This week, I speak with Raymond Liu, a pediatric orthopedic surgeon at University Hospitals, Rainbow Babies & Children’s Hospital, and the Victor M. Goldberg Endowed Chair in Orthopaedics. 

He is a world-renowned expert on complex hip pathology and has published extensive research focusing on sophisticated analysis of different osteological collections.

We begin by discussing slipped capital femoral epiphysis (SCFE) and its association with athletic activity, Challenging the notion that this condition is less frequent in children involved in athletic activities.

We then examine the similarities and, more importantly, the big differences between the so-called primary Cam morphology of the proximal femur and SCFE.

He explains a paper comparing similarities in the proximal femoral anatomy between 3 distinct historical populations: a Neolithic population from the Middle East, a medieval population from Eastern Europe, and a more recent aboriginal population from Australia.

We talk about the spinopelvic relationship and its relation to the development of Cam morphology.

We discuss the epiphyseal tubercle, which he has described elegantly and signaled its importance, the distinction between stable and unstable slips, and its relationship to the blood vessels that supply the femoral head.

We also consider his current and future research endeavors, amongst other things.

This week I talk with Ken Noonan, Professor of Orthopedic Surgery at the University of Wisconsin, in Madison, and the Editor-in-Chief of the Journal of the Pediatric Orthopedic Society of North America

We talk about understanding the landscape of medical publishing and how to measure productivity in publishing and research.

We discuss the role of Open-Access Publishing; its advantages and challenges, including maintaining quality control.

We exchange ideas about so-called predatory journals; how these can be defined, and how to identify them. We also discussed how all medical journals could be considered predatory.

We then focused on three pediatric hip conditions and discussed three papers looking at three different ways of analyzing the literature.

The first is a citation analysis on developmental dysplasia of the hip published in the journal of pediatric orthopedics B: 

Moscona L, Castañeda P, Masrouha K. Citation analysis of the highest-cited articles on developmental dysplasia of the hip. J Pediatr Orthop B. 2020 May;29(3):235-247. doi: 10.1097/BPB.0000000000000715. PMID: 31923135.

The second is a systematic review of patient level analysis on the treatment of stable slipped capital femoral epiphysis published in the Journal of Orthopedics and Traumatology which looks at information that is available to patients and families: 

Naseem H, Chatterji S, Tsang K, Hakimi M, Chytas A, Alshryda S. Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis. J Orthop Traumatol. 2017 Dec;18(4):379-394. doi: 10.1007/s10195-017-0469-4. Epub 2017 Aug 22. PMID: 28831651; PMCID: PMC5685987.

Finally, we discuss a paper on the global trends in research on Legg Calves Perthes, published in Frontiers in Pediatrics, an interesting journal with a very transparent and rigorous peer review model: 

Qin W, He M, Qin H, Wei Q, Yan H. Global trends in the research on Legg-Calve-Perthes disease in Web of Science. Front Pediatr. 2024 Mar 7;12:1335118. doi: 10.3389/fped.2024.1335118. PMID: 38516353; PMCID: PMC10954890.

We considered ethical and methodological concerns in publishing.

and we explore future directions and opportunities, amongst other things.

This week, I speak with Ernie Sink from the Hospital for Special Surgery (HSS) in New York.

Dr Sink is a world-renowned expert in hip preservation surgery, and today, we discuss surgical hip dislocation as an approach to treating hip pathology.

We talk about femoroacetabular impingement or FAI and its description by the group led by Prof. Reinhold Ganz in Bern, Switzerland, and the evolution towards arthroscopic approaches to treating it.

We discuss objective measures to quantify FAI, the importance of making an accurate diagnosis, and the difficulties in distinguishing subtle abnormalities. 

We talk about a recent paper he published that analyzed the outcomes of the surgical dislocation approach for treating complex FAI and how he distinguishes complex FAI from milder conditions, considering it a spectrum of pathology.

We then consider two papers comparing surgical hip dislocation and arthroscopy to treat this condition.

The first, a comparison in an adult population, showed that both treatments were equally effective. We discussed surgeon preference for one or another, leading to its being offered.

A more recent study in an adolescent population found that females with subtle Cam deformities on the femoral neck who did not participate in sports were at higher risk of having a sub-optimal outcome, and we discussed this.

We conclude on the current state and future of open hip surgery in the era of arthroscopy.

This week I recap the most recent episodes and answer some audience questions.

