseph M. Schwab (00:07):
I had the opportunity a few weeks ago to
sit down with a group ofAustralian hip surgeons.
Through our conversation theyhelped me understand the
landscape of anterior approachhip surgery in Australia.
In fact, they weren't shy insharing their opinions about the
good, the bad and the ugly oftraining on anterior approach
from down under.
(00:27):
Over the course of almost anhour we discussed how the
Australian market compares toother national markets like the
United States and Great Britain.
According to the AustralianNational Joint Registry,
anterior approach makes up justover 30% of all primary total
hip arthroplasties.
For me, this enlighteningdiscussion helped me understand
(00:47):
what's driving the increase inpopularity for anterior approach
in Australia.
The surgeons I talked to werePatrick Weinrauch, Jit
Balakumar, and Ilan Freedman.
All practicing hip surgeons inAustralia.
Also in on the conversation wasJoe Scerri, a sales rep for
Applied Medical, who has aparticular passion for anterior
(01:09):
approach.
Over the course of the next fewepisodes, we'll cover the whole
conversation.
But let's begin by learningabout.
each surgeon.
starting with.
Mr.
Patrick.
Weinrauch.
Patrick Weinrauch (01:21):
Yes I'm a a, hip surgeon.
I, do only hips.
I've been in private practice,for about 16 years now and I've
been doing anterior approach forabout 13 years or so, 12, 13
years, something like that.
probably 75 to 80 percent of mypractice is arthroplasty, about
(01:45):
20 percent is arthroscopy.
I do a fair number of,resurfacing procedures, so out
of my primary arthroplasty,about 50 percent of my work is
resurfacing and 50 percent isconventional total hip
replacement.
Joseph M. Schwab (02:02):
Are you using anterior approach for both,
resurfacings and, standardconventional total hips?
Patrick Weinrauch (02:09):
No, so I use, posterior approaches for my
resurfacing, anterior approachfrom a conventional total hip
replacements, and revisions area bit of a mix.
Predominantly posteriorapproaches for my revisions,
depends on the clinicalsituation.
Joseph M. Schwab (02:26):
And, Elan, tell us about yourself.
Ilan Freedman (02:28):
Yes, I, finished training in 2012.
I actually followed Patrick thesame, uk hip arthroscopy
fellowship.
but when I was in the UK I gotthe, opportunity to spend a
weekend in France with,Frederick Laude anterior hip
surgeon.
hip arthroscopy didn't reallygel that much with me, but from
that opportunity ended up doing,anterior approach through
(02:49):
Frederick.
And, I just do, adultarthroplasty, probably 60% hip,
40% knee.
Purely anterior approach formost, except for a difficult
revisions
Joseph M. Schwab (03:02):
You're quite active on LinkedIn, I see, as
well.
You've got, almost 15, 000followers on LinkedIn.
Ilan Freedman (03:09):
Yeah, I try to be.
I'm purely private practice, soI don't have the luxury of a
public appointment, so it'spurely private.
So initially it was a bit ofawareness and I guess a bit of
marketing, I enjoy posting whatI do, enjoy posting papers,
enjoy being a little bit,challenging or, mildly
controversial, but it's beengood to just get a bit of
awareness for my practice, butI've kept it up and you actually
(03:31):
learn a lot.
I've learned more from some ofthe case studies on LinkedIn.
Then I do from, journal papers,people posting interesting stuff
and commenting and sharing.
And it's been quite a goodforum.
Joseph M. Schwab (03:42):
We certainly don't shy from controversy here.
Jit, why don't you tell us alittle bit about yourself?
Jit Balakumar (03:47):
So I finished medical school in 1998, finished
my orthopedic training in 2006.
So similar to Patrick.
and, even though I'm apediatric, type surgeon, look,
my practice is probably 70percent arthroplasty, and 20 to
30 percent arthroscopy and 20,10 percent osteotomies.
(04:10):
I do a lot of osteotomies, PAOs,but, like overall picture, it's
probably a small proportion ofmy practice.
