June 27, 2025 • 27 mins
Join host Joe Schwab on the AHF Podcast as he discusses the nuances of hip disease and surgery with Mr. Jonathan Hutt, a consultant orthopedic surgeon specializing in hip reconstruction and preservation at the London Hip Unit. Jonathan shares his journey from a surgical trainee considering plastic reconstructive surgery to becoming a dedicated hip specialist. They dive into the details of hip preservation, the significance of the anterior approach in hip replacements, and the upcoming European anterior hip meeting. Discover how technological advancements are shaping their practice and Jonathan's vision for the future of hip surgery. Tune in for an engaging and insightful conversation about hip care and innovations in the field.
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Episode Transcript
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Joseph M. Schwab (00:36):
Hello everyone and welcome to the AHF Podcast.
I'm your host, Joe Schwab.
My guest today is Mr.
Jonathan Hutt, a consultantorthopedic surgeon, specializing
in hip disease at the London HipUnit.
He specializes in hipreconstruction as well as
preservation, having trained inplaces like Montreal, as well as
(00:58):
in the uk.
He is one of the few surgeons inthe UK who openly admits to
performing anterior approachtotal hip replacement, and his
passion for comprehensive hipcare has landed him on the
organizing committee of the veryfirst European anterior hip
meeting.
Jonathan, welcome to the AHFpodcast.
Jonathan Hutt (01:20):
So.
Joseph M. Schwab (01:22):
So let's start by having you take us back a
little bit to what first sparkedyour interest in orthopedics and
maybe even more specifically hipsurgery.
Jonathan Hutt (01:34):
That's taken me back a little while actually.
Um, well actually, when I, whenI was a surgical trainee, um, as
you know, in the uk we don'tspecialize first up straight
outta med school, so we do sortof a lot of surgical
specialties.
So at that point, I was actuallyconsidering plastic
reconstructive surgery as anoption.
Um, and as part of my rotation,I, I did a six month.
(01:54):
Post, and it was actually duringthat post, I realized I, I've
been heading down the wrongtrack and so I made a, a hand
brake turn, changed all myplans, ditched everything I've
got, and, uh, headed straightto, I haven't really looked back
since.
Actually, it's definitely thebest decision I.
Um, I then, as a result of that,did another hip, uh, surgery
job, uh, shortly after that.
(02:15):
And, uh, it was with a, um, aconsultant, uh, called Mark
Banks, who's a hip preservationsurgeon in London.
Uh, and that really kind of gotme, uh, going down the hip track
quite early on in my orthopedictraining.
And I, and I sort of neverreally deviated from that.
I've always found, uh, the hipboth from a sort of preservation
and a reconstruction one.
(02:36):
In the body and I've always kindof, you know, focused my sort of
ladder training and fellowship,uh, all around that.
Uh, which has sort of landed me,um, in the place I'm at now,
which is great.
I have a sort of half and halfpractice of preservation and,
uh, and replacement essentially.
Joseph M. Schwab (02:51):
And is it, is it roughly about 50 50 or do you
do, uh, more preservation than,uh, reconstruction or the other
way around?
Jonathan Hutt (02:59):
Oh, it varies a bit, but I would say probably
hits about 50 50 these days.
Joseph M. Schwab (03:04):
And who were your preservation, mentors
Jonathan Hutt (03:07):
yeah, so.
The, the guy who trained me, um,I, he did get a lot, a lot of
exposure to preservationactually, at that point.
He was, um, you know, we weresort of talking late 2010s,
sorry, mid 2010s I guess.
And, you know, there wasn't thatmany people in and around, uh,
London or even UK doing, uh,high volume hit preservation
work.
So, um, I would certainly saythat he was the one who.
(03:33):
George's hospital in SouthLondon, and, and I moved after a
few years to where I'm from mymain NHS post now, which is, uh,
university College London, uh,hospital, which is, uh, you
know, in central North London.
Um, and there I've worked withanother, uh, sort of very well
known, uh, colleague of mine,Johan Witt, who, um, is a very
well known hip preservationspecialist, as well as another,
uh, fan of anterior hip surgery.
Joseph M. Schwab (03:56):
Uh, and what keeps you, uh, you're focused on
hip preservation, you're heavilyfocused on hip preservation.
What keeps you passionate aboutthat?
Or what, what do you findinteresting about that area?
Jonathan Hutt (04:07):
Well, it's, um, I mean it's, it's very different,
um, in terms of the sort ofpatients you might see.
So, I mean, I'll treat anyoneprobably from about age 12.
I don't really do pediatricsurgery, but I'll do surgery on
adolescence.
Um, and I think it's just.
To, to, to the job.
Um, you know, there's somethinga bit different and technically
challenging about hippreservation surgery.
(04:28):
You know, I do a lot ofosteotomy as well as, uh,
arthroscopy and I find thatvariation, uh, in my sort of,
you know, surgical life, sort ofvery interesting and very, sort
of keeps me enthusiastic.
Joseph M. Schwab (04:41):
And, uh, do you find, um, sort of the
difference in age range, youknow, the d the different aged
patients that you see?
Does that make it.
Difficult.
Does that make it moreinteresting?
Does that make it, um, uh, doyou have to be on your toes with
different areas of the, uh,literature in order to feel like
you're doing that well?
How, how does that affect yourpractice?
Jonathan Hutt (05:02):
Yeah, I, I think that's true.
I mean, I think it, it, it feelsin some ways, like it's two
slightly separate things, butactually in many ways it's
continuation.
Um, whatever's coming throughthe door from the perspective of
what you can achieve for thatpatient.
And it's, if you've got thatrange of tools, uh, at your
disposal, then it helps you kindof, um, you know, you don't feel
like you're trying to shoehornone technique in when another
(05:23):
one would be perhaps moreappropriate.
And that, I find is quitehelpful.
And, you know, the age thing isinteresting.
I think it, I.
You know, different cohorts ofsociety in different ways.
Um, you know, my patients rangequite wildly.
Even my hip replacement patientsrange from.
Joseph M. Schwab (05:43):
Yeah.
And so speaking of hipreplacements, so this June, um,
you are helping lead theEuropean anterior hip meeting,
uh, which takes place in Londonand seems to be.
A rather significant milestonefor the European community in
terms of embracing anteriorapproach.