This week I speak with William Morris of the Texas Scottish Rite for Children, in Dallas. He recently published two papers questioning the efficacy of bracing for reducing the incidence of acetabular dysplasia after a closed or open reduction

We discuss the treatment of developmental dislocation of the hip by attaining stable reduction whether by closed or open means, and what acetabular dysplasia signifies

He talks about the challenges of performing a retrospective study which encompassed over 40 years experience at the Texas Scottish Rite, as well as the difficulties of interpreting handwritten notes in old medical records 

We discussed the theoretical benefit of bracing as well as the physiology implied in the development of the hip joint

We discuss surgeon preference and prescribing bracing based on acquired dogma rather than proven science

We talk about ways to supplement acetabular development other than bracing

And we talk about the possibility of setting up a randomized control trial to determine the efficacy of bracing.

This week, I speak with Blaise Nemeth, a pediatric orthopedist affiliated with the University of Wisconsin in Madison. He is one of the few non-operative pediatric orthopedists in the United States also known as NoPos.

We talk about the pathway to becoming a non-operative pediatric orthopedist and the value they can bring to benefit patients as well as his career path

We discuss practical issues, including the financial aspects of incorporating non-operative orthopedists and advanced practice providers.

He explained his approach to diagnosing and managing hip dysplasia in infants and how to integrate other specialties when dealing with complex patients.

We examine the bias in most literature regarding Legg Calvé Perthes, where surgeons have typically run research, which creates a bias towards surgical treatment.

We discussed slipped capital femoral epiphysis and speculated on the rapid rise in popularity of GLP-1agonists for weight loss and their implications for musculoskeletal medicine, specifically pediatric orthopedic conditions. We also talked about the support structure and networks available to non-operative orthopedists.

In today's episode, I have the honor of speaking with Dr. Stuart Weinstein, a distinguished figure in pediatric orthopedics and a renowned expert in hip dysplasia. Dr. Weinstein's illustrious career includes leadership roles in prominent orthopedic societies and groundbreaking research on the long-term outcomes of various orthopedic conditions.

Our conversation delves into the rich history of orthopedic surgery at the University of Iowa under the initial guidance of Arthur Steindler, exploring its pivotal contributions to our understanding of hip dysplasia spanning over a century. Dr. Weinstein shares insights into the transformative impact of Ignacio Ponseti's contributions to hip dysplasia treatment and reflects on his own extensive career devoted to pediatric orthopedics.

With unparalleled enthusiasm, wisdom, and eloquence, Dr. Weinstein discusses historical perspectives, current best practices, and his vision for the future of treating patients with hip dysplasia, offering a compelling glimpse into the evolving landscape of pediatric orthopedics.

This week, I had the privilege of conversing with Valerie Parrish, a highly accomplished professional in pediatric hip pathology. Valerie is a certified physician assistant at Texas Children's Hospital and has dedicated her career to the specialized area of pediatric orthopedics. Her role as an advanced practice provider has afforded her with unique insights into the job of a physician assistant, the intricacies of pediatric orthopedics, and the efficient management of a practice.

We discussed the modern physician assistant movement, how it began, and how it can enhance surgical practices. we talk about both surgical and non-surgical PAs and how they can improve teaching for orthopedic trainees

We talked about her education, how she became a PA, and specifically how she became involved in pediatric hip.

We discuss managing complex patients with hip dysplasia in clinic and incorporating other healthcare professionals to provide an integral strategy that benefits all.

We deliberated on some shared frustrations with Legg Calvé Perthes and how PA involvement can alleviate surgeons' workloads, improving patient care and outcomes. This can also increase the surgical yield of orthopedic clinics, an often-used marker of efficiency.

She also talks about how developing professional relationships is a key to success, amongst other topics

This week I speak with Mr. Alexander Aarvold a consultant pediatric orthopedic surgeon in Southampton England. 

He has published extensively in the field of hip dysplasia and has recently been advocating for a growth-stimulating procedure to improve the outcomes when treating developmental dislocation of the hip with open reduction by adding a procedure called a pelletoplasty

We begin the discussion talking about screening and the fact that despite having a national screening program in England, the rate of late-detected hip dysplasia does not seem to have changed over the last few decades, and he has led efforts to find ways to improve this.

We then talk about the risk of radiation from repeated pelvic X-rays, a topic he has researched and which parents are always rightfully concerned about.

Most of the discussion was centered around a procedure he has termed the pelletoplasty a technical modification to one of the standard procedures for the surgical treatment of developmental dislocation of the hip, which has resulted in excellent outcomes. 

We discuss the efficacy of the procedure, the technical details,how one can learn to do it and maintain proficiency. and we talk about the future of research in hip dysplasia.

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,