And, I started the DAA journeyactually, similar to Ilan, I was
doing a fellowship in France,and even before that I saw it in
Australia, but I saw, I wasdoing a knee fellowship and saw
frederick Laude next door, andthe controversies he was
(04:33):
creating at the time, and then,I spent some time with Keith
Berend just doing somevisitations, came back to
Australia, just made perfectsense with the arthroscopy and
osteotomy practice to dosomething supine with
fluoroscopic guidance, for me,it was all about trying to
incorporate that into mypreservation practice and then I
(04:55):
spent two weeks with Dr.
Joel Matta, who started yourAHF, I can see, I was very lucky
DePuy had funded that and I'vegone through a journey on table,
off table with DePuy and then,now with Medacta.
I am a zealot when it comes toanterior hips, but look, to be
honest, as I tell patients, Idon't, they're all the same
(05:18):
anterior posterior at 3 to 6months.
It's probably something that, Iused to use my enabling
technology to, hopefully improvepatient outcomes.
Joseph M. Schwab (05:29):
In your journey through trying out
different technologies,identifying different implant
companies, what is it that youfeel?
pushes you in one directionhelps you gravitate towards a
specific technology.
The people that you work with?
Is it the results that you get?
Is it the, shine and the glitterof the technology, so to speak?
(05:52):
what's your biggest factor?
Jit Balakumar (05:55):
I think the people I work with really,
that's probably Patrick and I'veactually worked on a few things
together, but the people I workwith is probably the most
important thing.
I feel like there's a lot ofyoung who are spheres of
influence they're very smart,really, disruptors in the
traditional sense.
I don't want to work with peoplewho are disrupting for the sake
(06:16):
of disrupting, but, it has tocome out into metrics such as
improved patient outcomes,satisfaction.
And I think, that's where yousee really good diversity when
you work with great people,who've got very different
thought processes.
So that to me is the mostimportant.
One of my colleagues, AndrewShuman, Aaron Buckland, they're
(06:37):
the pioneers of this.
Hip spinal pelvic.
they're very much.
he's very much a posteriorapproach surgeon so it is
interesting to be part of thatand you almost have to be very
careful how you do the anteriorapproach in that space where I
was the junior surgeon So butit's been embraced very well in
(06:58):
that space
Joseph M. Schwab (06:59):
And, Joe, last but not least, you and, quite
honestly, I'm not sure thisgroup would have come together
if it had not been for youreaching out Tell me a little
bit about, your work withApplied Medical and how you, how
you came to put this grouptogether to have this
conversation.
Joe Scerri (07:17):
Yeah, I think I would probably characterize it
as serendipitous because, withthe, the business that I'm
working with at the moment,which is, the Alexis, protector
for, for tissue protection.
when I had a look at the users,around the country, what I found
(07:38):
was the majority of them weredoing the anterior approach.
And so what I tried to do was totry and find out which surgeons
were actually performing thatcase, even though we have
products for the as well, andlateral and so on, depending on
the incision size, I could notfind a group of people that came
together as anterior hipsurgeons.
(08:02):
And so as part of that,investigation, I discovered, the
Anterior Hip Foundation, whichyou're heading up, Joe uh Joe.
And it just struck me that whydon't we have something like
that?
And a couple of us have talkedabout that.
And so that's when I reached outto you and I mentioned that, in
(08:24):
your introduction, that 30percent of cases in Australia
are done anterior.
And it just struck me that we'vegot lots of meetings around the
country for sports medicine, thehips, the shoulders, the knees.
And then subspecialty groupswithin that, but there's
nothing, about direct anteriorand given that it's 30 percent
(08:44):
of something like 54, 000 caseslast year.
It just struck me that when Ilook at some of the things that
your, your foundation put outand just seen recently with the
masterclass and things likethat.
That you're quite advanced interms of how you bring, the
things that apply those peopletogether.
(09:07):
And even as most recently withsome of those, starting from the
basics really, right through torevision cases and so on.
I guess I've got a vestedinterest in terms of where our
product lies.
But at the same time, I see thebenefits and I take Jit's point.
But when you look at it as ayounger person.
(09:27):
Even though maybe six monthsout, three months out, you might
be the same.
Most people want to get back towork really quickly.
