July 4, 2025 • 28 mins
In this episode of the AHF Podcast, host Joe Schwab interviews Dr. John Horberg. They first met in the fall of 2024 during the Revision Round Table series, where John's complex cases from rural Wyoming impressed Joe. John discusses his journey from Southern Illinois to building a successful total joint practice with Premier Bone & Joint Centers in Laramie, Wyoming. They talk about the logistics of running a practice with twelve locations and a fleet of planes to reach patients across the state, the value of preparation, and the complexity of handling revisions from an anterior approach. John also shares insights on building a supportive team, succession planning, and the challenges and rewards of practicing in a rural setting.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Joseph M. Schwab (00:24):
Hi everyone and welcome.
Welcome back to the AHF Podcast.
I'm your host, Joe Schwab.
I first met John Horberg in thefall of 2024 while recording a
series of episodes that we endedup calling the Revision round
Table.
I'll put a link to thoseepisodes in the description and
I encourage everyone to go backand watch them.
(00:44):
John submitted cases and videosthat we could review and discuss
as part of the broadcast, and Iwas really impressed by the
complexity of cases that he wasdealing with.
Little did I realize the complexand challenging environment he
was doing those cases in.
As I got talking to him more, Irealized one thing about John:
he's a problem solver.
(01:04):
And he's put his problem solvingskills to building a complex
total joint practice in achallenging environment.
John joins me today to talkabout his journey to building a
practice of complex hips inrural Wyoming.
John, welcome back to the AHFPodcast.
John Horberg (01:22):
Good to be here.
Joseph M. Schwab (01:24):
So tell me a little bit, how did you, my
recollection from our initialdiscussion is that you're from
Southern Illinois, right?
John Horberg (01:32):
Yeah, I grew up in, farm country in central
Illinois and trained in thatarea.
after my fellowship, I went backand I practiced, where I trained
for a few a period of a fewyears at a level one trauma
center.
I.
All the resources you could hopefor from a surgical standpoint.
but my wife and I are both, inlove with the mountains.
She grew up in rural Wyoming,and we decided after a couple
(01:54):
years of practice in, anacademic setting that it was
time to move out west.
And now I'm practicing inLaramie, Wyoming, with the
Premier Bona Joint Centers.
Joseph M. Schwab (02:03):
And it, was it your, was it your wife really
who got you interested inWyoming or was that something
you had been independentlyinterested in?
John Horberg (02:12):
I had always been in love with the mountains.
I'd grown up skiing and rockclimbing, mountain biking,
hiking, hunting, all the classicoutdoor stuff.
but my wife, being from Wyomingis what made us settle on the
rural state as opposed to any ofthe other states in the mountain
west.
I.
Joseph M. Schwab (02:28):
And so when you started looking at practice
opportunities in Wyoming, wasthere something you found
immediately or was it adifficult, a difficult search
for you?
John Horberg (02:37):
In some ways it was a difficult search.
when I came to Wyoming, I wasthe only fellowship trained
joint surgeon in the state.
no other practices were lookingfor one.
I.
So I put my feelers out and Icold called a couple of
practices and I was fortunatethat the group that I'm with now
was, had the foresight to saythat yeah, we can make this
(02:57):
work.
It's a good opportunity and itworks for both of us.
I.
Joseph M. Schwab (03:01):
And tell me a little bit about your practice
setup at the moment.
John Horberg (03:06):
Yeah, we have a fairly unique model.
We're a, single specialtyprivate practice physician
owned.
we work on a spoken wheel model.
We have, our headquarters inLaramie, Wyoming, which is,
where the University ofWyoming's located.
we have our surgery center thereand our main office, but I.
Wyoming being such a largegeographically, but small from a
(03:27):
population standpoint state.
we travel to outlying clinicsaround the state.
We have 12 locations, and thenwe see patients as close as we
can to where they're from andthen bring them back to our
central locations to operate.
And to do that, we have, a fleetof four twin engine turboprop
airplanes, and three full-timepilots, that help us get around.
(03:48):
a lot of folks aren't.
familiar, but a lot of roads inWyoming get closed sometimes as
many as 60 or 80 days outta theyear for Interstate 80.
So we have to fly over theweather if we're gonna get to
these outreach clinics.
I.
Joseph M. Schwab (04:00):
Yeah, so I think of, there being
geographic, issues with a lot ofdifferent types of, practices,
but a practice that has fourplanes and three pilots, that's
gotta be an additional.
Headache on your, the managementof your practice?
what sort of, what sort ofdifficulties has that created
(04:22):
for you and your partners orwhat sort of opportunities
John Horberg (04:26):
it's, both, obvious.
the obvious, biggest concern isthe cost.
it's not cheap to own your ownairplanes.
It's not cheap to maintain anaviation operation.
But, my, my partners have beenflying, for 50 years now,
starting off in small singleengine airplanes, up to the,
fleet of planes we have now.
And what we've found is from aneconomic standpoint, we can make
(04:49):
it work just by staying busy.
We, go all across the state, wesee as many folks as we can, and
a lot of these patients, theironly other opportunity was to
drive to Montana or to Utah orto Colorado, which sometimes is
a six or seven or eight hourdrive for them to get
musculoskeletal care.
So for us, we o overcome thecost of the aviation with
(05:09):
volume.
And then from an administrativestandpoint, we've just.
Been fortunate and, relied onexcellent administrators who can
not only run clinical practice,a surgical center, our
ancillary, revenue streams, butalso manage an aviation
business, coordinate with thestate, coordinate with local
airports.
it's a big complex machine witha lot of moving parts for a
(05:30):
practice of nine physicians.
But, it allows us to do what wedo and we're passionate about
taking care of people in ruralenvironments without having them
feel like they need to leave thestate.
Joseph M. Schwab (05:40):
So you mentioned you were the first,
total joint fellowship trained,surgeon that came and joined
that practice.
Were your partners before doingany complex revisions?
Were they handling complex casesor what was happening in those
circumstances?
John Horberg (05:58):
for the majority of cases, the, complex primaries
and the revisions, were beingreferred down to the university
depending on where the patientin the state came from, whether
it be the University ofColorado, the University of,
Utah, or some other largercenters in surrounding states.
my partners who were doingprimary toll, joint arthroplasty
would take on basic revisions,bearing changes and things like
(06:20):
that.
But for the most part, we were,Relying on the surrounding
states to take care of thecomplex cases.
I was a bit nervous coming injust from a volume standpoint,
being the only joints guy, andnot having a prerequisite,
model, to see if I could dothese things.
