On this episode I have a candid conversation with: Dror Paley, the founder of the Paley Orthopedic & Spine Institute in Florida, the Paley European Institute in Poland, and the Paley Institute Middle East in Abu Dhabi. He’s a pioneer in deformity correction and one of the surgeons who introduced the Ilizarov method to North America. In hip surgery, he developed the SUPER Hip procedure, along with more than a hundred other techniques.

But this episode isn’t about applause. It’s about ambition, controversy, and what it means to innovate in a field that often resists disruption.

We talked about the cost of leadership: how innovation can be mistaken for ego, how financial success can attract criticism, and how doing what’s right isn’t always what’s expected.

We explored brand building, the moral imperative behind patient care, and the obligation to advance the field itself. We discussed the challenges of being a disruptor and the complicated path to peer recognition.

On the clinical side, we covered complex hip reconstructions including the SUPER Hip, femoral head reduction osteotomy, and the so-called “extreme PAO.”

I asked him some hard questions: Where’s the line between surgical creativity and overreach? What scares him more: stagnation or automation?

We also talked about the future of limb reconstruction, the promise of regenerative medicine, and the potential of integrating what’s increasingly referred to as “One Medicine.”

This was a wide-ranging conversation with someone who’s changed the field and taken a few hits for it. I hope you find it as provocative and inspiring as I did.

On today’s episode, I talk with Emily Dodwell of the Hospital for Special Surgery in New York. 

We begin discussing her background and how she views some of the known facts about hip dysplasia, such as risk factors and current best practices for non-operative treatment, leading into variation in screening strategies around the world.

We talk about a population-based study she published using data from New York state to determine the rate of surgery for hip dysplasia in infants and variations thereupon how this sheds light on the state of affairs in a highly developed region.

We discuss health economics and so-called “Parent-Derived Health State Utilities,” a useful tool to evaluate the burden of treatment for patients and parents of patients  with hip dysplasia.

Finally we discuss the fragility of our evidence base and a paper she coauthored looking at another measure called the fragility index which shows that the science may not be anywhere near strong enough for the decisions we make, ending on a philosophical discussion of what would it take structurally to improve the science from both a power and transparency standpoint, whether randomized control trials are truly feasible in surgery or prospective registries may be the best we will have for the foreseeable future.  

This week, I speak with Dave Bailey, the CEO of OrthoPediatrics, an American bioscience company based in Warsaw, Indiana, that designs, develops, manufactures, and distributes orthopedic implants and instruments for pediatric issues.

I invited Dave to discuss the intersection of industry and patient care. His vision talk at a recent event resonated with my mission to provide the best care to as many patients as possible.

We explore Dave's professional background and leadership journey, his vision for OrthoPediatrics, and the company's commitment to education and its vital role in the industry.

We delve into challenges like funding and competition, industry-research collaboration, and how surgeons can partner with industry to enhance patient care.

We also examine economic and operational considerations, balancing cost, quality, and accessibility. We also discuss a recent paper analyzing pediatric device innovation, highlighting the rarity of such advancements through the FDA process.

We conclude with a forward-looking vision of how innovations are improving patient outcomes.

On today’s episode, I talk with Simon Thomas, Consultant Paediatric Orthopaedic Surgeon at the Bristol Royal Hospital for Children. Trained in both the United Kingdom and Canada, including under the legacy of John Wedge and Robert Salter in Toronto, Simon offers a perspective shaped by two systems with different approaches to developmental dysplasia of the hip.

We begin by examining how training lineage and institutional norms influence clinical decisions, particularly concerning surgical timing, the use of the Pavlik method, and criteria for progression to open or closed reduction.

We discuss the landmark study he co-authored with Wedge and Salter, following patients for over 45 years after open reduction and innominate osteotomy, and what such long-term data can teach us about survival, revision, and functional outcomes.

We talk about the strength of the evidence in orthopedic surgery and the reasons for the demise of a prospective randomized control trial set up in the UK, looking at the presence or absence of the ossific nucleus when considering surgical treatment of developmental dislocation of the hip that could not be implemented due to logistics, and turn to his work on the medial approach and how to balance the risk of complications with surgical completeness.

Finally, we zoom out and reflect on the broader themes: what defines success in pediatric hip surgery, what a 50-year prospective study should look like, and whether certification diplomas should be widespread

This episode is a masterclass in long-term thinking, featuring a thoughtful surgeon who has witnessed hips transition from Pavlik harness to total hip replacement.

In this special recap episode, I revisit highlights from recent episodes of Straight from the Hip, covering topics including social media’s influence on patient narratives, burnout and work-life boundaries, and the evolving landscape of hip preservation.

I share insights from conversations with Joel Wells, Chris Iobst, and Ben Domb, respond to listener questions, and reflect on how centers of excellence and training in hip surgery should be defined.

The episode also touches on recent findings in infantile hip dysplasia from guests like Evelyn Kuong, Harry Kim, Shevaun Doyle, and Wesley Theunissen, emphasizing thoughtful, evidence-based care.

This week, I’m talking about simulation in healthcare and medical education. Whether in surgery, anesthesiology, or even hip dysplasia screening, simulation allows for repeated practice, error correction, and improved confidence—all without putting patients at risk.

To explore this, I’m joined by Rodrigo Rubio, professor of anesthesiology and director of the Center for Simulation at the American British Cowdray Hospital in Mexico City, and Carlos Vidal, an orthopedic surgeon leading an initiative to teach physicians how to perform ultrasound screening for hip dysplasia using a simulation model.

We begin with a unique perspective—how the principles of stage magic can enhance healthcare simulation. Just like a magician creates an illusion that captivates an audience, a well-designed simulation must immerse the learner in an experience that feels real. We discuss the principles that make this possible, from shaping perception and managing attention to leveraging cognitive biases to reinforce learning.