Um, how did you become part ofthat platform?
(06:04):
What drove you to be interestedin, in that platform?
Jonathan Hutt (06:08):
Yeah, I think it's, you know, so I've been
doing the anterior approach fora while now.
Um, in the UK there really isn'tan awful lot of it going on.
Uh, and there hasn't been,there's been, you know, a few
people who've been very positiveabout it, but it's never really
gained an awful lot of.
Traction.
Um, certainly when I started itwas still, you know, relatively
infrequent to come across otherpeople doing it.
(06:29):
I would say I think we're at abit of a zeitgeist moment now in
the uk.
Um, and there's a lot of reasonsfor that.
You know, if you go around, if Italk to my trainees and
particularly the people who arecoming up for fellowship, if I
go around the country atconferences and courses and I
chat to the junior consultants,enthusiasm.
(06:52):
You know, as UK surgeons, weoften travel to the us, to
Canada, to Australia, uh, forour fellowship training, um, you
know, even to Europe as well.
Um, and therefore people arepicking up these techniques and
wanting to come back and, uh,and use them.
So, um, you know, it's aninteresting thing because of
course in Europe it's, it's nota new thing at all.
I mean, it's been wellestablished for forever, really
(07:13):
and quite interesting when.
Novel technique in manyrespects.
And, uh, you know, I think thesurgical community in the UK has
not really come round to it in,in a hugely enthusiastic manner
as a, as a large body.
But I think there is now asignificant portion of people
who have seen it done well andare really interested in kind
(07:34):
of, you know, continuing it intheir practice.
Um, so actually when I wasthinking about.
The sort of meeting I wanted torun, I, I was thinking, well,
what I would love to do is kindof, um, you know, get, get the
sort of UK on side and showthem, you know, what the
anterior approach is all about.
Try and infuse everyone aboutit.
You know, try and get some, somefurther traction really in, in,
(07:55):
in the community here.
But then, you know, I waschatting with Richard about it.
And his idea was a, a muchbroader and, and better one, as
it often is.
And he said, well, you know,let's run it as a European
meeting.
And then of course you, you canbring on all the, you know, the
great European guys and, and,and the rest of the crew that
we've got organizing it.
And I think that's gonna, youknow, really hopefully cement,
uh, a really good meeting thissummer.
Joseph M. Schwab (08:18):
Uh, coming from the perspective of the
Anterior Hip Foundation, it, itlooks to me looking at the
outline of the program, thatthere are some aspects that are
very, um, similar to what we'vedone through the AHF.
Do you feel that was, um, wasthat a deliberate approach to
the meeting?
Was that accidental?
Does it just turn out that greatminds think alike and so do
ours?
(08:38):
H how did that, uh, what do,what's your perspective on that?
I.
Jonathan Hutt (08:42):
Um, well, I mean, there's.
You know, the model of themeeting that the AHF has set up
is a really good one.
And I think it was almostinevitable that we were gonna,
you know, look at that and seehow, uh, we could do something
along similar lines.
I mean, in many respects, Isuppose you're gonna think very
similarly, but I think there's,there, there's little things
about how you run the meetingout there that are quite
(09:04):
appealing.
So obviously there's the, youwould expect most meetings to
bit.
Bringing along the sort of DAAsurgery along with the
technology and the innovationand, and the disruption and all
the rest of it, that, that Ithink gives it that little bit
extra.
And I think that's part of whatthe has done so well that we
(09:25):
would like to introduce into ourmeeting as well, because I think
it creates a very different andmore enthusiastic environment.
Joseph M. Schwab (09:32):
Yeah.
And as a matter of fact, youjust posted this morning on, uh,
on LinkedIn about yourexcitement, about the debate
about technology, whattechnologies really needed to do
this sort of, well.
Is the focus on innovation andtechnology within the space of
anterior hip surgery somethingthat was attractive to you?
Or, um, was that something thatwas a driving focus for this?
Jonathan Hutt (09:55):
I mean, I think it's, I, I'm, you know, a
surgeon.
I'm very enthusiastic abouttechnology and I, I, the future
of our, our specialty.
I, I don't see technology being,I see it.
Refined and, um, you know,obviously working in tandem with
technology, certainly for mycareer and going forward.
I think there's a lot of reallyinteresting things happening in
(10:16):
that, in that space.
And, you know, my practice, I, Iuse a fair amount of technology.
Um, I don't expect that tochange, you know.
I'm quite enthusiastic about thebenefits, not only for, you
know, my operations, but alsofor when I'm talking to people
at the start of practice andthey're looking to kind of, you
know, get into their groovewithout having any problems,
without having any difficulties.
(10:37):
And it's, and I think it'sreally good for training.
I think it's really good fornarrowing your bandwidth.
While you are really getting togrips with something, you know,
when you are experienced and.
Joseph M. Schwab (10:55):
So I think it's exciting.
It, you know, from myperspective, to see anterior
approach taking a bit centerstage, especially in, in London,
right in the heart of the uk.
Um, but as you pointed out,adoption in in the UK has not
always been easy.
Um, do you.
Uh, what are some of the biggestmyths that you encounter or
(11:18):
hesitations that you hear fromfellow surgeons in the uk and
how do you address it?
Jonathan Hutt (11:25):
So yeah, stories when I Canada one destinations.
Um, and I, I in fact, um, turneddown the opportunity to go and
do Paul Vallas fellowship, and Idid that on the basis that I
decided I didn't want to learnanterior hip surgery.
Uh, because at the time that wasmy perception being trained in
(11:48):
the uk that it was, I, I can't,probably can't even really
remember exact thoughts aboutit, but there's certainly an
element to where it was seen asa sort of passing trend.
Um, perhaps quite a bit ofsomething, a little bit niche.
The environment in which you'retrained.
If there is a very consistentenvironment in which you're
(12:09):
trained, and the UK is a veryconsistent place in many
respects, particularly when itcomes to approach, then that's
often where you come to by theend.
And if you're not exposed tothese things in training, it's a
very different experience tryingto get into the mid practice and
you know, because we've now.
Awareness of the anteriorapproach and what it can do.
(12:31):
So I think, going back to yourquestion, you know, the sort of
things that I, I think peopledon't often necessarily say
outright, but are rethinkingwhen they're talking to you
about it, is they say, you know,it, it's a marketing trend.