But the volume was certainlythere.
It was just more getting mysystem set up so I could
(06:41):
actually do those cases inhospitals and centers that
weren't used to doing them.
Joseph M. Schwab (06:45):
Yeah, and it had to have been more than just
travel logistics too, right?
what sort of things did youneed?
To do, to prep your practice forbeing able to do some of the
complex cases that you're, doingnow.
It's not just like flipping on alight switch, I imagine.
John Horberg (07:00):
Yeah, exactly.
the, things that I anticipatedcoming in and I had come from a
place where I had every resourceunder the sun.
We were the referral center.
I.
I could start a uni and end updoing a distal femoral
replacement if I wanted to,'cause everything lived in house
and was sterile.
So I, had anticipated needing tocoordinate with vendors for
implants, inventoryinstrumentation, especially less
(07:23):
common instruments.
burrs and, saws and cementremoval equipment, extraction
equipment.
There's little things that Ihadn't anticipated.
Just simple stuff like, multiplesuture options, arrogance for
the complex cases.
so those were the things that Ihad focused on.
Initially.
We bought ha beds for all myfacilities, for my anterior
(07:45):
approach.
I'm, an on table surgeon.
but there's a lot of otherthings that go into.
Doing complex cases that areabove and beyond the, what
happens in the actual or theavailability of, ICU care, the
availability of blood, which we,had to coordinate, the
availability of infectiousdisease and other consultants,
(08:05):
plastic surgeons, people to helpyou with complex wound closure
to help you with infection andan antibiotic management.
and then also getting buy-infrom.
Staff at the facilities thatyes, we can do these complex
cases from, centralsterilization that yes, we can
turn trays for big revisions ina small facility from anesthesia
(08:26):
that yeah, these folks thatwe're not used to taking care of
this complex of surgery and thissick of a patient.
it, took a lot more logisticsand a lot of the problems were
problems that I discovered alongthe way.
But, the one thing that'swonderful about Wyoming is it's
a blue collar state ofhardworking people who love to
rise to a challenge.
I,
Joseph M. Schwab (08:46):
I can imagine.
And it sounds like you've risento that challenge too.
I think back when I was aresident, we, were, able to do,
A rotation in Nicaragua for amonth and do some surgery,
excuse me, for a week, Iapologize.
and do some surgery down there.
And we used to talk about, thechanges that you make to your
practice or the things you learnabout what you can do during
(09:09):
surgery, from environments thataren't fully resourced, full
environments.
Is there anything you've learnedabout how to approach a revision
or how to approach the care ofpatients following or leading up
to a revision?
just by practicing in theenvironment that you're in.
John Horberg (09:28):
I think the thing that I learned the most is the
value of preparation.
just like you mentioned, whenyou're in training at a big
academic center or you're inpractice in a, large tertiary
referral center, you take forgranted all the resources that
are there and all the stuff thatcan be done on the fly.
So for me, I look at, I.
Even, cases that I wouldn'tnecessarily consider terribly
(09:49):
complicated, but that could haveunexpected problems, but
especially the revisions.
What's my plan A, what's my planB?
What's my plan C?
What instruments am I gonna needfor that?
And which ones do we have andwhich ones do we not have?
What, implants and systems do Ineed to have available?
And make sure that we can getthem there logistically in
certain times of year.
That can also be a challengejust with the weather problems
(10:11):
that we have getting to ourclinics.
the vendors have those sameproblems, getting those implants
from their larger distributordistribution centers to, to our
facility.
and then all the preoperativeand perioperative care needs.
for infections, I try to makesure that I get consultations
with infectious disease prior tosurgery.
I try to anticipate whether ornot I'm gonna need a plastic
(10:32):
surgery consult because I mightnot have a plastic surgeon, in
the hospital for.
Weeks at a time, unless Iarrange it in advance.
anticipating the needs of,higher blood loss, potential
need for blood after surgery,potential need for, intensive
care.
even simple things from acritical access facility,
needing to know if there's gonnabe a bed available for my
(10:54):
patient after surgery in a stepdown or an intensive care unit.
Most of the problems that Ianticipate in advance my team
and my vendors and myconsultants and everyone else
likes to give me a hard timethat, you brought in 40 trays
and you had three doctorsavailable and you had a bunch of
blood in the building and youdidn't use any of it.
but then there's those caseswhere you get into something
(11:16):
that you weren't expecting andyou always wanna make sure it's
there.
The worst thing you can do isget into a surgery, be in the,
or have the patient open andsay, oh shit, I can't do what I
want to do.
Joseph M. Schwab (11:28):
you mentioned your team, the team can be as
small as, you and your ma, yourpa, the team can be as large as
anyone who's gonna see and touchthe patient, at the time,
through their, through theirtime in the hospital.
Was there pushback from acertain groups, or certain,
people who played certain rolesor, administration or anything
(11:49):
like that, that you had tonegotiate?
how did you navigate that?
John Horberg (11:54):
Yeah, it, for me, it started small and then grew.
I was fortunate that right offthe bat, the ma that they hired
for me before I even got there,is the best MA I've ever worked
with.
she works her ass off.
She coordinates with all thesepeople and she's even gone out
of her way to find a.
Things that have helped us takecare of our patients.
She found a home healthorganization and coordinated
(12:15):
with them.
So we had some step down carefor people who were 500 miles
away from me in a rural marketon a ranch in the snow, who
might not get into PT asfrequently.
but then every step of the way,there's little things.
the anesthesiologist initiallybox saying, we can't do these
big complex cases here forcardiac issues or pulmonary
issues.
(12:35):
But then, I talked with them andfigured out what are their
concerns, what can we do priorto surgery to optimize them.
Sometimes that means we have todo more in-depth screening for
pulmonary issues, for cardiacissues, and do a little bit more
to optimize'em prior to surgeryto facilitate them feeling
comfortable doing the bigsurgeries.
at our surgery center, the mostjoints they'd ever done in a
(12:56):
day, between multiple surgeonswas six before I got here, and
now I do 12 in a day.
it.
Wasn't so much pushback.
It was more skepticism.
Can we really do this?
Can we really turn these traysover?
and then I had to figure outwhat are the issues there.
And some of them were, it'sgonna take us forever to turn
these trays over, but we foundout that I can eliminate 70% of
(13:19):
the trays'cause it's a bunch ofsuperfluous instruments and
facilitate faster turnaround tothose trays, working with the
vendors to get more sets ofsterile.
