Straight From The Hip

Today I am joined by Daphne Sorensen, Chief Executive Officer of MiracleFeet. https://www.miraclefeet.org

Daphne is not an orthopedic surgeon, and that is precisely what makes this conversation so useful. Her background is in international development, child rights, and global health systems, and under her leadership MiracleFeet has expanded a model that now supports clubfoot care across dozens of countries.

Clubfoot is one of the clearest examples in pediatric musculoskeletal care of how a condition can be highly treatable and still cause lifelong disability when children are not identified, referred, or kept in care. MiracleFeet has helped turn the Ponseti method from a clinical treatment into a global delivery system, built around local providers, braces, family support, training, data, and follow-up.

For those of us working in hip dysplasia, the challenge is different but familiar. The diagnosis is less obvious, the pathway is less uniform, and the treatment depends on age, imaging, stability, and many other factors. But the larger question is the same: how do we build systems that find children early and connect them to effective care?

Our conversation ranges widely. We talk about global health, implementation, local clinical leadership, fundraising, data, and what makes a treatment scalable. We also talk about the culture around disability and deformity, including Frida Kahlo, whose own life and art remind us how deeply physical disability can shape identity, perception, and the way society looks at the body.

Most of all, this is a conversation about moving beyond knowing what works and asking the harder question: how do we make sure it actually reaches the child who needs it?

Today I am joined by Dr. Whitney Casares, a pediatrician, author, and founder of Modern Mommy Doc.

Whitney has built much of her work around a problem that every pediatric clinician recognizes: families are trying to make good decisions for their children while being exposed to an enormous amount of information, much of it conflicting, emotionally charged, or simply wrong.

Her new book, Raising Body-Confident Kids, (https://a.co/d/08KEtBsa) looks at how parents can help children develop a healthy relationship with food, movement, health, and their own bodies without making weight or appearance the center of the conversation.

That may sound slightly outside the usual territory of Straight from the Hip, but it is actually highly relevant to pediatric musculoskeletal care.

As orthopedic surgeons, pediatricians, and parents, we frequently have to talk with children about movement, pain, weight, physical activity, body image, and health. Those conversations can help children, but handled poorly, they can also create shame, fear, or avoidance.

So this episode is really about how we communicate.

We talk about how parents process medical information, how social media changes those conversations before a clinician ever enters the room, how we can address genuine health concerns without stigmatizing children, and what clinicians can do differently when discussing weight, activity, and musculoskeletal health.

It is a thoughtful conversation about evidence, language, and how we help families make better decisions without adding unnecessary anxiety.

Today I am joined by Min Kocher, one of the most accomplished academic pediatric orthopedic surgeons of his generation.

Min is Chief of the Division of Sports Medicine at Boston Children’s Hospital, holds the O’Donnell Family Endowed Chair, and is Professor of Orthopedic Surgery at Harvard Medical School. His career has combined clinical practice, research, mentorship, sports medicine, and national leadership in a way that very few people have managed to do.

Many listeners will know his name from the Kocher criteria, developed to help distinguish septic arthritis of the hip from transient synovitis in children. But that is only one part of a much broader career. He was also early in the development of pediatric sports medicine as a true specialty and in the use of hip arthroscopy in children and adolescents.

What interested me most about this conversation, though, was not one operation or one paper. It was the arc of Min’s career and what it tells us about how pediatric orthopedics has changed.

We talked about the move from experience-based medicine toward evidence and outcomes, how to use clinical rules without allowing them to replace judgment, what sports medicine taught pediatric orthopedics, and what pediatric orthopedics can still teach sports medicine. We also talked about academic careers, mentorship, leadership, institutional culture, and how your priorities change when the goal is no longer simply to build your own career, but to help build the careers of the people who come after you.

This is a conversation about evidence, judgment, leadership, and the long view of pediatric orthopedics.

