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.

In this mini series, of episodes, I’ve been exploring the lived experience of hip dysplasia, not just the science, but what it actually feels like to live with this condition.

Today’s guest is Samantha “Sammy” Krathen, one of the founders of a community called 

The Hipsters: the-hipsters.com

Sammy brings a perspective we don’t hear often enough in medicine, the voice of a teenager navigating hip dysplasia while still figuring out who she is, what matters to her, and what life should look like.

For Sammy, this journey isn’t only about doctors’ visits or recovery from surgery. It’s about being a high school student, going to summer camp, building friendships, and forming an identity while dealing with something that many people around her can’t see or fully understand.

That perspective matters. For other young people going through the same experience, it can be reassuring to hear that they’re not alone. And for clinicians, it’s a reminder that behind every diagnosis is a person whose life continues far beyond the clinic or the operating room.

This episode is part of a Patient Leadership Series, where I highlight the voices of individuals who have lived with hip dysplasia and chosen to turn that experience into action.

Today I’m speaking with Gemma Barber from the United Kingdom. Gemma has lived with developmental dysplasia of the hip and has become a powerful advocate within the UK community. Through her advocacy work and her recent Springtime fundraising ball in the Wirral, near Liverpool, supporting hip dysplasia awareness, she has helped build support networks for families navigating diagnosis, treatment, and long-term uncertainty.

In this conversation, we talk about what it means to grow up with hip dysplasia, how different healthcare systems shape the patient experience, and why peer support remains essential even in countries with universal healthcare. It is a discussion about resilience, community, and the importance of making sure no family feels alone when they hear the words hip dysplasia.

This is a special video episode of the podcast meant as a public service announcement to help parents understand what matters for baby hips!

On this podcast, I've explore developmental dysplasia of the hip from every angle: the science, the evolution of treatment, the lived experience, and how patients and families make sense of a diagnosis that can follow them across decades.

Today’s episode is a wide-ranging conversation with Betsy Miller, author of The Parents’ Guide to Hip Dysplasia, (https://betsymillerbooks.weebly.com), a book she published nearly twenty years ago, around the same time the International Hip Dysplasia Institute was founded. Betsy wrote that book not as a physician, but as someone who had been treated for hip dysplasia as an infant and later realized how little practical, accessible information existed for parents facing a brace, a cast, or surgery. With a background in technical writing, she set out to create the resource she wished had existed.

Although she did well for many years, she was later told she had residual dysplasia, something that came as a surprise. We discuss how hip dysplasia can remain silent for decades, why some people do not realize they have it, and how the field of hip preservation emerged in response to these late presentations.

We also talk about how people get their information in 2026, whether books still matter, the challenges of nonprofit education, and what happens when hip preservation is no longer enough. Betsy ultimately underwent bilateral hip replacements and is now writing a new book, Hip Replacement at Any Age, aimed at younger patients who often feel alone in a space dominated by older adults.

It is a thoughtful conversation about information, identity, and how a diagnosis in infancy can echo throughout a lifetime.

Today I’m joined by Maurizio De Pellegrin from Parma, Italy, and we’re going to do something I enjoy: highlight a set of practical contributions, then stress-test what the data really support. 

We start with a question parents ask all the time—often more urgently than they ask about the hip itself: Will treatment delay my child’s milestones? De Pellegrin’s recent work examines walking age and motor development in severe DDH, and it helps us speak to families with greater precision about timing, severity, and what happens when treatment begins early.

From there, we tackle a classic piece of folk remedy: double diapering. It’s common advice, it sounds plausible, and it persists. We’ll review what happens when you actually measure hip position with and without it, and what that should mean for pediatric counseling.

Then we shift to ultrasound biology, what the labrum looks like, and how it changes in dysplastic and dislocated hips during stabilization. I’m especially interested in echogenicity: whether it’s a risk marker, a response marker, or both.

Finally, we’ll go beyond typical DDH and discuss hip ultrasound in Hurler syndrome (MPS I) after hematopoietic stem cell gene therapy, what ultrasound can still tell us when anatomy is atypical, and what the next outcome questions should be.

Today’s guest is Dr. Thomas Youm from NYU Langone Health a high-volume hip arthroscopist.

The focus of the conversation is a niche but common clinical scenario: femoroacetabular impingement syndrome in the setting of borderline hip dysplasia—typically defined by a lateral center-edge angle between 20 and 25 degrees.

We use several recent papers from Dr. Youm’s group as the starting point, but the discussion stays practical: when a hip lives near that borderline zone, where undercoverage and potential instability may coexist with impingement morphology, who truly benefits from arthroscopy, who should be screened out, and what long-term outcome studies can—and cannot—claim.

We talk about definitions that drive everything: how “borderline dysplasia” is operationalized beyond a single angle, how FAIS is defined and selected for surgery, and how labral and capsular management can shift a hip toward stability or toward symptoms.

We talk about imaging as decision-making, not just documentation: what plain radiographs miss, how MRI can (and should) classify the labrum and cartilage more meaningfully, when CT adds value for combined femoral and acetabular version, and how those parameters change counseling and surgical indications.

We talk about dynamic assessment—especially the role of ultrasound to evaluate motion-dependent instability in select patients—and how that complements static imaging when the story and exam do not match the radiographs.

We also spend time on endpoints. We talk about what “survivorship” means when studies use revision arthroscopy and conversion to total hip arthroplasty, and how that aligns—or fails to align—with the outcomes that matter most to patients: pain, function, athletic participation, and the possibility that some hips may later need a reorientation procedure rather than another arthroscopic intervention.

This 50th-episode recap of Straight from the Hip brings together some of the most important themes we’ve covered over the past block of conversations: how we share knowledge, how we generate and question evidence, and how we safely push the field forward. I revisit episodes with Nick Fletcher on podcasting as a serious medium for medical education; Simon Thomas and Emily Dodwell on long-term outcomes, fragile statistics, and what that means for counseling families; Perry and Jon Schoenecker on the tension and harmony between clinical experience and basic science; and Valerie Parrish on what IHDI 2.0 is actually doing for real babies and families right now. We then move into innovation and leadership with Dror Paley, Michael Vitale, and Dan Sucato, touching on moral ambition, safety culture, robotics, FHRO, and the real value (and limits) of rankings. It’s a chance to zoom out, connect the dots, and respond to some of your questions about where hip preservation is going next.

Today I’m joined by Dan Sucato, Chief of Staff at Texas Scottish Rite for Children, an institution that currently sits at the top of the U.S. News & World Report rankings for pediatric orthopedics.

We start with Perthes, specifically, one of the most complex reconstructions we have for the post-Perthes deformity: femoral head reduction osteotomy. Dr. Sucato is one of the few surgeons worldwide to have published on this procedure. I was able to pick his brain about when he considers it, how he executes it, whether it can realistically be taught, and how to think about adolescents and young adults with painful, misshapen femoral heads who are still “too young” for arthroplasty. We dig into what problem FHRO is really trying to solve, how he selects patients, what he tells families about risk and recovery, and where he draws the line between attempting salvage and accepting that a hip is no longer reconstructable.

From there, we shift into leadership. I asked him what it actually means to lead a program that everyone else sees as “number one”: what metrics he trusts more than USNWR, how he balances volume, access, and complexity, and how he protects trainees and staff from chasing rankings instead of chasing better care. We talk about culture, humility, and how to build a place where people can speak up, disagree, and still move in the same direction.

It was a grounded, honest conversation about hard hips and real leadership.