Implant and, system specifictrays available at our facility,
getting a larger stock ofimplants, in-house.
and then I think one of theother challenges was getting
(13:40):
care for my patients all overthe state.
getting, I.
doing an ACL and a 25-year-old,you don't necessarily need
pre-op clearance and COPDscreening and sleep apnea
screening and cardiac clearance.
So we had to figure out waysthat we could get labs, EKGs
testing, and a physician toclear these patients prior to
surgery.
And a lot of this stuff just.
(14:01):
Took being a nice guy and,trying to go out to these
environments and talk to people.
I met with primary care doctorsin their communities.
I met with local therapy groupsaround the state.
We have a physical therapy groupin Laramie, but we cover the
entire state, and we don't havea therapy office in every single
town.
So meeting with the privatetherapists in their own
communities, meeting with theinfectious disease teams,
(14:21):
meeting with the plasticsurgeons.
and another thing in privatepractice that was.
Surprising, but refreshing to meis meeting with my competitors.
a lot of groups around thestate, they're local, they're
hospital employed.
They're a small private groupthat covers a small community,
and they didn't want to be doingsome of these bigger cases.
They were happy that I wouldtake care of their patients and
they were also happy to takecare of my patients when the
(14:43):
need arose.
As long as, I'd be willing to dothe same for them.
Joseph M. Schwab (14:47):
So there was somewhat of a handoff agreement
between, the, competingphysicians, right?
If you're taking care of theirpatients.
And, that's interesting.
so all that travel around thestate, are you going on those
planes as well or is the planesfor patient and, goods
transport?
What, tell me how that works.
John Horberg (15:07):
Yeah, so we all live in Laramie and then, our
philosophy is that, we'll go andsee the patients in their
communities.
So we have 12 outlying officesand we'll fly, to go see the
patients.
but that takes a five hour driveand turns it into a 35 minute
flight.
We all get to sleep in our ownbeds at night.
We all get to put our own kidsto bed.
(15:28):
but.
We get to go see the patients.
They don't have to travelthrough the perioperative
period.
They only come to see us oncefor surgery, and then they get
to stay in their own communitiesand we take care of them where
they are.
Joseph M. Schwab (15:39):
So I had a group of surgeons recently, that
I interviewed for the podcastwho, started in practice doing
posterior approach and hadtransitioned to doing anterior
approach.
I.
There was a discussion that cameup in there about the, utility
of revisions from an anteriorapproach, which it sounds like
you do the vast majority throughan anterior approach.
(16:02):
Is that correct?
John Horberg (16:03):
Yeah.
since I've been in practice,I've only ever done an anterior
approach.
I still haven't found anindication for going in from the
back.
Joseph M. Schwab (16:11):
So I'd be interested to hear your
perspective on this.
'cause the, discussion which Ithought was a reasonable one
was, there, there should be, ahip surgeon should have, many
quivers in their, many arrows intheir quiver, right?
So to speak, should be able todo things from all different
approaches and that there's avalue in considering different
(16:32):
approaches in revisionscenarios.
But it sounds like you who doquite a number of revisions.
In a very challenging setting,continue to do it through an
anterior approach.
And I'm curious to know, isthat, is there something with
the way you've set up your, yoursystem to facilitate that?
(16:52):
Is it the types of cases thatyou see?
Is it just the type of trainingthat you have?
What, can you tell me aboutthat?
John Horberg (17:00):
I think some of it does come down to training.
I'm certainly more comfortableoperating from the front than I
am from any other approach.
if you asked me to, told me Ihad to get through a posterior
approach, I could probably doit, but I certainly wouldn't be
nearly as comfortable as I amfrom the front.
from a case selectionstandpoint, I.
I'm non-selective.
I've done everything fromproximal femoral replacement,
(17:22):
periprosthetic fractures, triflange, cup cage, pretty much
anything that's a classicchallenging revision hip case.
I've done from the front and Ithink I.
A, that comes from the fact thatI trained to learn how to do
these things from the front.
B, it comes from, working withorganizations like the Anterior
Hip Foundation, doing some ofthe teaching and consulting.
(17:43):
I do, you get to work withexperts from across the field.
Every time I teach a course, Ilearn something new.
I feel more and more comfortabledoing those cases, but it's also
easier for my facilities.
I have.
Aana bit everywhere I went.
That was one of the challenges,alluding to your prior question,
is getting administration to buyme a table everywhere I went.
But then it's the same table forevery hip.
(18:04):
There's no question mark on howI'm gonna set up.
that eliminates the need for asmany staff.
I, I do my revisions withmyself, one pa or a surgical
first assistant, and then onetech handing me instruments, my
vendors run the table.
it decreases the amount ofresources needed.
In the OR per case for the team.
(18:26):
but I, just haven't really foundanything that I feel like I need
to go from another exposurefrom.
there are certainly cases wherethat may be of benefit, but one
argument people have for doingrevisions, from the back or from
another approach is.
you need to go in the way thatthe prior surgeon did.
I think the benefits of doing ananterior approach revision are
(18:46):
one, you have often a virginplane to work through.
if it was a prior anteriorapproach, it's still a minimally
invasive surgery and that you'renot cutting muscles, you're not
releasing things, you're notcutting tendons, you're just
removing soft tissue from aroundthe femur itself as a part of
your perioperative releases, butyou're keeping all the
musculature intact.
(19:07):
You diminish the risk ofinstability.
So it's a much more recoveryfriendly approach in my mind.
I've done, large femoral sidedrevisions on patients that I'm
shocked that they're sitting atthe side of their bed on post-op
day one with their clothes on,wondering why they can't go
home.
Whereas sometimes you do thosesame cases from the back and the
patients are in the hospital forthree or four days, and that a
(19:28):
20 bed critical access facilitywith limited nursing.
a lot of times that's achallenging thing to have
patients that want to, or needto be in the hospital for
several days.
Joseph M. Schwab (19:38):
So is there anything you do, with, or for
your team members?
Make it so that this isn't,something they want to rebel
against.
it seems like there's, they,you're giving them almost every
reason in the world to say,gosh, I don't know.
I don't know.
But you seem to be successful indoing this.
(20:00):
is it personality?
Is it, gifts?
what, how are you making thishappen?
John Horberg (20:07):
my wife could attest.
It's certainly not personality,the, my philosophy is.
First and foremost, there's noneed to be that surgeon.
Everyone knows who that surgeonis.
if you're kind and affablethroughout the day, you show
appreciation to the team whenthey work hard for you.
I say thank you after every caseand after every day to the
people I work with and just I.
(20:28):
Letting the team know that youcare goes a long way.