On today’s episode, I speak with Ana Laura Arenas and Alejandro Dabaghi from Shriners Children’s Mexico. We discuss their recent paper published in Archives of Orthopaedic and Trauma Surgery, titled Protective Effect of Modified Lange “Second Position” for Developing Avascular Necrosis Following Closed Reduction for Developmental Dysplasia of the Hip.

This is an important topic because closed reduction remains one of the central treatments for infants with a dislocated hip, but one of its most feared complications is avascular necrosis, or what we increasingly think of as proximal femoral growth disturbance. The balance is delicate: we want the hip reduced and stable, but we also want to avoid positioning that compromises the blood supply to the femoral head.

Their study compares two immobilization strategies after closed reduction. One group remained in the traditional human position throughout casting, while the other transitioned to a modified Lange second position for the second cast. They reported a lower rate of avascular necrosis in the modified Lange group, with no significant difference in redislocation or residual dysplasia.

In our conversation, we go beyond the headline. We discuss what these positions actually mean, why eponyms can sometimes obscure the mechanics, and whether we should be speaking less about named positions and more about exact degrees of flexion, abduction, and rotation. We also talk about Robert Bruce Salter’s work, the vascular rationale behind the human position, the timing of vascular injury, and whether cast positioning may have a more cumulative effect than we sometimes assume.

This is a technical but very practical discussion about closed reduction, hip stability, femoral head perfusion, and how we interpret clinical studies that may influence practice

On this episode, my guest is Marie-Louise Goode, a midwife from the United Kingdom and author of The Modern Midwife’s Guide to Pregnancy, Birth and Beyond and The Modern Midwife’s Guide to the First Year. Both books share a clear and important message: early life works best when we understand physiology rather than fight against it. Pregnancy, birth, feeding, sleep, movement, and development all become less frightening when parents receive clear, practical, evidence-based guidance.

That idea connects directly to hip health. Hip dysplasia is a developmental condition, and the newborn hip is shaped not only by genetics and anatomy, but also by early positioning, swaddling, carrying, and how parents are taught to care for their babies.

In this conversation, Marie-Louise helps us understand what midwives do and the central role they play in pregnancy, birth, and the early postnatal period. We talk about why midwives are often overlooked in conversations about early detection and prevention, even though they are frequently among the first professionals to guide new parents.

We discuss pregnancy, birth, newborn development, baby carriers, swaddling, infant positioning, and how simple, calm education can help families support healthy hip development without creating unnecessary fear.

This was a thoughtful and very practical conversation about prevention, trust, and the enormous value of educating parents early, before problems are missed and before anxiety takes over.

In this special season recap of Straight From the Hip, I reflect on nine conversations that explored hip dysplasia from multiple perspectives: patients and families, psychology, clinical decision-making, trust, innovation, and the future of care.

Drawing on discussions with Betsy Miller, Gemma Barber, Sammy Krathen, Dr. Kelly Rabenstein, Dr. Maurizio De Pellegrin, Dr. Joel Warsh, Dr. Tom Youm, Dr. Manoj Ramachandran, and Dr. Jacob Jaremko, this episode examines the themes that connected the season and answers questions submitted by listeners.

Topics include the lifelong impact of hip dysplasia, parental anxiety and resilience, borderline dysplasia, shared decision-making, the role of innovation in orthopedics, and how artificial intelligence may transform screening and diagnosis in the years ahead.

From patient stories to system design, this episode explores a central idea that emerged throughout the season: hip dysplasia is not just an anatomical condition; it is a developmental condition that requires long-term thinking.

Whether you are a parent, patient, clinician, researcher, or advocate, this episode offers a chance to step back, connect the dots, and look ahead to the future of hip preservation and hip dysplasia care.

My guest today is Dr. Jacob Jaremko, and we are discussing a topic that may change how we diagnose developmental dysplasia of the hip around the world: artificial intelligence.

For decades, hip ultrasound has been central to early detection. Yet despite its value, it remains highly dependent on the person performing and reading the scan. Small differences in image acquisition, landmark identification, probe position, and measurement thresholds can lead to very different interpretations—and, ultimately, different treatment decisions.

But what if we could standardize that process?