Um, it's, you know, it's just afad.
It doesn't really add anything.
Um, you know, the, what's thebenefits and also look.
(12:55):
Um, you know, and the truth isthat the data is now there to
support the fact that thosestatements really aren't true.
You know, we know that thereare, you know, benefits to the
approach.
Um, we know what they are.
Um, we also know that there's nodetriment.
And I, I often say my argumentto them is not, I'm not trying
to tell everybody that youshould go anterior'cause it's
way better if you're a goodposterior surgeon.
(13:15):
I don't think that's a reallyterribly valid argument, but I'm
saying that if I can dosomething and I can see the
benefits from my patients.
I'm doing any downsides ineither the.
Joseph M. Schwab (13:33):
So it's one thing to talk to your fellow
surgeons who are in practice, ormaybe even your senior surgeons
who have questions or uh,concerns.
Um, it's another thing to be amentor and a teacher to the
younger surgeons who are intraining.
How do you approach the nextgeneration of surgeons who wanna
explore, we'll say anteriorapproach?
(13:55):
Uh, total hip replacements orhip preservation?
Jonathan Hutt (13:59):
Um, yeah, so I think it's, um, in some ways
it's probably easier, uh, nowthan it was when I was training.
I mean, I'm not, I'm not thatold, but, you know, I think that
it is possible now to map outfor someone how they might
approach their final years inpractice if they're wanting to
specialize in a particulartechnique.
Um, and you know, if we, if wetake the anterior approaches as
(14:20):
a good example, you know, I'vegot colleagues, uh, sorry,
colleagues of fellows really andsenior residents as we now call
'em as well, who are interestedin the technique and they'll
come and spend time with, youknow, me or another surgeon in
the UK who does the technique.
That's the sort of startingpoint.
They can get a feel for it andsee if that's what they wanna
do.
And now there's lots build on.
(14:42):
Fellowship training in it.
I, you know, having not had thatmyself, I can definitely attest
to the fact that that will makeyour transition and your
adoption of the new surgicaltechnique so much easier than if
you try and just pick it up inpractice.
Um, and they'll see there'sloads of great courses, there's
loads of great conferences.
You know, there's a whole worldyou can immerse yourself in now
where people are really happyand willing to share their
(15:02):
expertise, uh, and theirexperience with you.
And I think that practice.
That's particularly unusual, uh,or that they don't have enough
experience to take onindependently.
Um, I do try and say to them,you know, if they can find
people to work with who aredoing it already.
I found that immensely helpfulwhen I, when I was really, I
(15:24):
mean, um, Richard was one of thefirst people who introduced me
to the approach, but I was inthe process of moving hospitals
at the time.
So we did a handful of cases,uh, together.
Um, but when I moved to UCH andI had Johan there pretty much in
the next theater team, me doingthe approach as well, that's
very reassuring.
It means I've got a little bitof cover and I've given a
similar amount to my juniorcolleagues as well who come and
(15:46):
work in at once to start theapproach as well.
So I think that sort of ongoingmentorship and practice is
extremely helpful, whatever yourspecialty.
Uh, but certainly in the worldof, um, you know, anterior hips
and, and particularly in hippreservation is something we.
Joseph M. Schwab (16:01):
You mentioned with learners in the UK it's
quite common for them to go dofellowships abroad, whether it's
in the us, whether it's inCanada, whether it's in Europe.
Um, certainly not to, um, aaddress this politically, but
looking at how Brexit may or maynot have changed the educational
opportunities for the uk, hasthere been any effect that
you've seen?
(16:21):
I.
Jonathan Hutt (16:22):
Um, I don't think from that perspective, no.
Um, you know, the, thefellowship kind of model was, is
quite well established.
Um, and I, I don't think itseems to have affected many
people's choices.
I think that there are a portionof people who will be, you know,
do want to and do go to Europefor their fellowships there.
I have to say, you know, as, asBritish people, the language
(16:43):
bar.
Well enough to reallycommunicate properly in two
different languages and makeourselves useful, uh, as a ve
and I think that's part of thereason why we gravitate to
places like Australia and, and,and Canada and US if you have
the time and inclination to do,of course.
But that's often a bit of a bigburden as you the end of
(17:04):
orthopedic training if youhaven't done it.
Joseph M. Schwab (17:07):
Yeah.
Yeah, for sure.
Um, I'm, I'm curious, is there acase that you can think of,
whether it's anterior approachor whether it's hip
preservation?
Um, can you share a case thathas really stayed with you, that
made a particular impression onyou, or something that reminds
you of the importance of what itis that you do?
Jonathan Hutt (17:30):
Oh, that's quite a deep question.
Um, um, yeah, I guess, um.
I think, I think the ones that Ifind quite affecting are, are,
are sort of the adolescentpatients that I get that, I
mean, I would give you two sidesto that.
I have adolescent patients whohave preservation surgery, so if
(17:53):
you do preservation surgery inPeros osteotomy in particular on
young patients, 15, 16, that isan amazing operation.
You know, they heal so, soquickly and they just get back
to stuff and.
It's super rewarding to see.
Um, and you know, a similar, ina similar manner, some of the
(18:15):
patients I get who are sent tome for possible preservation
surgery and they're in theadolescence and they've got, you
know, variety of different sortof problems going on.
But really there's no salvageoperation that's possible and
short of joint replacement, it'sreally, um, rewarding to take
(18:35):
replacement in.
Whereas actually, you know, ourexperience of it is, is
reasonable and, and you know,provided you choose well and
wisely and do the operationwell, they do extremely well.
And you know, you can reach thepoint where, you know, I had a
very young girl came to meprobably about 18 months, two
years ago now.
Um, and she was at the pointwhere she was basically going to
(18:56):
school in a wheelchair.
They'd been setting uporthopedic beds at home.
You know, she loads of care,loads of time off school and all
the rest of it.
And you know, we took themthrough the, the kind of the
problem that she had, which wasa complex kind of, uh,
congenital sort of deformityissue.
She had a hip replacement sixweeks later she was walking
normally.
And, you know, that was reallysomething to see, you know,
(19:18):
just, you know, from our ownpersonal outcomes, but also from
the family and, and howdifferent their life is now.