I make sure that I personallyround on all my patients.
I do my complex patients where Ianticipate inpatient stays in my
home facility.
I do some stuff in remotefacilities that are gonna be
outpatient surgery, where I'vegot a PA on backup who can
round.
But in general, I see all my ownpatients personally.
(20:49):
all the nurses on the floors,all the hospitalists, all the
consultants all have my cellphone number.
They know they can call medirectly day or night, they
don't have to.
I call my hand partner whohappens to be on call to answer
a question.
so I think buy-in comes frompeople feeling like they're.
Doing something valuable.
They're taking care of people intheir community.
(21:09):
And Wyoming is very stronglysupportive of and proud of
taking care of our own patients,but also being the surgeon who
appreciates the work that peopledo for you.
and I do think I.
Being efficient is alsoimportant.
we all know that speed isn't themost important metric of
success, but being efficient andnot being the guy that everyone
(21:31):
looks at the day and says, ohGod, we've got 12 primaries at
the surgery center.
We're not gonna leave untilmidnight.
If they're walking out the doorat four o'clock, everyone's
happy and bought in.
And then on those rare occasionswhere cases go longer than you
expect, or the day goes longer,you haven't had on, people are
much more happy to stick aroundand work with you as long as.
They know that you're making aneffort to respect their time and
(21:54):
showing up early.
I'm always there 45 minutesbefore my cases.
All my patients are marked, allmy paperwork's done, all my
orders are done, and I'm helpingthe team if I need to.
Joseph M. Schwab (22:02):
Yeah.
So you set up a system likethis, super efficient, able to
service your community.
And obviously you've got, you'rea young guy, you've got a
significant.
Amount of your career left, butat some point you hand over the
reins and, keeping somethinglike this going after, hopefully
you do it for a long period oftime and it gets to be an
(22:25):
established portion of yourcommunity or an expectation.
Have you thought aboutsuccession planning or what that
looks like?
How, when do you start thinkingabout something like that?
John Horberg (22:35):
that's a great question.
One of the things that I thinkmy practice in general has done
phenomenally well at is,strategic planning, succession
planning and growth.
we celebrated our 50thanniversary.
Anniversary last year, as apractice, as a, group that
focuses only on fellowshiptrained specialists to serve our
(22:55):
broader community.
And they've always done a goodjob of continuing to bring in
new specialists.
We just hired a new spinesurgeon, who I'm quite proud of
'cause she used to be one of myformer residents from my
academic days.
The same thing goes for me.
when I came here, I didn't knowif there'd be volume enough for
me as a recon specialist doingjust joints and not having a
(23:16):
little bit of a general flare tomy practice.
And now I'm as busy as I wannabe.
I'm probably leaning towardshiring a second recon partner in
the next five or so years tohelp me share the load, grow the
joints, practice, and then,allow them to, in stepwise
fashion, take over for me as Iwind down hopefully in 20 years.
(23:37):
but always having somebody thereand ready to take over your
workload before you're ready toleave, I think is valuable in
recruiting to Wyoming.
Is in some ways easy and in someways incredibly hard.
we always joke that we don'tlook at the surgeon, we look at
their spouse.
if they come into town andthey're looking for shopping
(23:58):
malls and fancy restaurants and,professional sporting events,
it's, it can be a challenge.
But if they come in and they,they love the outdoors, they
love the things that makeWyoming great.
Every outdoor opportunity isavailable.
The University of WyomingSports, we're all Josh Allen
zealots at this point because ofour favorite alumnus.
(24:19):
you, recruit the right peoplewho buy into the mission, and we
do have a school of medicine inWyoming as well.
So I teach some of the students,I'm a orthopedic proctor for
their fourth year rotations.
And making those relationshipswith people from the community
who may wanna come back to thecommunity when they finish their
training out and about isanother way to make sure that we
keep bringing people in.
Joseph M. Schwab (24:39):
And apart from the teaching that you're doing
at the university, you're gonnabe talking, revisions at the
upcoming AHF annual meeting inNashville in June.
We're happy to have you.
We're looking forward to that.
And it sounds like you givecourses, or you teach courses,
through industry as well,
John Horberg (24:57):
I do, yeah, I, I do some consulting work for a
couple of different, implantvendors.
I teach, primary and revision,hip and knee replacement
largely.
the hip stuff is largely,anterior approach, whether it's
beginner, anterior approachrevision, anterior approach,
complex primary.
I've been fortunate enough toteach with the Anterior Hip
Foundation, which I think is oneof the best meetings in the
(25:20):
country.
Plugged to anyone listening tothe podcast, come see us in
Nashville.
and then other academicsocieties.
And I think teaching is anotherwonderful way to a, grow your
network.
I'm on, on an island out here,but I've got a network of
surgeons around the country thatif I have a complicated case and
I wanna send it to Jonathan, youand he can send me a profanity,
(25:42):
lace, bit of advice, I'm, happyto receive it.
But that's been another way tonetwork and it's also another
way to find surgeons who mightwanna come out and join me.
Joseph M. Schwab (25:51):
And are surgeons able to come visit you
and see what you do in youroperating room, or is that a
logistically difficult thinggiven your practice?
John Horberg (26:00):
both, yeah.
I do have surgeons come out andsee me.
they wanna see either highvolume, arthroplasty, which for
a rural center we're anextraordinarily efficient
facility, not just for mypractice, but for all the
subspecialties that, that weprovide.
I.
I have surgeons come out andwatch me operate.
I have surgeons come out, watchme do revisions, but it can be
(26:21):
logistically challenging.
In the winter, it's hard to getin.
sometimes we request that theyfly into Denver and rent a car
and drive up, which is a bit ofa bit of an issue.
But it's, one of the morerewarding parts of my practice
is teaching and showing otherpeople what I'm doing.
Joseph M. Schwab (26:38):
those surgeons have got a tremendously benefit
from your level of experienceand, what you've put together.
And I really, appreciate yousharing this with us today,
John, it was great to have you.
We look forward to seeing you inNashville.
We look forward to hearing moreabout revision, total, hips from
an anterior approach with you inNashville.
And, you're welcome back on theAHF podcast anytime.
John Horberg (27:01):
I look forward to it.
Thanks again for having me on.
Joseph M. Schwab (27:05):
Thank you for joining me for this episode of
the AHF Podcast.
We think of the AHF as a family.
So if you can remember to take amoment to like and subscribe,
you would be helping us findmore people just like you to
share our thoughts with.