Recent advances in artificial intelligence, machine learning, and three-dimensional ultrasound are challenging many of our assumptions about how hip dysplasia should be diagnosed. New multicenter studies suggest that AI-assisted ultrasound can approach expert-level diagnostic accuracy, improve reproducibility, and expand access to high-quality screening far beyond specialized centers.

In this episode, we discuss the latest evidence behind AI-assisted hip ultrasound, the role of 3D imaging, how these tools may reduce variability, and whether the future of DDH screening will focus less on measuring angles and more on predicting risk and guiding clinical decisions.

We also explore practical implementation: scan quality, handheld ultrasound, global screening programs, and the potential impact on patients and families worldwide.

Today’s episode is a conversation with Dr. Joel “Gator” Warsh — a pediatrician who has written extensively about trust, communication, and decision-making in modern pediatrics. He is the author of Between a Shot and a Hard Place, which explores the vaccine conversation through the lens of informed consent and respectful dialogue, and Parenting at Your Child’s Pace, which focuses on development, environment, and long-term health.

But this episode is not a vaccine debate. It is a conversation about something deeper: how pediatricians communicate uncertainty, how we balance prevention with overmedicalization, and how we think about conditions that begin early in life but may not manifest consequences until decades later.

Hip dysplasia is one of those conditions. It is developmental. It can be silent. And when missed, it can lead to arthritis in early adulthood. So the themes of trust, screening, parental agency, and long-horizon thinking are not abstract — they are deeply relevant to orthopedics.

In this discussion, we explore how pediatric medicine navigates nuance, how to talk to families about risk without coercion, and how early structural and environmental factors shape adult health. This is a conversation about development, transparency, and building healthier adults by thinking earlier.

Today’s episode is about innovation in orthopedics — where it works, where it fails, and how ideas actually move from theory into clinical practice.

My guest is Manoj Ramachandran, a pediatric orthopedic surgeon who has consistently positioned himself as an innovator operating at the intersection of surgery, technology, and systems design . Over the years, he has explored artificial intelligence in medicine, surgical innovation pathways, and the broader ecosystem that connects clinicians, engineers, startups, and hospitals.

We discuss where surgical innovation really comes from — whether it begins in the clinic, in industry, or in engineering labs — and why so many promising ideas never make it into day-to-day practice . We examine the tension between innovation and evidence, and whether innovation inevitably moves faster than validation . We talk about AI in orthopedics, separating hype from practical value, and ask where artificial intelligence will genuinely change musculoskeletal care in the next decade .

We also explore the role of the entrepreneurial physician — how surgeons can shape technology development, advisory work, and innovation platforms without losing clinical credibility. And we look ahead: what ideas seem unrealistic today but may become routine in the near future.

This was a transformative conversation because it challenges assumptions. It forces us to think critically about what innovation actually means, what problems remain unsolved in orthopedics, and how surgeons should engage with technology responsibly.

If you care about the future of musculoskeletal medicine, about artificial intelligence, about surgical innovation, and about how ideas become reality, this episode will push you to think differently.

This episode is part three of this mini-series dedicated to Patient Leadership. Today, we approach hip dysplasia from a different, essential perspective: behavioral health.

I’m lucky to be joined by Dr. Kelly Rabenstein, a Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina in Charleston. She is a licensed psychologist working in Bio-Behavioral Medicine, and our conversation explores the psychological dimensions of developmental hip dysplasia that are often present but rarely addressed directly.

We discuss parental anxiety at the time of diagnosis, the behavioral challenges surrounding treatment

 adherence in infancy, and the longer-term psychological impact on adolescents and young adults living with hip dysplasia. We talk about how uncertainty is processed, how medical language shapes perception, and how clinicians can communicate in ways that reduce fear while preserving clarity.

This episode is forward-looking. If hip dysplasia is a condition that can span decades, then behavioral health cannot be peripheral to care. It must be integrated from the beginning. I think you will find this discussion thoughtful, practical, and deeply relevant to both clinicians and families navigating this journey.