You know, that that's been superrewarding and.
Joseph M. Schwab (19:29):
Let's, let's talk a just a little bit about
your, your setup for how you doan anterior approach.
'cause obviously there's table,there's orthopedic table,
there's standard table, there'snavigation, there's fluoroscopy,
there's all sorts of technologythat can be used.
Can you give us a sense of whatyou're using?
Um, and for instance, in thiscase that you just mentioned,
(19:49):
would you be doing anythingdifferent in an adolescent who's
gonna be undergoing that?
Jonathan Hutt (19:55):
Yeah.
So, um, where I am now isproduct of going through a lot
of the things you've mentioned.
So, you know, I.
My first few cases doing a tablebased, uh, extension of based
approach, um, I didn't reallyget on with it very well.
I found that the jump from beingessentially freehand posterior,
which is what I was before, tobeing very sort of tied up in
(20:17):
the, in the mechanics of thetable, that felt like too big a
jump for me.
So, um, and that was thetechnique that I'd done a bit
with Richard, but I then tovisit Christoph in Belgium.
Um, release.
I decided that was, that was theway for me.
So I, I pretty much modeled mytechnique on, on the things that
(20:38):
I learned from him that day.
Um, I now do it sort of onstandard operating table, uh,
without any extra bits andpieces.
Probably two and a half, maybein three years of, of, of my D
approach.
I had inoperative fluoroscopy.
Um, I used that initiallybecause I had no other sort of,
uh, check and I really wanted tomake sure I didn't make any
(20:58):
mistakes.
You know, one of the thingsabout doing the approach in the
UK is people are waiting for youto make some mistakes, so I
wanted to give them noopportunities that weren't, you
know, unavoidable, wean myselfoff Fluor.
You know, it's, it's, it's a bitof an inconvenience.
Um, there's a lot of faffingaround involved in it.
Um, and also there, I really, Iwear lead for lots of
(21:20):
operations.
I really wanted to get outta thelead.
So I, I've now transitioned to,um, a simple navigation system.
So, uh, it's a sort ofcombination for me of anatomical
stuff and, uh, a fairlysimplistic optical navigation
system.
And.
Radiology free for about a yearnow.
(21:42):
Um, there are probably somecases where I might consider
bringing it in, um, if I've got,you know, maybe complex femoral
deformity or, you know, verystrange acetabular deformity.
And, you know, as I wastransitioning over in my
practice, I would, I didn't goall in from the start with the
cases that I would take on foranterior surgery and it before
I.
(22:04):
So reserve right fact, have tobe as precise as you possibly
can in a way that doesn'tdisrupt.
Workflow too much in a way thatdoesn't bring in too much cost
in a way that that works foryou, then that's, that's always
(22:26):
been my aim.
So that's kind of why I've stuckwith the, with having something
in the form of the navigation.
And I still will sort ofprobably keep the image
intensifier on the, on the backshelf for occasional, but I
haven't yet done that in myrebirth as a II based surgeon.
Joseph M. Schwab (22:41):
So you, you described some change to your
technique over the past fewyears.
If you were to look ahead andproject forward maybe five or 10
years.
Years.
Are there innovations that yousee or technologies that you
would want to see that youbelieve may transform what you
do in hip surgery, whether it'sreconstruction or preservation?
Jonathan Hutt (23:03):
I mean, certainly in the preservation world,
there's a, there's a hugeopportunity te.
Know, we take a complex threedimensional problem and then we
try and solve it.
Having planned it in 3D in ourheads and on, you knows, and
dimensional imaging inoperating, I've always.
(23:27):
So, uh, and that is coming and,you know, there are a few things
that on the market or coming tomarket or certainly in people's
minds, that, that I think we'regonna see some very interesting
technology, particularly from anosteotomy perspective, you know,
in the coming years.
Um, the problem I suppose isthat there isn't quite the
industry funding and interestbehind it because unlike hip
replacements, you're not sellingan awful lot, you know, three
(23:49):
screw for an industry partner.
So, you know.
It is more difficult, I think,to infuse the industry to join
us on that particular journey.
Uh, but I would say that as aspace, that that is the space
that probably has more coming toit of interest soon than maybe
joint replacement, where there'squite a lot happening all the
(24:10):
time and, you know, a lot ofinteresting things on and off
the market.
Um, and we're probably makingquicker strides towards, you
know, interesting technology inthat space.
Uh.
Joseph M. Schwab (24:22):
What do you hope people walk away from the
European anterior hip meeting,having experienced, having
learned after attending it?
What do you want them to walkaway with?
Jonathan Hutt (24:35):
So I think I, what I want from the meeting is
I, I want people to come, I wantto, you know, they can be
already doing the approach.
They could be thinking aboutstarting.
I want come by it to recognizethat it's pretty established.
There's lots of really goodtechniques out there.
I want.
Make some changes to theirpractice, want to go away and
take on more complex cases, orbuild their practice or, or make
(24:56):
the swap or make the change.
That's what I would like tohappen because, you know, and,
and feel that they've got thiscommunity of surgeons which they
can then rely on and, and, andcontinue to network with us as
time goes forward.
Um, and then we can take alittle bit more of a piece of
what's going on in, in UKarthroplasty and, you know, have
a bigger voice in the, in theinternational community when it.
Joseph M. Schwab (25:19):
Are there plans for a second EAHM or
possibly a a UK a HM?
Jonathan Hutt (25:25):
So I, I would love for this to continue.
Um, I think that's all of ourplans.
You know, we were provisionallysaying, we'll do it, we'll do it
in London this year.
We'll go to Europe, uh, for thenext one.
So, you know, I see this as thefirst of many and hopefully
maybe a collaboration with theAHF.
Joseph M. Schwab (25:41):
Well, we're, we're looking forward, uh, on
behalf of the AHF leadership tobe part of the EAHM this year
and, and seeing what you puttogether, we know partnership
across the world makeseverything grow stronger and
faster.
So, um, Jonathan, it's beenreally a pleasure to talk with
you today and to hear yourperspective and, um, I look
forward to seeing what you'reable to put together in London
(26:03):
this summer.
Jonathan Hutt (26:04):
Yeah, thanks.
Joseph M. Schwab (26:07):
Yes.