And as an AHF family member, youcan always drop an idea for a
topic or any feedback you likein the comments below.
(27:29):
You can find the AHF podcast onApple Podcasts, Spotify, or in
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation, all one word.
New episodes of the AHF podcastcome out on Fridays.
(27:51):
I'm your host, Joe Schwab,asking you like John Horberg to
keep all your hips happy andhealthy.
Hi everyone and welcome.
Welcome back to the AHF Podcast.
I'm your host, Joe Schwab.
I first met John Horberg in thefall of 2024 while recording a
series of episodes that we endedup calling the Revision round
Table.
I'll put a link to thoseepisodes in the description and
I encourage everyone to go backand watch them.
(00:44):
John submitted cases and videosthat we could review and discuss
as part of the broadcast, and Iwas really impressed by the
complexity of cases that he wasdealing with.
Little did I realize the complexand challenging environment he
was doing those cases in.
As I got talking to him more, Irealized one thing about John:
he's a problem solver.
(01:04):
And he's put his problem solvingskills to building a complex
total joint practice in achallenging environment.
John joins me today to talkabout his journey to building a
practice of complex hips inrural Wyoming.
John, welcome back to the AHFPodcast.
John Horberg (01:22):
Good to be here.
Joseph M. Schwab (01:24):
So tell me a little bit, how did you, my
recollection from our initialdiscussion is that you're from
Southern Illinois, right?
John Horberg (01:32):
Yeah, I grew up in, farm country in central
Illinois and trained in thatarea.
after my fellowship, I went backand I practiced, where I trained
for a few a period of a fewyears at a level one trauma
center.
I.
All the resources you could hopefor from a surgical standpoint.
but my wife and I are both, inlove with the mountains.
She grew up in rural Wyoming,and we decided after a couple
(01:54):
years of practice in, anacademic setting that it was
time to move out west.
And now I'm practicing inLaramie, Wyoming, with the
Premier Bona Joint Centers.
Joseph M. Schwab (02:03):
And it, was it your, was it your wife really
who got you interested inWyoming or was that something
you had been independentlyinterested in?
John Horberg (02:12):
I had always been in love with the mountains.
I'd grown up skiing and rockclimbing, mountain biking,
hiking, hunting, all the classicoutdoor stuff.
but my wife, being from Wyomingis what made us settle on the
rural state as opposed to any ofthe other states in the mountain
west.
I.
Joseph M. Schwab (02:28):
And so when you started looking at practice
opportunities in Wyoming, wasthere something you found
immediately or was it adifficult, a difficult search
for you?
John Horberg (02:37):
In some ways it was a difficult search.
when I came to Wyoming, I wasthe only fellowship trained
joint surgeon in the state.
no other practices were lookingfor one.
I.
So I put my feelers out and Icold called a couple of
practices and I was fortunatethat the group that I'm with now
was, had the foresight to saythat yeah, we can make this
(02:57):
work.
It's a good opportunity and itworks for both of us.
I.
Joseph M. Schwab (03:01):
And tell me a little bit about your practice
setup at the moment.
John Horberg (03:06):
Yeah, we have a fairly unique model.
We're a, single specialtyprivate practice physician
owned.
we work on a spoken wheel model.
We have, our headquarters inLaramie, Wyoming, which is,
where the University ofWyoming's located.
we have our surgery center thereand our main office, but I.
Wyoming being such a largegeographically, but small from a
(03:27):
population standpoint state.
we travel to outlying clinicsaround the state.
We have 12 locations, and thenwe see patients as close as we
can to where they're from andthen bring them back to our
central locations to operate.
And to do that, we have, a fleetof four twin engine turboprop
airplanes, and three full-timepilots, that help us get around.
(03:48):
a lot of folks aren't.
familiar, but a lot of roads inWyoming get closed sometimes as
many as 60 or 80 days outta theyear for Interstate 80.
So we have to fly over theweather if we're gonna get to
these outreach clinics.
I.
Joseph M. Schwab (04:00):
Yeah, so I think of, there being
geographic, issues with a lot ofdifferent types of, practices,
but a practice that has fourplanes and three pilots, that's
gotta be an additional.
Headache on your, the managementof your practice?
what sort of, what sort ofdifficulties has that created
(04:22):
for you and your partners orwhat sort of opportunities
John Horberg (04:26):
it's, both, obvious.
the obvious, biggest concern isthe cost.
it's not cheap to own your ownairplanes.
It's not cheap to maintain anaviation operation.
But, my, my partners have beenflying, for 50 years now,
starting off in small singleengine airplanes, up to the,
fleet of planes we have now.
And what we've found is from aneconomic standpoint, we can make
(04:49):
it work just by staying busy.
We, go all across the state, wesee as many folks as we can, and
a lot of these patients, theironly other opportunity was to
drive to Montana or to Utah orto Colorado, which sometimes is
a six or seven or eight hourdrive for them to get
musculoskeletal care.
So for us, we o overcome thecost of the aviation with
(05:09):
volume.
And then from an administrativestandpoint, we've just.
Been fortunate and, relied onexcellent administrators who can
not only run clinical practice,a surgical center, our
ancillary, revenue streams, butalso manage an aviation
business, coordinate with thestate, coordinate with local
airports.
it's a big complex machine witha lot of moving parts for a
(05:30):
practice of nine physicians.
But, it allows us to do what wedo and we're passionate about
taking care of people in ruralenvironments without having them
feel like they need to leave thestate.
Joseph M. Schwab (05:40):
So you mentioned you were the first,
total joint fellowship trained,surgeon that came and joined
that practice.
Were your partners before doingany complex revisions?
Were they handling complex casesor what was happening in those
circumstances?
John Horberg (05:58):
for the majority of cases, the, complex primaries
and the revisions, were beingreferred down to the university
depending on where the patientin the state came from, whether
it be the University ofColorado, the University of,
Utah, or some other largercenters in surrounding states.
my partners who were doingprimary toll, joint arthroplasty
would take on basic revisions,bearing changes and things like
(06:20):
that.
But for the most part, we were,Relying on the surrounding
states to take care of thecomplex cases.
I was a bit nervous coming injust from a volume standpoint,
being the only joints guy, andnot having a prerequisite,
model, to see if I could dothese things.
But the volume was certainlythere.
It was just more getting mysystem set up so I could
(06:41):
actually do those cases inhospitals and centers that
weren't used to doing them.
Joseph M. Schwab (06:45):
Yeah, and it had to have been more than just
travel logistics too, right?
what sort of things did youneed?