And if they've got a choicebetween the two, then that's
probably what they'll select inthe hands of the right person.
Joseph M. Schwab (09:39):
let's talk a little bit about that 30 percent
that you're seeing in Australia,because by comparison, if you
look at the National JointRegistry in the UK, it's about 1
percent of primary total hipsare done through an anterior
approach.
the American Joint ReplacementRegistry, the AJRR, It doesn't,
(10:02):
actually, interestingly enough,capture approach, but the
American Association of Hip andKnee Surgeons at their annual
meeting usually does a surveyand the most recent survey that
they've published from 2022indicated around 56, 57 percent
of total hips are being donethrough an anterior approach.
(10:23):
I bring these two up becausegiven that Australia and the
United Kingdom havehistorically, nationally,
economically had greateralignment.
why do you think Australia iscloser in number to the U.
S.
than the U.
K.
in anterior approach?
Patrick Weinrauch (10:42):
I, think that it's probably worthwhile looking
back at the, history of theintroduction of, DAA to
Australia.
if you go 15, 16 years ago, theDAA was not really commonly
performed in Australia.
The two main surgical approacheswould've been posterior and then
anterolateral actually beingpretty common.
(11:04):
and, that's I think probably avestige of our training through,
public hospital systems andprobably a legacy of, as you
say, from our, heritage with alot of us going and doing
fellowships in the UK.
when you look at the uptake,Over the last eight or nine
years on it in our registry,we've seen that the, poster
(11:29):
approaches stayed actuallypretty steady.
It's been, it's stayed at about55 percent the whole way along
the last, eight years.
And what we've seen is a meltingaway of the anterolateral
approach and, and those numbers.
down to 10, 15 percent now,whereas the anterior approaches
has taken up that slack.
(11:53):
yes, I think it's worthwhilesort of reflecting on that.
And we've seen that over thelast few years, it's been a
fairly static sort of, split of55%, 30%, 50%.
10, 15%.
Ilan Freedman (12:06):
I was last week in Europe and they had a, at a
European anterior hip meetingand they went through basically
country by country.
And I think America was about55%.
Most European countries areabout 40%.
Sweden, for whatever reason, was1 percent and the UK was 1%.
So I think the UK, first of all,has a very proud tradition in
Exeter and elsewhere in terms ofwhy they do things the way that
(12:27):
they do.
I think there's a little bit of,Anglo Franco, dislike.
I think that I think it wasinitially seen maybe as a French
operation.
but also I think in Australiahas a public and private health
care system and the majority ofjoints now done in the private
system.
And I think frankly, initiallythere is some, there's some
competition, who can getpatients better quicker, who can
(12:49):
recover faster.
There's a little bit of lookingfor a point of difference in
Australia and in the States,whereas the UK and elsewhere,
which is purely public, they maynot have that.
that rivalry or competitionbetween surgeons, which drives
some of these, quicker, fasterout of hospital quicker.
It's not maybe not ascompetitive.
I think the anterior approachhas been driven at least
(13:10):
initially by some competitiveadvantage.
but yeah, just maybe the UK andSweden are the ones that are
holding out and the rest of theworld is, I think, coming on
board.
Jit Balakumar (13:24):
I might, add to that and I'm going to say
something controversial and say,look, I think problem with
anterior approach is surgeonshave ruined it, right?
They've, used it as a marketingtool.
And, and I would say again, I'min a big private practice where
I'm cognizant of the fact that,my point of difference was I'm a
hip preservation surgeon, I'lldo, a lot of arthroplasty
(13:48):
probably more than myarthroplasty colleagues.
I'm not going to make that apoint.
And that also includes nottalking about anterior.
it's like the Mako revolutionthat's happened with the knee.
and I would argue that it's,very, the natural, the organic
revolution is actually patientdriven.
The market wants it, right?
(14:09):
And, I'll have patients comingin.
I don't even talk aboutanterior.
And they will say, just to beclear, do you do the anterior
approach?
And I'm like, look, why I showedyou the cut is in the front of
the hip, right?
But I don't really like to talkabout this.
And I think this is where haveto be careful.
I think Pat made an excellentpoint, really what it comes down
to is approach, the Hardinge,which is very safe.