Sounds good.
Thank you.
Thank you for joining me forthis episode of the AHF podcast,
and thank you to our guest, Mr.
Jonathan Hut.
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an idea for a topic or anyfeedback you like in the
comments below.
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.
(26:49):
New episodes of the AHF Podcastcome out on Fridays.
I'm your host, Joe Schwab,asking you to help keep those
hips happy and healthy.
Hello everyone and welcome to the AHF Podcast.
I'm your host, Joe Schwab.
My guest today is Mr.
Jonathan Hutt, a consultantorthopedic surgeon, specializing
in hip disease at the London HipUnit.
He specializes in hipreconstruction as well as
preservation, having trained inplaces like Montreal, as well as
(00:58):
in the uk.
He is one of the few surgeons inthe UK who openly admits to
performing anterior approachtotal hip replacement, and his
passion for comprehensive hipcare has landed him on the
organizing committee of the veryfirst European anterior hip
meeting.
Jonathan, welcome to the AHFpodcast.
Jonathan Hutt (01:20):
So.
Joseph M. Schwab (01:22):
So let's start by having you take us back a
little bit to what first sparkedyour interest in orthopedics and
maybe even more specifically hipsurgery.
Jonathan Hutt (01:34):
That's taken me back a little while actually.
Um, well actually, when I, whenI was a surgical trainee, um, as
you know, in the uk we don'tspecialize first up straight
outta med school, so we do sortof a lot of surgical
specialties.
So at that point, I was actuallyconsidering plastic
reconstructive surgery as anoption.
Um, and as part of my rotation,I, I did a six month.
(01:54):
Post, and it was actually duringthat post, I realized I, I've
been heading down the wrongtrack and so I made a, a hand
brake turn, changed all myplans, ditched everything I've
got, and, uh, headed straightto, I haven't really looked back
since.
Actually, it's definitely thebest decision I.
Um, I then, as a result of that,did another hip, uh, surgery
job, uh, shortly after that.
(02:15):
And, uh, it was with a, um, aconsultant, uh, called Mark
Banks, who's a hip preservationsurgeon in London.
Uh, and that really kind of gotme, uh, going down the hip track
quite early on in my orthopedictraining.
And I, and I sort of neverreally deviated from that.
I've always found, uh, the hipboth from a sort of preservation
and a reconstruction one.
(02:36):
In the body and I've always kindof, you know, focused my sort of
ladder training and fellowship,uh, all around that.
Uh, which has sort of landed me,um, in the place I'm at now,
which is great.
I have a sort of half and halfpractice of preservation and,
uh, and replacement essentially.
Joseph M. Schwab (02:51):
And is it, is it roughly about 50 50 or do you
do, uh, more preservation than,uh, reconstruction or the other
way around?
Jonathan Hutt (02:59):
Oh, it varies a bit, but I would say probably
hits about 50 50 these days.
Joseph M. Schwab (03:04):
And who were your preservation, mentors
Jonathan Hutt (03:07):
yeah, so.
The, the guy who trained me, um,I, he did get a lot, a lot of
exposure to preservationactually, at that point.
He was, um, you know, we weresort of talking late 2010s,
sorry, mid 2010s I guess.
And, you know, there wasn't thatmany people in and around, uh,
London or even UK doing, uh,high volume hit preservation
work.
So, um, I would certainly saythat he was the one who.
(03:33):
George's hospital in SouthLondon, and, and I moved after a
few years to where I'm from mymain NHS post now, which is, uh,
university College London, uh,hospital, which is, uh, you
know, in central North London.
Um, and there I've worked withanother, uh, sort of very well
known, uh, colleague of mine,Johan Witt, who, um, is a very
well known hip preservationspecialist, as well as another,
uh, fan of anterior hip surgery.
Joseph M. Schwab (03:56):
Uh, and what keeps you, uh, you're focused on
hip preservation, you're heavilyfocused on hip preservation.
What keeps you passionate aboutthat?
Or what, what do you findinteresting about that area?
Jonathan Hutt (04:07):
Well, it's, um, I mean it's, it's very different,
um, in terms of the sort ofpatients you might see.
So, I mean, I'll treat anyoneprobably from about age 12.
I don't really do pediatricsurgery, but I'll do surgery on
adolescence.
Um, and I think it's just.
To, to, to the job.
Um, you know, there's somethinga bit different and technically
challenging about hippreservation surgery.
(04:28):
You know, I do a lot ofosteotomy as well as, uh,
arthroscopy and I find thatvariation, uh, in my sort of,
you know, surgical life, sort ofvery interesting and very, sort
of keeps me enthusiastic.
Joseph M. Schwab (04:41):
And, uh, do you find, um, sort of the
difference in age range, youknow, the d the different aged
patients that you see?
Does that make it.
Difficult.
Does that make it moreinteresting?
Does that make it, um, uh, doyou have to be on your toes with
different areas of the, uh,literature in order to feel like
you're doing that well?
How, how does that affect yourpractice?
Jonathan Hutt (05:02):
Yeah, I, I think that's true.
I mean, I think it, it, it feelsin some ways, like it's two
slightly separate things, butactually in many ways it's
continuation.
Um, whatever's coming throughthe door from the perspective of
what you can achieve for thatpatient.
And it's, if you've got thatrange of tools, uh, at your
disposal, then it helps you kindof, um, you know, you don't feel
like you're trying to shoehornone technique in when another
(05:23):
one would be perhaps moreappropriate.
And that, I find is quitehelpful.
And, you know, the age thing isinteresting.
I think it, I.
You know, different cohorts ofsociety in different ways.
Um, you know, my patients rangequite wildly.
Even my hip replacement patientsrange from.
Joseph M. Schwab (05:43):
Yeah.
And so speaking of hipreplacements, so this June, um,
you are helping lead theEuropean anterior hip meeting,
uh, which takes place in Londonand seems to be.
A rather significant milestonefor the European community in
terms of embracing anteriorapproach.
Um, how did you become part ofthat platform?
(06:04):
What drove you to be interestedin, in that platform?
Jonathan Hutt (06:08):
Yeah, I think it's, you know, so I've been
doing the anterior approach fora while now.
Um, in the UK there really isn'tan awful lot of it going on.
