December 20, 2024 • 15 mins
In Part III of our series, Joe Schwab continues his discussion with Australian hip surgeons Patrick Weinrauch, Ilan Freedman, and Jit Balakumar, along with orthopedic sales rep Joe Scerri. They discuss the biggest disruptors in their practices, the importance of the surgical team, the role of technology, and their personal experiences with the anterior approach in hip surgeries.
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):
Welcome to part three of examining the
anterior approach from downunder.
Let's get back to the lastportion of our conversation with
Australian hip surgeons, PatrickWeinrauch, Ilan Freedman, and
Jit Balakumar, as well asorthopedic sales rep, Joe
Scerri.
Speaking of things that havechanged how you look at or how
(00:28):
you think or how you learn inyour surgical approaches, what
would you, if we can go aroundto each of you, but what would
you say have been the singlesort of biggest disruptors in
your practice, whether it's anactual practical technique that
you've learned around theanterior approach, an implant,
or a new piece of technologythat's really changed or
(00:49):
improved the way that you'vedone anterior total hips.
Ilan Freedman (00:54):
Yeah, no single, Technology, I think, just, I
think using fluoro, and then Ithink there's a whole lot of
fluoro based systems, whetherit's verifier or Velys or
whatever.
I think, I've changed incisionfrom longitudinal to bikini,
this little, but these thingsare chasing the 2 percent
(01:14):
improvements.
I don't think there's been asingle element of anterior
that's, that's changed.
I looked briefly at off table,went back to what I knew, but
little things that make marginaldifferences.
I use special, I use a specialskin sealant.
So just, we're chasing, the onepercenters now.
(01:36):
There's no single thing that'sreally revolutionized, my
anterior approach specifically.
Patrick Weinrauch (01:43):
Mine's, mine's not surgical.
so I'd say, the, incorporationof low dose spinal, right?
So low dose spinal has made, hasreally made a big difference to
my patient's first 24 hours and,their experience of the surgery.
(02:04):
a spinal where they're able tostill walk straight away and, to
be able to, they haven't lostmotor function.
Yet they don't need big doses ofopiates and yeah, they're really
comfy and they've got no nauseaand they don't get, they get
less constipation and all thatsort of stuff.
So I think for me, if I look atthe one thing that's really made
my patients most happy, becauselisten, I do lots of posterior
(02:27):
approaches to you see, And, andthey both go really well, right?
And I suppose that leads intothe second thing.
If I'm allowed a seconddisruptive technology,
Joseph M. Schwab (02:38):
of
Patrick Weinrauch (02:38):
the second disruptive technology is just
the change in mindset of, of ourteams, right?
Where we've got teams oftherapists and nurses who are,
willing to be able to get peoplemobilized, early and they've
got, they're quite used todealing with all of that.
(03:01):
any of the problems that peoplemight see in the peri surgical
period, yet still push on withgood rehabilitation.
And, so that mindset that youdon't have to lie a patient in
24 hours and that's so if I'vegot two, it'd be the spinal and
it'd be the team, right?
It's actually for me, it'sprobably not the approach.
Ilan Freedman (03:23):
Yeah, no, I'd say having a, having a regular team.
I was working in a hospitalwhere.
Every theater list would be adifferent team.
And I think, anterior approachis, it's, intense for the
surgeon, but, also pretty hardfor the scrub nurse if they're a
newbie.
So I think hospitals which haverecognized, Just giving you a,
consistent scrub team, who knowyour instruments, having a
(03:45):
company rep, which, doesn'tchange every week, just giving,
I agree with Pat that the teamis beyond just, the surgeon.
There's so many sub teams withinthat, within the anterior
approach, which are veryimportant.
Jit Balakumar (03:58):
Look, I think the table I've been using the HANA
table, since Dr Matta convincedme to his probably to his
benefit.
We've got about three of thosetables in our hospital.
and I love it.
I've tried to, for J and J.
I was like the K.
O.
L.
For off table for the whole ofAsia Pacific, and it was just
the most unpleasant experiencewith, 140 kilo, 160 kilo
(04:21):
patients.
It's not fun, but look, it's,each of them have its own
benefits and disadvantages.
But I think the table for me isbig disruptor.
And, I think, planning to me isa big change only to, I would
say, we all know, total hip inthe century, 95 percent improved
(04:45):
patient outcomes, 60 percentforgotten hip, but I'm confident
that either through experience,through impeccable planning, 3D
planning, my bandwidth offorgotten hip is increasing.