(14:33):
I'm going to offend someone andsay, look, I call it lovingly
the burglars approach becauseyou're robbing someone of their
abductors potentially for theirlife, but, it's potentially
taken that group and said, okay,let's incorporate that the
anterior approach clearly hassome advantages, but it has some
disadvantages in learning curve.
(14:54):
And, and scenarios, perhaps it'snot the right thing.
I don't think, I think what wewill see is over time.
people will use the anteriorapproach and one of public
hospitals I work at, which isthe last bastion of, training.
So we've got to train, similarto your academic institutions in
(15:15):
the US.
the trainees have to be able todo the approach and the surgery,
the majority of it, if not allof it, and certainly when I was
training, I was doing all of itwithout the, the, boss in
theater, but it'd be pretty hardto show an anterior approach
through a fairly small incisionto a trainee and then be
confident they're doing it wellwithout you looking over their
(15:37):
shoulder.
But now we've got six surgeonsin one of the public hospitals I
work at who do anterior.
So it's slowly changing, I wouldsay, and I think the best thing
is it's happening organically.
Joseph M. Schwab (15:48):
I know you, you had mentioned spending time
with Dr.
Matta and I've had extensiveconversations with Dr.
Matta about this concept of, isit the marketing or is it the
market?
And he has always, held thebelief or he's expressed the
belief to me anyway, thatapproaches, or, surgical
advancements that rely simply onmarketing have a tendency to
(16:14):
fall apart if they're not,worthwhile surgical approaches,
whereas something like theanterior approach has really
benefited from the marketdeciding it's what it wants and,
and people being able to delivera good quality product based on
that, or in this case, a goodquality surgery based on that.
Join me next week for part twoof examining the anterior
(16:36):
approach from down under.
I'll return with my guests,Patrick Weinrauch, Jit
Balakumar, Ilan Fredman, and JoeScerri.
You can check our show notes forinformation about each of their
practices, and don't forget tolike, and subscribe so we can
keep this type of contentcoming.
Until next week, this is JoeSchwab reminding you to keep
those hips happy and healthy.
I had the opportunity a few weeks ago to
sit down with a group ofAustralian hip surgeons.
Through our conversation theyhelped me understand the
landscape of anterior approachhip surgery in Australia.
In fact, they weren't shy insharing their opinions about the
good, the bad and the ugly oftraining on anterior approach
from down under.
(00:27):
Over the course of almost anhour we discussed how the
Australian market compares toother national markets like the
United States and Great Britain.
According to the AustralianNational Joint Registry,
anterior approach makes up justover 30% of all primary total
hip arthroplasties.
For me, this enlighteningdiscussion helped me understand
(00:47):
what's driving the increase inpopularity for anterior approach
in Australia.
The surgeons I talked to werePatrick Weinrauch, Jit
Balakumar, and Ilan Freedman.
All practicing hip surgeons inAustralia.
Also in on the conversation wasJoe Scerri, a sales rep for
Applied Medical, who has aparticular passion for anterior
(01:09):
approach.
Over the course of the next fewepisodes, we'll cover the whole
conversation.
But let's begin by learningabout.
each surgeon.
starting with.
Mr.
Patrick.
Weinrauch.
Patrick Weinrauch (01:21):
Yes I'm a a, hip surgeon.
I, do only hips.
I've been in private practice,for about 16 years now and I've
been doing anterior approach forabout 13 years or so, 12, 13
years, something like that.
probably 75 to 80 percent of mypractice is arthroplasty, about
(01:45):
20 percent is arthroscopy.
I do a fair number of,resurfacing procedures, so out
of my primary arthroplasty,about 50 percent of my work is
resurfacing and 50 percent isconventional total hip
replacement.
Joseph M. Schwab (02:02):
Are you using anterior approach for both,
resurfacings and, standardconventional total hips?
Patrick Weinrauch (02:09):
No, so I use, posterior approaches for my
resurfacing, anterior approachfrom a conventional total hip
replacements, and revisions area bit of a mix.
Predominantly posteriorapproaches for my revisions,
depends on the clinicalsituation.