Uh, and there hasn't been,there's been, you know, a few
people who've been very positiveabout it, but it's never really
gained an awful lot of.
Traction.
Um, certainly when I started itwas still, you know, relatively
infrequent to come across otherpeople doing it.
(06:29):
I would say I think we're at abit of a zeitgeist moment now in
the uk.
Um, and there's a lot of reasonsfor that.
You know, if you go around, if Italk to my trainees and
particularly the people who arecoming up for fellowship, if I
go around the country atconferences and courses and I
chat to the junior consultants,enthusiasm.
(06:52):
You know, as UK surgeons, weoften travel to the us, to
Canada, to Australia, uh, forour fellowship training, um, you
know, even to Europe as well.
Um, and therefore people arepicking up these techniques and
wanting to come back and, uh,and use them.
So, um, you know, it's aninteresting thing because of
course in Europe it's, it's nota new thing at all.
I mean, it's been wellestablished for forever, really
(07:13):
and quite interesting when.
Novel technique in manyrespects.
And, uh, you know, I think thesurgical community in the UK has
not really come round to it in,in a hugely enthusiastic manner
as a, as a large body.
But I think there is now asignificant portion of people
who have seen it done well andare really interested in kind
(07:34):
of, you know, continuing it intheir practice.
Um, so actually when I wasthinking about.
The sort of meeting I wanted torun, I, I was thinking, well,
what I would love to do is kindof, um, you know, get, get the
sort of UK on side and showthem, you know, what the
anterior approach is all about.
Try and infuse everyone aboutit.
You know, try and get some, somefurther traction really in, in,
(07:55):
in the community here.
But then, you know, I waschatting with Richard about it.
And his idea was a, a muchbroader and, and better one, as
it often is.
And he said, well, you know,let's run it as a European
meeting.
And then of course you, you canbring on all the, you know, the
great European guys and, and,and the rest of the crew that
we've got organizing it.
And I think that's gonna, youknow, really hopefully cement,
uh, a really good meeting thissummer.
Joseph M. Schwab (08:18):
Uh, coming from the perspective of the
Anterior Hip Foundation, it, itlooks to me looking at the
outline of the program, thatthere are some aspects that are
very, um, similar to what we'vedone through the AHF.
Do you feel that was, um, wasthat a deliberate approach to
the meeting?
Was that accidental?
Does it just turn out that greatminds think alike and so do
ours?
(08:38):
H how did that, uh, what do,what's your perspective on that?
I.
Jonathan Hutt (08:42):
Um, well, I mean, there's.
You know, the model of themeeting that the AHF has set up
is a really good one.
And I think it was almostinevitable that we were gonna,
you know, look at that and seehow, uh, we could do something
along similar lines.
I mean, in many respects, Isuppose you're gonna think very
similarly, but I think there's,there, there's little things
about how you run the meetingout there that are quite
(09:04):
appealing.
So obviously there's the, youwould expect most meetings to
bit.
Bringing along the sort of DAAsurgery along with the
technology and the innovationand, and the disruption and all
the rest of it, that, that Ithink gives it that little bit
extra.
And I think that's part of whatthe has done so well that we
(09:25):
would like to introduce into ourmeeting as well, because I think
it creates a very different andmore enthusiastic environment.
Joseph M. Schwab (09:32):
Yeah.
And as a matter of fact, youjust posted this morning on, uh,
on LinkedIn about yourexcitement, about the debate
about technology, whattechnologies really needed to do
this sort of, well.
Is the focus on innovation andtechnology within the space of
anterior hip surgery somethingthat was attractive to you?
Or, um, was that something thatwas a driving focus for this?
Jonathan Hutt (09:55):
I mean, I think it's, I, I'm, you know, a
surgeon.
I'm very enthusiastic abouttechnology and I, I, the future
of our, our specialty.
I, I don't see technology being,I see it.
Refined and, um, you know,obviously working in tandem with
technology, certainly for mycareer and going forward.
I think there's a lot of reallyinteresting things happening in
(10:16):
that, in that space.
And, you know, my practice, I, Iuse a fair amount of technology.
Um, I don't expect that tochange, you know.
I'm quite enthusiastic about thebenefits, not only for, you
know, my operations, but alsofor when I'm talking to people
at the start of practice andthey're looking to kind of, you
know, get into their groovewithout having any problems,
without having any difficulties.
(10:37):
And it's, and I think it'sreally good for training.
I think it's really good fornarrowing your bandwidth.
While you are really getting togrips with something, you know,
when you are experienced and.
Joseph M. Schwab (10:55):
So I think it's exciting.
It, you know, from myperspective, to see anterior
approach taking a bit centerstage, especially in, in London,
right in the heart of the uk.
Um, but as you pointed out,adoption in in the UK has not
always been easy.
Um, do you.
Uh, what are some of the biggestmyths that you encounter or
(11:18):
hesitations that you hear fromfellow surgeons in the uk and
how do you address it?
Jonathan Hutt (11:25):
So yeah, stories when I Canada one destinations.
Um, and I, I in fact, um, turneddown the opportunity to go and
do Paul Vallas fellowship, and Idid that on the basis that I
decided I didn't want to learnanterior hip surgery.
Uh, because at the time that wasmy perception being trained in
(11:48):
the uk that it was, I, I can't,probably can't even really
remember exact thoughts aboutit, but there's certainly an
element to where it was seen asa sort of passing trend.
Um, perhaps quite a bit ofsomething, a little bit niche.
The environment in which you'retrained.
If there is a very consistentenvironment in which you're
(12:09):
trained, and the UK is a veryconsistent place in many
respects, particularly when itcomes to approach, then that's
often where you come to by theend.
And if you're not exposed tothese things in training, it's a
very different experience tryingto get into the mid practice and
you know, because we've now.
Awareness of the anteriorapproach and what it can do.
(12:31):
So I think, going back to yourquestion, you know, the sort of
things that I, I think peopledon't often necessarily say
outright, but are rethinkingwhen they're talking to you
about it, is they say, you know,it, it's a marketing trend.
Um, it's, you know, it's just afad.
It doesn't really add anything.
Um, you know, the, what's thebenefits and also look.
(12:55):
Um, you know, and the truth isthat the data is now there to
support the fact that thosestatements really aren't true.