From there, we shift to the practical side of simulation in orthopedic education. Ultrasound screening for hip dysplasia is a critical skill, but traditionally, it has been challenging to teach due to limited patient exposure. Simulation provides a way to overcome this, allowing physicians to practice on phantom models before transitioning to real infants. We discuss how this method builds technical proficiency and removes the anxiety of making a mistake on a real patient.

Beyond ultrasound, we explore different types of simulation models, how they fit into medical training, and how we can apply concepts from aviation safety—like checklists, crisis management, and high-fidelity simulations—to improve surgical training. We also touch on the future of medical education, including virtual reality and augmented reality.

On today’s episode, I sit down with Wesley Theunissen, an orthopedic surgeon based at the Máxima Medical Center in Veldhoven, Netherlands. He recently published a compelling study on spontaneous recovery in stable dysplastic hips, challenging the traditional approach of immediate bracing.

Hip dysplasia management remains a controversial topic, particularly in mild cases. Some hips initially classified as dysplastic can normalize over time with natural development and adherence to hip-healthy practices. Theunissen and his team found that over 90% of Graf IIb hips improved spontaneously, raising important questions about the necessity of early intervention. We discuss the predictors of spontaneous resolution, both positive and negative, and what this means for clinical decision-making.

From there, we shift the conversation to the downsides of bracing, even for mild dysplasia, particularly its impact on parents and caregivers. Another of his studies provides quantitative insights into the parental experience, revealing the emotional and logistical burden that bracing can place on families. We explore how information overload and uncertainty can make the process overwhelming for parents.

We then turn to a third study, which focuses on strategies to improve information delivery for parents. His research highlights that young parents overwhelmingly prefer visually supported, personalized information, which can help reduce anxiety and improve adherence to treatment recommendations. However, we also acknowledge the challenges of implementing these strategies in overburdened healthcare systems.

Throughout our conversation, we touch on the logistics of running an infant hip clinic, the influence of surgeon bias, and the role of experience in guiding clinical decisions. 

On today’s episode, I’m joined by Dr. Evelyn Kuong, a consultant in the Department of Orthopedics and Traumatology and an Honorary Clinical Associate Professor at the University of Hong Kong.

We start by discussing her recent research on predicting residual dysplasia at skeletal maturity after closed reduction for developmental dislocation of the hip, identifying age-specific acetabular index cutoffs that can help guide decision-making when monitoring patients post-reduction.

From there, we dive into her work on establishing normative radiographic values for hip dysplasia in a pediatric Chinese population. Her findings reveal significant differences compared to Northern European reference values, highlighting the importance of region-specific data in diagnosis and treatment. We also explore the broader implications of these differences—considering not just genetics but also environmental and lifestyle factors, particularly in today’s increasingly globalized world.

We touch on the limitations of standard radiographs in assessing a complex, three-dimensional structure like the hip while recognizing their practicality as the most widely accessible imaging tool worldwide.

Finally, we wrap up with a discussion on spinal muscular atrophy and the impact of disease-modifying drugs like Nusinersen. Dr. Kuong’s research suggests that while these treatments improve certain functional outcomes, they haven’t addressed hip instability. With longer life expectancy and better function in these patients, there may be a case for a more proactive surgical approach—particularly in SMA type 2.

On today’s episode, I’m joined by Dr. Shevaun Doyle, a pediatric orthopedic surgeon from the Hospital for Special Surgery in Manhattan, New York. Dr. Doyle has an extensive practice focusing on both operative and nonoperative treatments for infantile hip dysplasia.

We dive into her recent paper on nerve palsy in children undergoing brace treatment for hip dysplasia. We discuss whether the term "palsy" is accurate, explore rare nerve issues that can arise, and unpack possible mechanisms behind these complications. While these nerve issues almost always resolve, they can complicate treatment of the underlying condition.

In a twist, Dr. Doyle flipped the script and interviewed me about my approach to managing failed Pavlik harness treatments and cases presenting at an older age. We talk about defining success after a closed reduction, counseling families on the spectrum of pathology, and the challenges of treating complex cases.

We also touch on another paper she co-authored, which examines health states as a measure used in value-based care.

This conversation reinforces that nonoperative treatment remains the gold standard for managing hip dysplasia.

In today's episode, I speak with Dr. Harry Kim from Texas Scottish Rite for Children about a condition that I have often said that  I love to think about but hate to treat:Legg-Calvé-Perthes, or juvenile osteochondritis of the proximal femoral epiphysis. This condition has intrigued and frustrated orthopedic surgeons for over a century due to its unpredictability.  

We begin by delving into Dr. Kim's groundbreaking research utilizing perfusion MRI to better characterize this enigmatic disease. Perfusion MRI offers new insights into the vascular dynamics of the femoral epiphysis, shedding light on the revascularization process that has remained poorly understood.  

Our conversation explores the feasibility of conducting such studies, including the logistical and technical challenges involved. We also discuss how emerging tools like artificial intelligence and machine learning could enhance the accuracy and efficiency of interpreting the vast amount of data generated by these imaging studies. 

Dr. Kim shares patterns identified in revascularization as it occurs within the epiphysis, and we examine the implications these findings may have for future treatment strategies. This leads to a thoughtful discussion of current treatment options, both surgical and non-surgical, and the subtle nuances that influence the decision-making process for each approach.  

We also reflect on the long-term outcomes for patients with Legg-Calvé-Perthes disease, considering the benefits and limitations of using social media platforms to identify and study a large cohort of patients with extended follow-up data. Social media offers unique opportunities to gather patient perspectives and outcomes over time, but it also presents challenges in data validation and representation.  

Throughout the episode, we touch on a variety of related topics, bringing valuable insights into the management and understanding of this complex condition.