Joseph M. Schwab (02:26):
And, Elan, tell us about yourself.
Ilan Freedman (02:28):
Yes, I, finished training in 2012.
I actually followed Patrick thesame, uk hip arthroscopy
fellowship.
but when I was in the UK I gotthe, opportunity to spend a
weekend in France with,Frederick Laude anterior hip
surgeon.
hip arthroscopy didn't reallygel that much with me, but from
that opportunity ended up doing,anterior approach through
(02:49):
Frederick.
And, I just do, adultarthroplasty, probably 60% hip,
40% knee.
Purely anterior approach formost, except for a difficult
revisions
Joseph M. Schwab (03:02):
You're quite active on LinkedIn, I see, as
well.
You've got, almost 15, 000followers on LinkedIn.
Ilan Freedman (03:09):
Yeah, I try to be.
I'm purely private practice, soI don't have the luxury of a
public appointment, so it'spurely private.
So initially it was a bit ofawareness and I guess a bit of
marketing, I enjoy posting whatI do, enjoy posting papers,
enjoy being a little bit,challenging or, mildly
controversial, but it's beengood to just get a bit of
awareness for my practice, butI've kept it up and you actually
(03:31):
learn a lot.
I've learned more from some ofthe case studies on LinkedIn.
Then I do from, journal papers,people posting interesting stuff
and commenting and sharing.
And it's been quite a goodforum.
Joseph M. Schwab (03:42):
We certainly don't shy from controversy here.
Jit, why don't you tell us alittle bit about yourself?
Jit Balakumar (03:47):
So I finished medical school in 1998, finished
my orthopedic training in 2006.
So similar to Patrick.
and, even though I'm apediatric, type surgeon, look,
my practice is probably 70percent arthroplasty, and 20 to
30 percent arthroscopy and 20,10 percent osteotomies.
(04:10):
I do a lot of osteotomies, PAOs,but, like overall picture, it's
probably a small proportion ofmy practice.
And, I started the DAA journeyactually, similar to Ilan, I was
doing a fellowship in France,and even before that I saw it in
Australia, but I saw, I wasdoing a knee fellowship and saw
frederick Laude next door, andthe controversies he was
(04:33):
creating at the time, and then,I spent some time with Keith
Berend just doing somevisitations, came back to
Australia, just made perfectsense with the arthroscopy and
osteotomy practice to dosomething supine with
fluoroscopic guidance, for me,it was all about trying to
incorporate that into mypreservation practice and then I
(04:55):
spent two weeks with Dr.
Joel Matta, who started yourAHF, I can see, I was very lucky
DePuy had funded that and I'vegone through a journey on table,
off table with DePuy and then,now with Medacta.
I am a zealot when it comes toanterior hips, but look, to be
honest, as I tell patients, Idon't, they're all the same
(05:18):
anterior posterior at 3 to 6months.
It's probably something that, Iused to use my enabling
technology to, hopefully improvepatient outcomes.
Joseph M. Schwab (05:29):
In your journey through trying out
different technologies,identifying different implant
companies, what is it that youfeel?
pushes you in one directionhelps you gravitate towards a
specific technology.
The people that you work with?
Is it the results that you get?
Is it the, shine and the glitterof the technology, so to speak?
(05:52):
what's your biggest factor?
Jit Balakumar (05:55):
I think the people I work with really,
that's probably Patrick and I'veactually worked on a few things
together, but the people I workwith is probably the most
important thing.
I feel like there's a lot ofyoung who are spheres of
influence they're very smart,really, disruptors in the
traditional sense.
I don't want to work with peoplewho are disrupting for the sake
(06:16):
of disrupting, but, it has tocome out into metrics such as
improved patient outcomes,satisfaction.
And I think, that's where yousee really good diversity when
you work with great people,who've got very different
thought processes.
So that to me is the mostimportant.
One of my colleagues, AndrewShuman, Aaron Buckland, they're
(06:37):
the pioneers of this.