To do, to prep your practice forbeing able to do some of the
complex cases that you're, doingnow.
It's not just like flipping on alight switch, I imagine.
John Horberg (07:00):
Yeah, exactly.
the, things that I anticipatedcoming in and I had come from a
place where I had every resourceunder the sun.
We were the referral center.
I.
I could start a uni and end updoing a distal femoral
replacement if I wanted to,'cause everything lived in house
and was sterile.
So I, had anticipated needing tocoordinate with vendors for
implants, inventoryinstrumentation, especially less
(07:23):
common instruments.
burrs and, saws and cementremoval equipment, extraction
equipment.
There's little things that Ihadn't anticipated.
Just simple stuff like, multiplesuture options, arrogance for
the complex cases.
so those were the things that Ihad focused on.
Initially.
We bought ha beds for all myfacilities, for my anterior
(07:45):
approach.
I'm, an on table surgeon.
but there's a lot of otherthings that go into.
Doing complex cases that areabove and beyond the, what
happens in the actual or theavailability of, ICU care, the
availability of blood, which we,had to coordinate, the
availability of infectiousdisease and other consultants,
(08:05):
plastic surgeons, people to helpyou with complex wound closure
to help you with infection andan antibiotic management.
and then also getting buy-infrom.
Staff at the facilities thatyes, we can do these complex
cases from, centralsterilization that yes, we can
turn trays for big revisions ina small facility from anesthesia
(08:26):
that yeah, these folks thatwe're not used to taking care of
this complex of surgery and thissick of a patient.
it, took a lot more logisticsand a lot of the problems were
problems that I discovered alongthe way.
But, the one thing that'swonderful about Wyoming is it's
a blue collar state ofhardworking people who love to
rise to a challenge.
I,
Joseph M. Schwab (08:46):
I can imagine.
And it sounds like you've risento that challenge too.
I think back when I was aresident, we, were, able to do,
A rotation in Nicaragua for amonth and do some surgery,
excuse me, for a week, Iapologize.
and do some surgery down there.
And we used to talk about, thechanges that you make to your
practice or the things you learnabout what you can do during
(09:09):
surgery, from environments thataren't fully resourced, full
environments.
Is there anything you've learnedabout how to approach a revision
or how to approach the care ofpatients following or leading up
to a revision?
just by practicing in theenvironment that you're in.
John Horberg (09:28):
I think the thing that I learned the most is the
value of preparation.
just like you mentioned, whenyou're in training at a big
academic center or you're inpractice in a, large tertiary
referral center, you take forgranted all the resources that
are there and all the stuff thatcan be done on the fly.
So for me, I look at, I.
Even, cases that I wouldn'tnecessarily consider terribly
(09:49):
complicated, but that could haveunexpected problems, but
especially the revisions.
What's my plan A, what's my planB?
What's my plan C?
What instruments am I gonna needfor that?
And which ones do we have andwhich ones do we not have?
What, implants and systems do Ineed to have available?
And make sure that we can getthem there logistically in
certain times of year.
That can also be a challengejust with the weather problems
(10:11):
that we have getting to ourclinics.
the vendors have those sameproblems, getting those implants
from their larger distributordistribution centers to, to our
facility.
and then all the preoperativeand perioperative care needs.
for infections, I try to makesure that I get consultations
with infectious disease prior tosurgery.
I try to anticipate whether ornot I'm gonna need a plastic
(10:32):
surgery consult because I mightnot have a plastic surgeon, in
the hospital for.
Weeks at a time, unless Iarrange it in advance.
anticipating the needs of,higher blood loss, potential
need for blood after surgery,potential need for, intensive
care.
even simple things from acritical access facility,
needing to know if there's gonnabe a bed available for my
(10:54):
patient after surgery in a stepdown or an intensive care unit.
Most of the problems that Ianticipate in advance my team
and my vendors and myconsultants and everyone else
likes to give me a hard timethat, you brought in 40 trays
and you had three doctorsavailable and you had a bunch of
blood in the building and youdidn't use any of it.
but then there's those caseswhere you get into something
(11:16):
that you weren't expecting andyou always wanna make sure it's
there.
The worst thing you can do isget into a surgery, be in the,
or have the patient open andsay, oh shit, I can't do what I
want to do.
Joseph M. Schwab (11:28):
you mentioned your team, the team can be as
small as, you and your ma, yourpa, the team can be as large as
anyone who's gonna see and touchthe patient, at the time,
through their, through theirtime in the hospital.
Was there pushback from acertain groups, or certain,
people who played certain rolesor, administration or anything
(11:49):
like that, that you had tonegotiate?
how did you navigate that?
John Horberg (11:54):
Yeah, it, for me, it started small and then grew.
I was fortunate that right offthe bat, the ma that they hired
for me before I even got there,is the best MA I've ever worked
with.
she works her ass off.
She coordinates with all thesepeople and she's even gone out
of her way to find a.
Things that have helped us takecare of our patients.
She found a home healthorganization and coordinated
(12:15):
with them.
So we had some step down carefor people who were 500 miles
away from me in a rural marketon a ranch in the snow, who
might not get into PT asfrequently.
but then every step of the way,there's little things.
the anesthesiologist initiallybox saying, we can't do these
big complex cases here forcardiac issues or pulmonary
issues.
(12:35):
But then, I talked with them andfigured out what are their
concerns, what can we do priorto surgery to optimize them.
Sometimes that means we have todo more in-depth screening for
pulmonary issues, for cardiacissues, and do a little bit more
to optimize'em prior to surgeryto facilitate them feeling
comfortable doing the bigsurgeries.
at our surgery center, the mostjoints they'd ever done in a
(12:56):
day, between multiple surgeonswas six before I got here, and
now I do 12 in a day.
it.
Wasn't so much pushback.
It was more skepticism.
Can we really do this?
Can we really turn these traysover?
and then I had to figure outwhat are the issues there.
And some of them were, it'sgonna take us forever to turn
these trays over, but we foundout that I can eliminate 70% of
(13:19):
the trays'cause it's a bunch ofsuperfluous instruments and
facilitate faster turnaround tothose trays, working with the
vendors to get more sets ofsterile.
Implant and, system specifictrays available at our facility,
getting a larger stock ofimplants, in-house.
and then I think one of theother challenges was getting
(13:40):
care for my patients all overthe state.
getting, I.
doing an ACL and a 25-year-old,you don't necessarily need
pre-op clearance and COPDscreening and sleep apnea
screening and cardiac clearance.
So we had to figure out waysthat we could get labs, EKGs
testing, and a physician toclear these patients prior to
surgery.