And particularly in the anteriorapproach, I'm learning,
actually, you know what, I'llprobably put people, change
their anterior offset, reamed abit more anteriorly.
Now I'm focusing on reaming intothe right pillar.
(05:09):
obsessed about getting rid ofthe psoas impingement by tucking
the cup in deep, but you can getextra articular impingement,
which I wasn't appreciating asmuch with just Dynamic
examination.
So I think that 3D planningreally gives you that, bit of
information.
and to me, that's a bigdisruptor.
Joseph M. Schwab (05:29):
How were you guys incorporating your team in
the learning portion of the,approach?
How were you bringing a team upto speed?
Ilan Freedman (05:39):
I think, first of all, the company which I've had
referenced, which was sendingsurgeons education was also
sending the reps.
So they put a lot of investmentinto trying to educate not just
their team, but their salesteam.
And then it's up to the surgeonto, we run what we call in
services where you'd be runninga little mini workshop for your
team and the company would bringthe gear and the stuff and you
(06:01):
have to just give the time to gothrough the trays and to
workshop those cases and to,Also, you'd be a bit pushy
initially that you wanted aconsistent team.
The hospitals didn't necessarilygive it to you the first time
you asked for it.
Ironically, the more senior thesurgeon, the better the team.
So you had this situation wherewhen you were a very junior
surgeon without much experience,you'd get the least experienced
(06:22):
nursing team, which makes nosense.
it should be flipped the otherway.
But, having enough, havingenough, say in the hospital to,
to get the team that you wantand to spend the time educating
them.
Joseph M. Schwab (06:36):
Elon, as you become the more experienced
surgeon, are you willing to giveup the experienced team for the
less experienced one?
Ilan Freedman (06:43):
I should be, but no, you hang on to what you hang
on to what you've earned.
But, but it is a bit ironic thatthe, new surgeon in the hospital
gets the least experiencednurse,
Patrick Weinrauch (06:53):
That does bring up an important point,
though, is that, say, forinstance, when I do have someone
come and visit and they want tolearn anterior approach and
they, see it and they've maybethey've done a couple of
visitations, they're at thatpoint of getting ready to pull
the trigger and they ask me, howdo I incorporate this seamlessly
into my, into my practice, or,with the minimum amount of
(07:18):
turbulence and I think that the,you've got to think of the
surgery as a team sport, right?
And so you've got a mental modelof what you.
Wanted to look like becauseyou've seen it and you've
trained it and you've, thoughtabout it.
You read about it and you'vebeen on visitations and you've
done, certain about training,but the rest of the team, none
(07:39):
of them have seen it.
All right, so they got no, theygot, you haven't got a shared
mental model there.
And so to be able to achievethat, you've got to.
achieve.
You've got to deliver some formof education to them.
And I think the best way inwhich you, you can achieve that
is to bring that your key peoplewith you when you're learning,
(08:03):
right?
So if you go into a cadaver lab,if whoever's running the cadaver
lab will allow them to be ableto bring, for instance, your
first assistant or your scrubsister, right?
you scrub stuff, then they cansee that, right?
and we've had visitations wherethey've brought in the lead
scrub nurse, right?
And they, and because when theycome and see the procedure, the
(08:26):
surgeon is focused on do this,release that, do this, do that.
But the scrub sister's lookingat the flow and they're seeing
how they drape and, which, bitsof equipment they need and the
sort of, and so when it comes totime of actually needing to do
the surgery in their new place.
The thing that's going to be thehardest is the surgeon works and
(08:49):
walks in and he goes, Oh, let'swhack some drapes on.
But I wasn't really thinking, Iwasn't really taking much
attention to all of those littlethings that, that the other
members of the team, that'stheir world, right?
And they see that stuff, right?
And they grab it and then theytransplant it in.
And yeah, because we're sofocused on what we do, right?
(09:11):
So I think, I think, the keypoint out of that is that if you
can, get some form of educationfor your staff around you, and
that's, how I introduced it intomy practice.
I had my lead, surgicalassistant who happens also to be
a nurse, Come with me.
(09:32):
And then she was able to notonly, assist me.
so there was a buddy systemthere, but also she was able to
very easily translate that overto the other staff to be able to
say, this is what you need to doright in a way in which I
wouldn't have been able toarticulate myself.
Jit Balakumar (09:48):
The issue is for me, this is a, Ideal situation,
teamwork is dream work.
You've heard, I'm sure you'veall heard Christophe Corden
talking about the efficientanterior reproach.