Hip spinal pelvic.
they're very much.
he's very much a posteriorapproach surgeon so it is
interesting to be part of thatand you almost have to be very
careful how you do the anteriorapproach in that space where I
was the junior surgeon So butit's been embraced very well in
(06:58):
that space
Joseph M. Schwab (06:59):
And, Joe, last but not least, you and, quite
honestly, I'm not sure thisgroup would have come together
if it had not been for youreaching out Tell me a little
bit about, your work withApplied Medical and how you, how
you came to put this grouptogether to have this
conversation.
Joe Scerri (07:17):
Yeah, I think I would probably characterize it
as serendipitous because, withthe, the business that I'm
working with at the moment,which is, the Alexis, protector
for, for tissue protection.
when I had a look at the users,around the country, what I found
(07:38):
was the majority of them weredoing the anterior approach.
And so what I tried to do was totry and find out which surgeons
were actually performing thatcase, even though we have
products for the as well, andlateral and so on, depending on
the incision size, I could notfind a group of people that came
together as anterior hipsurgeons.
(08:02):
And so as part of that,investigation, I discovered, the
Anterior Hip Foundation, whichyou're heading up, Joe uh Joe.
And it just struck me that whydon't we have something like
that?
And a couple of us have talkedabout that.
And so that's when I reached outto you and I mentioned that, in
(08:24):
your introduction, that 30percent of cases in Australia
are done anterior.
And it just struck me that we'vegot lots of meetings around the
country for sports medicine, thehips, the shoulders, the knees.
And then subspecialty groupswithin that, but there's
nothing, about direct anteriorand given that it's 30 percent
(08:44):
of something like 54, 000 caseslast year.
It just struck me that when Ilook at some of the things that
your, your foundation put outand just seen recently with the
masterclass and things likethat.
That you're quite advanced interms of how you bring, the
things that apply those peopletogether.
(09:07):
And even as most recently withsome of those, starting from the
basics really, right through torevision cases and so on.
I guess I've got a vestedinterest in terms of where our
product lies.
But at the same time, I see thebenefits and I take Jit's point.
But when you look at it as ayounger person.
(09:27):
Even though maybe six monthsout, three months out, you might
be the same.
Most people want to get back towork really quickly.
And if they've got a choicebetween the two, then that's
probably what they'll select inthe hands of the right person.
Joseph M. Schwab (09:39):
let's talk a little bit about that 30 percent
that you're seeing in Australia,because by comparison, if you
look at the National JointRegistry in the UK, it's about 1
percent of primary total hipsare done through an anterior
approach.
the American Joint ReplacementRegistry, the AJRR, It doesn't,
(10:02):
actually, interestingly enough,capture approach, but the
American Association of Hip andKnee Surgeons at their annual
meeting usually does a surveyand the most recent survey that
they've published from 2022indicated around 56, 57 percent
of total hips are being donethrough an anterior approach.
(10:23):
I bring these two up becausegiven that Australia and the
United Kingdom havehistorically, nationally,
economically had greateralignment.
why do you think Australia iscloser in number to the U.
S.
than the U.
K.
in anterior approach?
Patrick Weinrauch (10:42):
I, think that it's probably worthwhile looking
back at the, history of theintroduction of, DAA to
Australia.
if you go 15, 16 years ago, theDAA was not really commonly
performed in Australia.
The two main surgical approacheswould've been posterior and then
anterolateral actually beingpretty common.
(11:04):
and, that's I think probably avestige of our training through,
public hospital systems andprobably a legacy of, as you
say, from our, heritage with alot of us going and doing
fellowships in the UK.
when you look at the uptake,Over the last eight or nine
years on it in our registry,we've seen that the, poster
(11:29):
approaches stayed actuallypretty steady.
It's been, it's stayed at about55 percent the whole way along
the last, eight years.
And what we've seen is a meltingaway of the anterolateral
approach and, and those numbers.
down to 10, 15 percent now,whereas the anterior approaches
has taken up that slack.
(11:53):
yes, I think it's worthwhilesort of reflecting on that.
And we've seen that over thelast few years, it's been a
fairly static sort of, split of55%, 30%, 50%.
10, 15%.
Ilan Freedman (12:06):
I was last week in Europe and they had a, at a
European anterior hip meetingand they went through basically
country by country.
And I think America was about55%.
Most European countries areabout 40%.