You know, we know that thereare, you know, benefits to the
approach.
Um, we know what they are.
Um, we also know that there's nodetriment.
And I, I often say my argumentto them is not, I'm not trying
to tell everybody that youshould go anterior'cause it's
way better if you're a goodposterior surgeon.
(13:15):
I don't think that's a reallyterribly valid argument, but I'm
saying that if I can dosomething and I can see the
benefits from my patients.
I'm doing any downsides ineither the.
Joseph M. Schwab (13:33):
So it's one thing to talk to your fellow
surgeons who are in practice, ormaybe even your senior surgeons
who have questions or uh,concerns.
Um, it's another thing to be amentor and a teacher to the
younger surgeons who are intraining.
How do you approach the nextgeneration of surgeons who wanna
explore, we'll say anteriorapproach?
(13:55):
Uh, total hip replacements orhip preservation?
Jonathan Hutt (13:59):
Um, yeah, so I think it's, um, in some ways
it's probably easier, uh, nowthan it was when I was training.
I mean, I'm not, I'm not thatold, but, you know, I think that
it is possible now to map outfor someone how they might
approach their final years inpractice if they're wanting to
specialize in a particulartechnique.
Um, and you know, if we, if wetake the anterior approaches as
(14:20):
a good example, you know, I'vegot colleagues, uh, sorry,
colleagues of fellows really andsenior residents as we now call
'em as well, who are interestedin the technique and they'll
come and spend time with, youknow, me or another surgeon in
the UK who does the technique.
That's the sort of startingpoint.
They can get a feel for it andsee if that's what they wanna
do.
And now there's lots build on.
(14:42):
Fellowship training in it.
I, you know, having not had thatmyself, I can definitely attest
to the fact that that will makeyour transition and your
adoption of the new surgicaltechnique so much easier than if
you try and just pick it up inpractice.
Um, and they'll see there'sloads of great courses, there's
loads of great conferences.
You know, there's a whole worldyou can immerse yourself in now
where people are really happyand willing to share their
(15:02):
expertise, uh, and theirexperience with you.
And I think that practice.
That's particularly unusual, uh,or that they don't have enough
experience to take onindependently.
Um, I do try and say to them,you know, if they can find
people to work with who aredoing it already.
I found that immensely helpfulwhen I, when I was really, I
(15:24):
mean, um, Richard was one of thefirst people who introduced me
to the approach, but I was inthe process of moving hospitals
at the time.
So we did a handful of cases,uh, together.
Um, but when I moved to UCH andI had Johan there pretty much in
the next theater team, me doingthe approach as well, that's
very reassuring.
It means I've got a little bitof cover and I've given a
similar amount to my juniorcolleagues as well who come and
(15:46):
work in at once to start theapproach as well.
So I think that sort of ongoingmentorship and practice is
extremely helpful, whatever yourspecialty.
Uh, but certainly in the worldof, um, you know, anterior hips
and, and particularly in hippreservation is something we.
Joseph M. Schwab (16:01):
You mentioned with learners in the UK it's
quite common for them to go dofellowships abroad, whether it's
in the us, whether it's inCanada, whether it's in Europe.
Um, certainly not to, um, aaddress this politically, but
looking at how Brexit may or maynot have changed the educational
opportunities for the uk, hasthere been any effect that
you've seen?
(16:21):
I.
Jonathan Hutt (16:22):
Um, I don't think from that perspective, no.
Um, you know, the, thefellowship kind of model was, is
quite well established.
Um, and I, I don't think itseems to have affected many
people's choices.
I think that there are a portionof people who will be, you know,
do want to and do go to Europefor their fellowships there.
I have to say, you know, as, asBritish people, the language
(16:43):
bar.
Well enough to reallycommunicate properly in two
different languages and makeourselves useful, uh, as a ve
and I think that's part of thereason why we gravitate to
places like Australia and, and,and Canada and US if you have
the time and inclination to do,of course.
But that's often a bit of a bigburden as you the end of
(17:04):
orthopedic training if youhaven't done it.
Joseph M. Schwab (17:07):
Yeah.
Yeah, for sure.
Um, I'm, I'm curious, is there acase that you can think of,
whether it's anterior approachor whether it's hip
preservation?
Um, can you share a case thathas really stayed with you, that
made a particular impression onyou, or something that reminds
you of the importance of what itis that you do?
Jonathan Hutt (17:30):
Oh, that's quite a deep question.
Um, um, yeah, I guess, um.
I think, I think the ones that Ifind quite affecting are, are,
are sort of the adolescentpatients that I get that, I
mean, I would give you two sidesto that.
I have adolescent patients whohave preservation surgery, so if
(17:53):
you do preservation surgery inPeros osteotomy in particular on
young patients, 15, 16, that isan amazing operation.
You know, they heal so, soquickly and they just get back
to stuff and.
It's super rewarding to see.
Um, and you know, a similar, ina similar manner, some of the
(18:15):
patients I get who are sent tome for possible preservation
surgery and they're in theadolescence and they've got, you
know, variety of different sortof problems going on.
But really there's no salvageoperation that's possible and
short of joint replacement, it'sreally, um, rewarding to take
(18:35):
replacement in.
Whereas actually, you know, ourexperience of it is, is
reasonable and, and you know,provided you choose well and
wisely and do the operationwell, they do extremely well.
And you know, you can reach thepoint where, you know, I had a
very young girl came to meprobably about 18 months, two
years ago now.
Um, and she was at the pointwhere she was basically going to
(18:56):
school in a wheelchair.
They'd been setting uporthopedic beds at home.
You know, she loads of care,loads of time off school and all
the rest of it.
And you know, we took themthrough the, the kind of the
problem that she had, which wasa complex kind of, uh,
congenital sort of deformityissue.
She had a hip replacement sixweeks later she was walking
normally.
And, you know, that was reallysomething to see, you know,
(19:18):
just, you know, from our ownpersonal outcomes, but also from
the family and, and howdifferent their life is now.
You know, that that's been superrewarding and.
Joseph M. Schwab (19:29):
Let's, let's talk a just a little bit about
your, your setup for how you doan anterior approach.
'cause obviously there's table,there's orthopedic table,
there's standard table, there'snavigation, there's fluoroscopy,
there's all sorts of technologythat can be used.