And a lot of this stuff just.
(14:01):
Took being a nice guy and,trying to go out to these
environments and talk to people.
I met with primary care doctorsin their communities.
I met with local therapy groupsaround the state.
We have a physical therapy groupin Laramie, but we cover the
entire state, and we don't havea therapy office in every single
town.
So meeting with the privatetherapists in their own
communities, meeting with theinfectious disease teams,
(14:21):
meeting with the plasticsurgeons.
and another thing in privatepractice that was.
Surprising, but refreshing to meis meeting with my competitors.
a lot of groups around thestate, they're local, they're
hospital employed.
They're a small private groupthat covers a small community,
and they didn't want to be doingsome of these bigger cases.
They were happy that I wouldtake care of their patients and
they were also happy to takecare of my patients when the
(14:43):
need arose.
As long as, I'd be willing to dothe same for them.
Joseph M. Schwab (14:47):
So there was somewhat of a handoff agreement
between, the, competingphysicians, right?
If you're taking care of theirpatients.
And, that's interesting.
so all that travel around thestate, are you going on those
planes as well or is the planesfor patient and, goods
transport?
What, tell me how that works.
John Horberg (15:07):
Yeah, so we all live in Laramie and then, our
philosophy is that, we'll go andsee the patients in their
communities.
So we have 12 outlying officesand we'll fly, to go see the
patients.
but that takes a five hour driveand turns it into a 35 minute
flight.
We all get to sleep in our ownbeds at night.
We all get to put our own kidsto bed.
(15:28):
but.
We get to go see the patients.
They don't have to travelthrough the perioperative
period.
They only come to see us oncefor surgery, and then they get
to stay in their own communitiesand we take care of them where
they are.
Joseph M. Schwab (15:39):
So I had a group of surgeons recently, that
I interviewed for the podcastwho, started in practice doing
posterior approach and hadtransitioned to doing anterior
approach.
I.
There was a discussion that cameup in there about the, utility
of revisions from an anteriorapproach, which it sounds like
you do the vast majority throughan anterior approach.
(16:02):
Is that correct?
John Horberg (16:03):
Yeah.
since I've been in practice,I've only ever done an anterior
approach.
I still haven't found anindication for going in from the
back.
Joseph M. Schwab (16:11):
So I'd be interested to hear your
perspective on this.
'cause the, discussion which Ithought was a reasonable one
was, there, there should be, ahip surgeon should have, many
quivers in their, many arrows intheir quiver, right?
So to speak, should be able todo things from all different
approaches and that there's avalue in considering different
(16:32):
approaches in revisionscenarios.
But it sounds like you who doquite a number of revisions.
In a very challenging setting,continue to do it through an
anterior approach.
And I'm curious to know, isthat, is there something with
the way you've set up your, yoursystem to facilitate that?
(16:52):
Is it the types of cases thatyou see?
Is it just the type of trainingthat you have?
What, can you tell me aboutthat?
John Horberg (17:00):
I think some of it does come down to training.
I'm certainly more comfortableoperating from the front than I
am from any other approach.
if you asked me to, told me Ihad to get through a posterior
approach, I could probably doit, but I certainly wouldn't be
nearly as comfortable as I amfrom the front.
from a case selectionstandpoint, I.
I'm non-selective.
I've done everything fromproximal femoral replacement,
(17:22):
periprosthetic fractures, triflange, cup cage, pretty much
anything that's a classicchallenging revision hip case.
I've done from the front and Ithink I.
A, that comes from the fact thatI trained to learn how to do
these things from the front.
B, it comes from, working withorganizations like the Anterior
Hip Foundation, doing some ofthe teaching and consulting.
(17:43):
I do, you get to work withexperts from across the field.
Every time I teach a course, Ilearn something new.
I feel more and more comfortabledoing those cases, but it's also
easier for my facilities.
I have.
Aana bit everywhere I went.
That was one of the challenges,alluding to your prior question,
is getting administration to buyme a table everywhere I went.
But then it's the same table forevery hip.
(18:04):
There's no question mark on howI'm gonna set up.
that eliminates the need for asmany staff.
I, I do my revisions withmyself, one pa or a surgical
first assistant, and then onetech handing me instruments, my
vendors run the table.
it decreases the amount ofresources needed.
In the OR per case for the team.
(18:26):
but I, just haven't really foundanything that I feel like I need
to go from another exposurefrom.
there are certainly cases wherethat may be of benefit, but one
argument people have for doingrevisions, from the back or from
another approach is.
you need to go in the way thatthe prior surgeon did.
I think the benefits of doing ananterior approach revision are
(18:46):
one, you have often a virginplane to work through.
if it was a prior anteriorapproach, it's still a minimally
invasive surgery and that you'renot cutting muscles, you're not
releasing things, you're notcutting tendons, you're just
removing soft tissue from aroundthe femur itself as a part of
your perioperative releases, butyou're keeping all the
musculature intact.
(19:07):
You diminish the risk ofinstability.
So it's a much more recoveryfriendly approach in my mind.
I've done, large femoral sidedrevisions on patients that I'm
shocked that they're sitting atthe side of their bed on post-op
day one with their clothes on,wondering why they can't go
home.
Whereas sometimes you do thosesame cases from the back and the
patients are in the hospital forthree or four days, and that a
(19:28):
20 bed critical access facilitywith limited nursing.
a lot of times that's achallenging thing to have
patients that want to, or needto be in the hospital for
several days.
Joseph M. Schwab (19:38):
So is there anything you do, with, or for
your team members?
Make it so that this isn't,something they want to rebel
against.
it seems like there's, they,you're giving them almost every
reason in the world to say,gosh, I don't know.
I don't know.
But you seem to be successful indoing this.
(20:00):
is it personality?
Is it, gifts?
what, how are you making thishappen?
John Horberg (20:07):
my wife could attest.
It's certainly not personality,the, my philosophy is.
First and foremost, there's noneed to be that surgeon.
Everyone knows who that surgeonis.
if you're kind and affablethroughout the day, you show
appreciation to the team whenthey work hard for you.
I say thank you after every caseand after every day to the
people I work with and just I.
(20:28):
Letting the team know that youcare goes a long way.
I make sure that I personallyround on all my patients.
I do my complex patients where Ianticipate inpatient stays in my
home facility.
I do some stuff in remotefacilities that are gonna be
outpatient surgery, where I'vegot a PA on backup who can
round.
But in general, I see all my ownpatients personally.