Sweden, for whatever reason, was1 percent and the UK was 1%.
So I think the UK, first of all,has a very proud tradition in
Exeter and elsewhere in terms ofwhy they do things the way that
(12:27):
they do.
I think there's a little bit of,Anglo Franco, dislike.
I think that I think it wasinitially seen maybe as a French
operation.
but also I think in Australiahas a public and private health
care system and the majority ofjoints now done in the private
system.
And I think frankly, initiallythere is some, there's some
competition, who can getpatients better quicker, who can
(12:49):
recover faster.
There's a little bit of lookingfor a point of difference in
Australia and in the States,whereas the UK and elsewhere,
which is purely public, they maynot have that.
that rivalry or competitionbetween surgeons, which drives
some of these, quicker, fasterout of hospital quicker.
It's not maybe not ascompetitive.
I think the anterior approachhas been driven at least
(13:10):
initially by some competitiveadvantage.
but yeah, just maybe the UK andSweden are the ones that are
holding out and the rest of theworld is, I think, coming on
board.
Jit Balakumar (13:24):
I might, add to that and I'm going to say
something controversial and say,look, I think problem with
anterior approach is surgeonshave ruined it, right?
They've, used it as a marketingtool.
And, and I would say again, I'min a big private practice where
I'm cognizant of the fact that,my point of difference was I'm a
hip preservation surgeon, I'lldo, a lot of arthroplasty
(13:48):
probably more than myarthroplasty colleagues.
I'm not going to make that apoint.
And that also includes nottalking about anterior.
it's like the Mako revolutionthat's happened with the knee.
and I would argue that it's,very, the natural, the organic
revolution is actually patientdriven.
The market wants it, right?
(14:09):
And, I'll have patients comingin.
I don't even talk aboutanterior.
And they will say, just to beclear, do you do the anterior
approach?
And I'm like, look, why I showedyou the cut is in the front of
the hip, right?
But I don't really like to talkabout this.
And I think this is where haveto be careful.
I think Pat made an excellentpoint, really what it comes down
to is approach, the Hardinge,which is very safe.
(14:33):
I'm going to offend someone andsay, look, I call it lovingly
the burglars approach becauseyou're robbing someone of their
abductors potentially for theirlife, but, it's potentially
taken that group and said, okay,let's incorporate that the
anterior approach clearly hassome advantages, but it has some
disadvantages in learning curve.
(14:54):
And, and scenarios, perhaps it'snot the right thing.
I don't think, I think what wewill see is over time.
people will use the anteriorapproach and one of public
hospitals I work at, which isthe last bastion of, training.
So we've got to train, similarto your academic institutions in
(15:15):
the US.
the trainees have to be able todo the approach and the surgery,
the majority of it, if not allof it, and certainly when I was
training, I was doing all of itwithout the, the, boss in
theater, but it'd be pretty hardto show an anterior approach
through a fairly small incisionto a trainee and then be
confident they're doing it wellwithout you looking over their
(15:37):
shoulder.
But now we've got six surgeonsin one of the public hospitals I
work at who do anterior.
So it's slowly changing, I wouldsay, and I think the best thing
is it's happening organically.
Joseph M. Schwab (15:48):
I know you, you had mentioned spending time
with Dr.
Matta and I've had extensiveconversations with Dr.
Matta about this concept of, isit the marketing or is it the
market?
And he has always, held thebelief or he's expressed the
belief to me anyway, thatapproaches, or, surgical
advancements that rely simply onmarketing have a tendency to
(16:14):
fall apart if they're not,worthwhile surgical approaches,
whereas something like theanterior approach has really
benefited from the marketdeciding it's what it wants and,
and people being able to delivera good quality product based on
that, or in this case, a goodquality surgery based on that.
Join me next week for part twoof examining the anterior
(16:36):
approach from down under.
I'll return with my guests,Patrick Weinrauch, Jit
Balakumar, Ilan Fredman, and JoeScerri.
You can check our show notes forinformation about each of their
practices, and don't forget tolike, and subscribe so we can
keep this type of contentcoming.
Until next week, this is JoeSchwab reminding you to keep
those hips happy and healthy.
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