And he did this great talk abouthow many minutes is saved in a
day translated to how many yearsit's saved in his life, right?
And, it made me very depressed,
Patrick Weinrauch (10:10):
least you're not waiting for, At least you're
not waiting for cement to set.
Jit Balakumar (10:17):
I realized is that every three years my table
technician moves on to, becomesa rep there.
They joined some company, right?
Oh, my nurses get pregnant or ifthey can't get pregnant, they
move on.
And, I always say, look, in ourhospital, we, I refer to the
surgeons as the big five, likein the game parks.
And, I'm just a hyena, jokinglyknowing that secretly I'm in the
(10:42):
big five, but you want to, Ithink you have to be open to the
idea that it's not like it usedto be.
Everyone's moving.
People have ambitions, thereally good stuff that we have
actually some time want to moveon, To something else.
it's a very hard, hard thing tobe able to do that.
(11:03):
And I think what I've actuallygot a lot more of is patience.
I've just realized I'm no longergetting frustrated.
And, I want to be more likeRoger Federer, when all those
unforced errors happen and notlike Nick Kyrgios, because when
I see that new member of nursingstaff in my theater, I don't
want to be smashing that racketon the floor.
And so I would say, look, Iagree with everything that Pat
(11:25):
and Alana are saying.
I have a different experience.
I'm getting to the stage whereI'm like, Oh my God, how did
this happen all of a sudden?
And there's some completely newmember of staff in my theater or
on the wall.
There's a physio who says, let'sstart using the walking frame
and don't sit and bend over morethan 90 degrees.
That's what's happened.
(11:48):
how did that happen?
And, I don't, are you, guysseeing that at all or not
really?
Maybe I'm the only one who'sjust getting all this change and
stuff.
Patrick Weinrauch (11:57):
No, I think, I think that having, I think the
benefit of having a, a highvolume practice though is that,
people can learn things prettyquickly because they, just get
repetition really fast, right?
and if they're, if you're doingenough volume, there's a
critical mass where, or, Yeah,even if they're not your regular
(12:23):
staff, even your irregular staffhave now had the opportunity to
be able to do lots of them.
So there's like depth in theteam.
so if you have a completestranger come in, you know that
you've you're surrounded by lotsof people who aren't complete
strangers.
So there's enough you canaccommodate there.
So we can have two new staffcome in.
(12:44):
And that's not that's fine.
We, we do that all the time.
and pretty quickly, they learnthe ropes because there's enough
resilience in the system to beable to compensate for that.
Yeah.
I think that's probably one ofthe, one of the, one of the,
tagline, benefits of having areasonable volume practice too.
(13:07):
Yeah.
Joe Scerri (13:08):
I was gonna say, the big thing that I've noticed is
if you go back maybe 15 years, asurgeon would change an implant
and nothing else would changearound him or her.
whereas, whereas now, if you goto, your question, Joe, direct
anterior, suddenly you've got tochange the draping, to Ilan's
(13:29):
point.
You might need to use plural oryou may not.
you might want to use the table.
You may not.
you're going to need a bunch ofdifferent retractors.
You may or may not.
you might do the figure four.
and so all of those things havenow changed.
As distinct from just changingfrom a, I don't know, porous
coated stem with HA or onewithout, or a polished stem and
(13:53):
maybe using cement.
Whereas now, suddenly, all thesepeople that are involved in you
having a successful outcome,there's a lot of moving parts
and what I've noticed, in thelast few years is just the
amount of laptops that are intheatre now looking at screens
and, what, what degree is thatand what, angle is that?
(14:13):
Whereas back in the old days,you were lucky sometimes if
someone did a pre op plan with atemplate.
so it's, what are you planning?
What's the strategy today, doc?
And it's I don't know.
I haven't seen the x ray yet.
and we've come a long way andthat's a credit to the industry
and people are getting thatgreat attention.
(14:35):
And also it was like back in theday it was, what clinical
history do you have?
And now it's more about how youput it in rather than what
you're putting in.
Joseph M. Schwab (14:43):
Gentlemen, I want to thank you for taking
time to talk with me today and,and thank you for helping
educate our listeners.
And of course, thank you foreverything you do for your
patients.
If you're interested in learningmore about today's guests, you
can check out our show notes fortheir practice links.
Join us every Friday for a newepisode of the AHF podcast.
(15:06):
You can find us an audio form inyour favorite podcast app, or
watch our video podcast onYouTube.