Can you give us a sense of whatyou're using?
Um, and for instance, in thiscase that you just mentioned,
(19:49):
would you be doing anythingdifferent in an adolescent who's
gonna be undergoing that?
Jonathan Hutt (19:55):
Yeah.
So, um, where I am now isproduct of going through a lot
of the things you've mentioned.
So, you know, I.
My first few cases doing a tablebased, uh, extension of based
approach, um, I didn't reallyget on with it very well.
I found that the jump from beingessentially freehand posterior,
which is what I was before, tobeing very sort of tied up in
(20:17):
the, in the mechanics of thetable, that felt like too big a
jump for me.
So, um, and that was thetechnique that I'd done a bit
with Richard, but I then tovisit Christoph in Belgium.
Um, release.
I decided that was, that was theway for me.
So I, I pretty much modeled mytechnique on, on the things that
(20:38):
I learned from him that day.
Um, I now do it sort of onstandard operating table, uh,
without any extra bits andpieces.
Probably two and a half, maybein three years of, of, of my D
approach.
I had inoperative fluoroscopy.
Um, I used that initiallybecause I had no other sort of,
uh, check and I really wanted tomake sure I didn't make any
(20:58):
mistakes.
You know, one of the thingsabout doing the approach in the
UK is people are waiting for youto make some mistakes, so I
wanted to give them noopportunities that weren't, you
know, unavoidable, wean myselfoff Fluor.
You know, it's, it's, it's a bitof an inconvenience.
Um, there's a lot of faffingaround involved in it.
Um, and also there, I really, Iwear lead for lots of
(21:20):
operations.
I really wanted to get outta thelead.
So I, I've now transitioned to,um, a simple navigation system.
So, uh, it's a sort ofcombination for me of anatomical
stuff and, uh, a fairlysimplistic optical navigation
system.
And.
Radiology free for about a yearnow.
(21:42):
Um, there are probably somecases where I might consider
bringing it in, um, if I've got,you know, maybe complex femoral
deformity or, you know, verystrange acetabular deformity.
And, you know, as I wastransitioning over in my
practice, I would, I didn't goall in from the start with the
cases that I would take on foranterior surgery and it before
I.
(22:04):
So reserve right fact, have tobe as precise as you possibly
can in a way that doesn'tdisrupt.
Workflow too much in a way thatdoesn't bring in too much cost
in a way that that works foryou, then that's, that's always
(22:26):
been my aim.
So that's kind of why I've stuckwith the, with having something
in the form of the navigation.
And I still will sort ofprobably keep the image
intensifier on the, on the backshelf for occasional, but I
haven't yet done that in myrebirth as a II based surgeon.
Joseph M. Schwab (22:41):
So you, you described some change to your
technique over the past fewyears.
If you were to look ahead andproject forward maybe five or 10
years.
Years.
Are there innovations that yousee or technologies that you
would want to see that youbelieve may transform what you
do in hip surgery, whether it'sreconstruction or preservation?
Jonathan Hutt (23:03):
I mean, certainly in the preservation world,
there's a, there's a hugeopportunity te.
Know, we take a complex threedimensional problem and then we
try and solve it.
Having planned it in 3D in ourheads and on, you knows, and
dimensional imaging inoperating, I've always.
(23:27):
So, uh, and that is coming and,you know, there are a few things
that on the market or coming tomarket or certainly in people's
minds, that, that I think we'regonna see some very interesting
technology, particularly from anosteotomy perspective, you know,
in the coming years.
Um, the problem I suppose isthat there isn't quite the
industry funding and interestbehind it because unlike hip
replacements, you're not sellingan awful lot, you know, three
(23:49):
screw for an industry partner.
So, you know.
It is more difficult, I think,to infuse the industry to join
us on that particular journey.
Uh, but I would say that as aspace, that that is the space
that probably has more coming toit of interest soon than maybe
joint replacement, where there'squite a lot happening all the
(24:10):
time and, you know, a lot ofinteresting things on and off
the market.
Um, and we're probably makingquicker strides towards, you
know, interesting technology inthat space.
Uh.
Joseph M. Schwab (24:22):
What do you hope people walk away from the
European anterior hip meeting,having experienced, having
learned after attending it?
What do you want them to walkaway with?
Jonathan Hutt (24:35):
So I think I, what I want from the meeting is
I, I want people to come, I wantto, you know, they can be
already doing the approach.
They could be thinking aboutstarting.
I want come by it to recognizethat it's pretty established.
There's lots of really goodtechniques out there.
I want.
Make some changes to theirpractice, want to go away and
take on more complex cases, orbuild their practice or, or make
(24:56):
the swap or make the change.
That's what I would like tohappen because, you know, and,
and feel that they've got thiscommunity of surgeons which they
can then rely on and, and, andcontinue to network with us as
time goes forward.
Um, and then we can take alittle bit more of a piece of
what's going on in, in UKarthroplasty and, you know, have
a bigger voice in the, in theinternational community when it.
Joseph M. Schwab (25:19):
Are there plans for a second EAHM or
possibly a a UK a HM?
Jonathan Hutt (25:25):
So I, I would love for this to continue.
Um, I think that's all of ourplans.
You know, we were provisionallysaying, we'll do it, we'll do it
in London this year.
We'll go to Europe, uh, for thenext one.
So, you know, I see this as thefirst of many and hopefully
maybe a collaboration with theAHF.
Joseph M. Schwab (25:41):
Well, we're, we're looking forward, uh, on
behalf of the AHF leadership tobe part of the EAHM this year
and, and seeing what you puttogether, we know partnership
across the world makeseverything grow stronger and
faster.
So, um, Jonathan, it's beenreally a pleasure to talk with
you today and to hear yourperspective and, um, I look
forward to seeing what you'reable to put together in London
(26:03):
this summer.
Jonathan Hutt (26:04):
Yeah, thanks.
Joseph M. Schwab (26:07):
Yes.
Sounds good.
Thank you.
Thank you for joining me forthis episode of the AHF podcast,
and thank you to our guest, Mr.
Jonathan Hut.
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comments below.
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.
(26:49):
New episodes of the AHF Podcastcome out on Fridays.
I'm your host, Joe Schwab,asking you to help keep those
hips happy and healthy.
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