(20:49):
all the nurses on the floors,all the hospitalists, all the
consultants all have my cellphone number.
They know they can call medirectly day or night, they
don't have to.
I call my hand partner whohappens to be on call to answer
a question.
so I think buy-in comes frompeople feeling like they're.
Doing something valuable.
They're taking care of people intheir community.
(21:09):
And Wyoming is very stronglysupportive of and proud of
taking care of our own patients,but also being the surgeon who
appreciates the work that peopledo for you.
and I do think I.
Being efficient is alsoimportant.
we all know that speed isn't themost important metric of
success, but being efficient andnot being the guy that everyone
(21:31):
looks at the day and says, ohGod, we've got 12 primaries at
the surgery center.
We're not gonna leave untilmidnight.
If they're walking out the doorat four o'clock, everyone's
happy and bought in.
And then on those rare occasionswhere cases go longer than you
expect, or the day goes longer,you haven't had on, people are
much more happy to stick aroundand work with you as long as.
They know that you're making aneffort to respect their time and
(21:54):
showing up early.
I'm always there 45 minutesbefore my cases.
All my patients are marked, allmy paperwork's done, all my
orders are done, and I'm helpingthe team if I need to.
Joseph M. Schwab (22:02):
Yeah.
So you set up a system likethis, super efficient, able to
service your community.
And obviously you've got, you'rea young guy, you've got a
significant.
Amount of your career left, butat some point you hand over the
reins and, keeping somethinglike this going after, hopefully
you do it for a long period oftime and it gets to be an
(22:25):
established portion of yourcommunity or an expectation.
Have you thought aboutsuccession planning or what that
looks like?
How, when do you start thinkingabout something like that?
John Horberg (22:35):
that's a great question.
One of the things that I thinkmy practice in general has done
phenomenally well at is,strategic planning, succession
planning and growth.
we celebrated our 50thanniversary.
Anniversary last year, as apractice, as a, group that
focuses only on fellowshiptrained specialists to serve our
(22:55):
broader community.
And they've always done a goodjob of continuing to bring in
new specialists.
We just hired a new spinesurgeon, who I'm quite proud of
'cause she used to be one of myformer residents from my
academic days.
The same thing goes for me.
when I came here, I didn't knowif there'd be volume enough for
me as a recon specialist doingjust joints and not having a
(23:16):
little bit of a general flare tomy practice.
And now I'm as busy as I wannabe.
I'm probably leaning towardshiring a second recon partner in
the next five or so years tohelp me share the load, grow the
joints, practice, and then,allow them to, in stepwise
fashion, take over for me as Iwind down hopefully in 20 years.
(23:37):
but always having somebody thereand ready to take over your
workload before you're ready toleave, I think is valuable in
recruiting to Wyoming.
Is in some ways easy and in someways incredibly hard.
we always joke that we don'tlook at the surgeon, we look at
their spouse.
if they come into town andthey're looking for shopping
(23:58):
malls and fancy restaurants and,professional sporting events,
it's, it can be a challenge.
But if they come in and they,they love the outdoors, they
love the things that makeWyoming great.
Every outdoor opportunity isavailable.
The University of WyomingSports, we're all Josh Allen
zealots at this point because ofour favorite alumnus.
(24:19):
you, recruit the right peoplewho buy into the mission, and we
do have a school of medicine inWyoming as well.
So I teach some of the students,I'm a orthopedic proctor for
their fourth year rotations.
And making those relationshipswith people from the community
who may wanna come back to thecommunity when they finish their
training out and about isanother way to make sure that we
keep bringing people in.
Joseph M. Schwab (24:39):
And apart from the teaching that you're doing
at the university, you're gonnabe talking, revisions at the
upcoming AHF annual meeting inNashville in June.
We're happy to have you.
We're looking forward to that.
And it sounds like you givecourses, or you teach courses,
through industry as well,
John Horberg (24:57):
I do, yeah, I, I do some consulting work for a
couple of different, implantvendors.
I teach, primary and revision,hip and knee replacement
largely.
the hip stuff is largely,anterior approach, whether it's
beginner, anterior approachrevision, anterior approach,
complex primary.
I've been fortunate enough toteach with the Anterior Hip
Foundation, which I think is oneof the best meetings in the
(25:20):
country.
Plugged to anyone listening tothe podcast, come see us in
Nashville.
and then other academicsocieties.
And I think teaching is anotherwonderful way to a, grow your
network.
I'm on, on an island out here,but I've got a network of
surgeons around the country thatif I have a complicated case and
I wanna send it to Jonathan, youand he can send me a profanity,
(25:42):
lace, bit of advice, I'm, happyto receive it.
But that's been another way tonetwork and it's also another
way to find surgeons who mightwanna come out and join me.
Joseph M. Schwab (25:51):
And are surgeons able to come visit you
and see what you do in youroperating room, or is that a
logistically difficult thinggiven your practice?
John Horberg (26:00):
both, yeah.
I do have surgeons come out andsee me.
they wanna see either highvolume, arthroplasty, which for
a rural center we're anextraordinarily efficient
facility, not just for mypractice, but for all the
subspecialties that, that weprovide.
I.
I have surgeons come out andwatch me operate.
I have surgeons come out, watchme do revisions, but it can be
(26:21):
logistically challenging.
In the winter, it's hard to getin.
sometimes we request that theyfly into Denver and rent a car
and drive up, which is a bit ofa bit of an issue.
But it's, one of the morerewarding parts of my practice
is teaching and showing otherpeople what I'm doing.
Joseph M. Schwab (26:38):
those surgeons have got a tremendously benefit
from your level of experienceand, what you've put together.
And I really, appreciate yousharing this with us today,
John, it was great to have you.
We look forward to seeing you inNashville.
We look forward to hearing moreabout revision, total, hips from
an anterior approach with you inNashville.
And, you're welcome back on theAHF podcast anytime.
John Horberg (27:01):
I look forward to it.
Thanks again for having me on.
Joseph M. Schwab (27:05):
Thank you for joining me for this episode of
the AHF Podcast.
We think of the AHF as a family.
So if you can remember to take amoment to like and subscribe,
you would be helping us findmore people just like you to
share our thoughts with.
And as an AHF family member, youcan always drop an idea for a
topic or any feedback you likein the comments below.
(27:29):
You can find the AHF podcast onApple Podcasts, Spotify, or in
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation, all one word.
New episodes of the AHF podcastcome out on Fridays.
(27:51):
I'm your host, Joe Schwab,asking you like John Horberg to
keep all your hips happy andhealthy.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.