Don't forget to like andsubscribe and leave us a five
star review to help us reach awider audience, and to keep this
content coming.
Until next week, this is JoeSchwab reminding you to keep
those hips happy and healthy.
Welcome to part three of examining the
anterior approach from downunder.
Let's get back to the lastportion of our conversation with
Australian hip surgeons, PatrickWeinrauch, Ilan Freedman, and
Jit Balakumar, as well asorthopedic sales rep, Joe
Scerri.
Speaking of things that havechanged how you look at or how
(00:28):
you think or how you learn inyour surgical approaches, what
would you, if we can go aroundto each of you, but what would
you say have been the singlesort of biggest disruptors in
your practice, whether it's anactual practical technique that
you've learned around theanterior approach, an implant,
or a new piece of technologythat's really changed or
(00:49):
improved the way that you'vedone anterior total hips.
Ilan Freedman (00:54):
Yeah, no single, Technology, I think, just, I
think using fluoro, and then Ithink there's a whole lot of
fluoro based systems, whetherit's verifier or Velys or
whatever.
I think, I've changed incisionfrom longitudinal to bikini,
this little, but these thingsare chasing the 2 percent
(01:14):
improvements.
I don't think there's been asingle element of anterior
that's, that's changed.
I looked briefly at off table,went back to what I knew, but
little things that make marginaldifferences.
I use special, I use a specialskin sealant.
So just, we're chasing, the onepercenters now.
(01:36):
There's no single thing that'sreally revolutionized, my
anterior approach specifically.
Patrick Weinrauch (01:43):
Mine's, mine's not surgical.
so I'd say, the, incorporationof low dose spinal, right?
So low dose spinal has made, hasreally made a big difference to
my patient's first 24 hours and,their experience of the surgery.
(02:04):
a spinal where they're able tostill walk straight away and, to
be able to, they haven't lostmotor function.
Yet they don't need big doses ofopiates and yeah, they're really
comfy and they've got no nauseaand they don't get, they get
less constipation and all thatsort of stuff.
So I think for me, if I look atthe one thing that's really made
my patients most happy, becauselisten, I do lots of posterior
(02:27):
approaches to you see, And, andthey both go really well, right?
And I suppose that leads intothe second thing.
If I'm allowed a seconddisruptive technology,
Joseph M. Schwab (02:38):
of
Patrick Weinrauch (02:38):
the second disruptive technology is just
the change in mindset of, of ourteams, right?
Where we've got teams oftherapists and nurses who are,
willing to be able to get peoplemobilized, early and they've
got, they're quite used todealing with all of that.
(03:01):
any of the problems that peoplemight see in the peri surgical
period, yet still push on withgood rehabilitation.
And, so that mindset that youdon't have to lie a patient in
24 hours and that's so if I'vegot two, it'd be the spinal and
it'd be the team, right?
It's actually for me, it'sprobably not the approach.
Ilan Freedman (03:23):
Yeah, no, I'd say having a, having a regular team.
I was working in a hospitalwhere.
Every theater list would be adifferent team.
And I think, anterior approachis, it's, intense for the
surgeon, but, also pretty hardfor the scrub nurse if they're a
newbie.
So I think hospitals which haverecognized, Just giving you a,
consistent scrub team, who knowyour instruments, having a
(03:45):
company rep, which, doesn'tchange every week, just giving,
I agree with Pat that the teamis beyond just, the surgeon.
There's so many sub teams withinthat, within the anterior
approach, which are veryimportant.
Jit Balakumar (03:58):
Look, I think the table I've been using the HANA
table, since Dr Matta convincedme to his probably to his
benefit.
We've got about three of thosetables in our hospital.
and I love it.
I've tried to, for J and J.
I was like the K.
O.
L.
For off table for the whole ofAsia Pacific, and it was just
the most unpleasant experiencewith, 140 kilo, 160 kilo
(04:21):
patients.
It's not fun, but look, it's,each of them have its own
benefits and disadvantages.
But I think the table for me isbig disruptor.
And, I think, planning to me isa big change only to, I would
say, we all know, total hip inthe century, 95 percent improved
(04:45):
patient outcomes, 60 percentforgotten hip, but I'm confident
that either through experience,through impeccable planning, 3D
planning, my bandwidth offorgotten hip is increasing.
And particularly in the anteriorapproach, I'm learning,
actually, you know what, I'llprobably put people, change
their anterior offset, reamed abit more anteriorly.
Now I'm focusing on reaming intothe right pillar.
