This week, I have a conversation with Rafael Sierra, MD, an orthopedic surgeon at the Mayo Clinic in Rochester, Minnesota, who has focused his career on hip preservation as well as hip replacement with a strong focus on hip dysplasia and femoroacetabular impingement.

This week's episode is a little longer than typical because we had a lot to discuss.

We centered the conversation on three papers he termed the Trident, the first defining the Natural History of osteoarthritis in patients with hip dysplasia and impingement.

Then, a paper that discusses how the natural history can be favorably altered by performing a periacetabular osteotomy, and finally, we talk about a paper that describes how to obtain optimal outcomes when performing this procedure

We talk about the spectrum of abnormalities that can affect hips, from a shallow acetabulum in dysplasia to over-coverage and impingement

We discuss the reasons why some hips become painful, and some don't, including genetics, metabolism, and level of activity.

We talk about the evolution of the periacetabular osteotomy since its inception and techniques to improve outcomes.

We discussed surgical variability and the level of expertise required for the performance of this procedure.

And we talk about the future, including robotics and individualized approaches to complex problems,