(05:09):
obsessed about getting rid ofthe psoas impingement by tucking
the cup in deep, but you can getextra articular impingement,
which I wasn't appreciating asmuch with just Dynamic
examination.
So I think that 3D planningreally gives you that, bit of
information.
and to me, that's a bigdisruptor.
Joseph M. Schwab (05:29):
How were you guys incorporating your team in
the learning portion of the,approach?
How were you bringing a team upto speed?
Ilan Freedman (05:39):
I think, first of all, the company which I've had
referenced, which was sendingsurgeons education was also
sending the reps.
So they put a lot of investmentinto trying to educate not just
their team, but their salesteam.
And then it's up to the surgeonto, we run what we call in
services where you'd be runninga little mini workshop for your
team and the company would bringthe gear and the stuff and you
(06:01):
have to just give the time to gothrough the trays and to
workshop those cases and to,Also, you'd be a bit pushy
initially that you wanted aconsistent team.
The hospitals didn't necessarilygive it to you the first time
you asked for it.
Ironically, the more senior thesurgeon, the better the team.
So you had this situation wherewhen you were a very junior
surgeon without much experience,you'd get the least experienced
(06:22):
nursing team, which makes nosense.
it should be flipped the otherway.
But, having enough, havingenough, say in the hospital to,
to get the team that you wantand to spend the time educating
them.
Joseph M. Schwab (06:36):
Elon, as you become the more experienced
surgeon, are you willing to giveup the experienced team for the
less experienced one?
Ilan Freedman (06:43):
I should be, but no, you hang on to what you hang
on to what you've earned.
But, but it is a bit ironic thatthe, new surgeon in the hospital
gets the least experiencednurse,
Patrick Weinrauch (06:53):
That does bring up an important point,
though, is that, say, forinstance, when I do have someone
come and visit and they want tolearn anterior approach and
they, see it and they've maybethey've done a couple of
visitations, they're at thatpoint of getting ready to pull
the trigger and they ask me, howdo I incorporate this seamlessly
into my, into my practice, or,with the minimum amount of
(07:18):
turbulence and I think that the,you've got to think of the
surgery as a team sport, right?
And so you've got a mental modelof what you.
Wanted to look like becauseyou've seen it and you've
trained it and you've, thoughtabout it.
You read about it and you'vebeen on visitations and you've
done, certain about training,but the rest of the team, none
(07:39):
of them have seen it.
All right, so they got no, theygot, you haven't got a shared
mental model there.
And so to be able to achievethat, you've got to.
achieve.
You've got to deliver some formof education to them.
And I think the best way inwhich you, you can achieve that
is to bring that your key peoplewith you when you're learning,
(08:03):
right?
So if you go into a cadaver lab,if whoever's running the cadaver
lab will allow them to be ableto bring, for instance, your
first assistant or your scrubsister, right?
you scrub stuff, then they cansee that, right?
and we've had visitations wherethey've brought in the lead
scrub nurse, right?
And they, and because when theycome and see the procedure, the
(08:26):
surgeon is focused on do this,release that, do this, do that.
But the scrub sister's lookingat the flow and they're seeing
how they drape and, which, bitsof equipment they need and the
sort of, and so when it comes totime of actually needing to do
the surgery in their new place.
The thing that's going to be thehardest is the surgeon works and
(08:49):
walks in and he goes, Oh, let'swhack some drapes on.
But I wasn't really thinking, Iwasn't really taking much
attention to all of those littlethings that, that the other
members of the team, that'stheir world, right?
And they see that stuff, right?
And they grab it and then theytransplant it in.
And yeah, because we're sofocused on what we do, right?
(09:11):
So I think, I think, the keypoint out of that is that if you
can, get some form of educationfor your staff around you, and
that's, how I introduced it intomy practice.
I had my lead, surgicalassistant who happens also to be
a nurse, Come with me.
(09:32):
And then she was able to notonly, assist me.
so there was a buddy systemthere, but also she was able to
very easily translate that overto the other staff to be able to
say, this is what you need to doright in a way in which I
wouldn't have been able toarticulate myself.
Jit Balakumar (09:48):
The issue is for me, this is a, Ideal situation,
teamwork is dream work.
You've heard, I'm sure you'veall heard Christophe Corden
talking about the efficientanterior reproach.
And he did this great talk abouthow many minutes is saved in a
day translated to how many yearsit's saved in his life, right?
And, it made me very depressed,
Patrick Weinrauch (10:10):
least you're not waiting for, At least you're
not waiting for cement to set.
Jit Balakumar (10:17):
I realized is that every three years my table
technician moves on to, becomesa rep there.
They joined some company, right?
Oh, my nurses get pregnant or ifthey can't get pregnant, they
move on.
And, I always say, look, in ourhospital, we, I refer to the
surgeons as the big five, likein the game parks.
And, I'm just a hyena, jokinglyknowing that secretly I'm in the
(10:42):
big five, but you want to, Ithink you have to be open to the
idea that it's not like it usedto be.
Everyone's moving.
People have ambitions, thereally good stuff that we have
actually some time want to moveon, To something else.
it's a very hard, hard thing tobe able to do that.
(11:03):
And I think what I've actuallygot a lot more of is patience.
I've just realized I'm no longergetting frustrated.
And, I want to be more likeRoger Federer, when all those
unforced errors happen and notlike Nick Kyrgios, because when
I see that new member of nursingstaff in my theater, I don't
want to be smashing that racketon the floor.
And so I would say, look, Iagree with everything that Pat
(11:25):
and Alana are saying.
I have a different experience.
I'm getting to the stage whereI'm like, Oh my God, how did
this happen all of a sudden?
And there's some completely newmember of staff in my theater or
on the wall.
There's a physio who says, let'sstart using the walking frame
and don't sit and bend over morethan 90 degrees.
That's what's happened.
(11:48):
how did that happen?
And, I don't, are you, guysseeing that at all or not
really?
Maybe I'm the only one who'sjust getting all this change and
stuff.
Patrick Weinrauch (11:57):
No, I think, I think that having, I think the
benefit of having a, a highvolume practice though is that,
people can learn things prettyquickly because they, just get
repetition really fast, right?
and if they're, if you're doingenough volume, there's a
critical mass where, or, Yeah,even if they're not your regular
(12:23):
staff, even your irregular staffhave now had the opportunity to
be able to do lots of them.
So there's like depth in theteam.
so if you have a completestranger come in, you know that
you've you're surrounded by lotsof people who aren't complete
strangers.
So there's enough you canaccommodate there.
So we can have two new staffcome in.
(12:44):
And that's not that's fine.
We, we do that all the time.
and pretty quickly, they learnthe ropes because there's enough
resilience in the system to beable to compensate for that.
Yeah.
I think that's probably one ofthe, one of the, one of the,
tagline, benefits of having areasonable volume practice too.
(13:07):
Yeah.
Joe Scerri (13:08):
I was gonna say, the big thing that I've noticed is
if you go back maybe 15 years, asurgeon would change an implant
and nothing else would changearound him or her.
whereas, whereas now, if you goto, your question, Joe, direct
anterior, suddenly you've got tochange the draping, to Ilan's
(13:29):
point.
You might need to use plural oryou may not.
you might want to use the table.
You may not.
you're going to need a bunch ofdifferent retractors.
You may or may not.
you might do the figure four.
and so all of those things havenow changed.
As distinct from just changingfrom a, I don't know, porous
coated stem with HA or onewithout, or a polished stem and
(13:53):
maybe using cement.
Whereas now, suddenly, all thesepeople that are involved in you
having a successful outcome,there's a lot of moving parts
and what I've noticed, in thelast few years is just the
amount of laptops that are intheatre now looking at screens
and, what, what degree is thatand what, angle is that?
(14:13):
Whereas back in the old days,you were lucky sometimes if
someone did a pre op plan with atemplate.
so it's, what are you planning?
What's the strategy today, doc?
And it's I don't know.
I haven't seen the x ray yet.
and we've come a long way andthat's a credit to the industry
and people are getting thatgreat attention.
(14:35):
And also it was like back in theday it was, what clinical
history do you have?
And now it's more about how youput it in rather than what
you're putting in.
Joseph M. Schwab (14:43):
Gentlemen, I want to thank you for taking
time to talk with me today and,and thank you for helping
educate our listeners.
And of course, thank you foreverything you do for your
patients.
If you're interested in learningmore about today's guests, you
can check out our show notes fortheir practice links.
Join us every Friday for a newepisode of the AHF podcast.
(15:06):
You can find us an audio form inyour favorite podcast app, or
watch our video podcast onYouTube.
Don't forget to like andsubscribe and leave us a five
star review to help us reach awider audience, and to keep this
content coming.
Until next week, this is JoeSchwab reminding you to keep
those hips happy and healthy.
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