This week I speak with Woody Sankar, Professor of Orthopedic Surgery by the Perelman School of Medicine at the University of Pennsylvania and Director of the Hip Preservation Team at the Children's Hospital of Philadelphia

We talk about outcomes of open reduction for developmental dislocation of the hip and the study he recently co-authored, which was the result of a multicentre effort led by the global hip dysplasia registry.

We talk about measuring outcomes for open reduction of developmental dislocation. Focusing on three suboptimal outcomes, Redislocation, proximal femoral growth disturbance, and residual acetabular dysplasia

We talk about surgical volume and variability and the possibility of measuring the quality of surgery

The study indicated that the rate of residual acetabular dysplasia was significantly lower in patients undergoing concomitant pelvic osteotomy, and how this finding must be contextualized.

We discuss the future of research in hip dysplasia, including the possibility of conducting a randomized controlled trial.

Amongst other things

This week, I talk with a true legend in Legg-Calvé-Perthes. Dr Tony Herring from Texas Scottish Rite for Children in Dallas

Dr. Herring has had an illustrious career dedicated to helping children with all sorts of musculoskeletal problems. He developed a particular interest in Legg-Calvé-Perthes.

Although he has published many articles on the subject, in 2004, he was the lead author in a study that is considered by many to be the landmark study in the understanding and treatment algorithm for patients with this condition.

We talk about how he formed a study group in the 1980s, the challenges of putting together such a large multi-center study in an era before e-mail or even fax machines were commonplace.

We discuss the development of the lateral pillar classification, commonly known as the Herring classification, and how it has maintained its value as the most important prognostic factor for this condition.

He explained how he has been able to review all of the images from the original study by digitizing them and, with the advantage of hindsight, has found new and unexpected changes in these radiographs.

We discuss treatment indications and the variability inherent to any surgical intervention.

We talk about the role of perfusion MRI in dictating the vascular status of the proximal femoral epiphysis and about future research directions.

This week, we are focusing on Legg-Calvé-Perthes, a condition that continues to frustrate patients, parents, and clinicians despite being described over 115 years ago. I speak with Dan Perry, a pediatric orthopedic surgeon and NIHR research professor at Alder Hey Hospital in Liverpool, England. 

We centered the conversation around the results of the British Orthopedic Society Surveillance Study, or BOSS study, on Perthes.

We discussed the paper they published in 2022, looking at epidemiology in the United Kingdom.

We talk about how dogma and not necessarily scientific evidence have influenced surgical Practice worldwide.

He explains how they set up a prospective nested cohort of patients nationwide in the United Kingdom.

We discuss the variability in treatment approaches and what led surgeons to intervene while others recommended nonoperative means. We talk about the importance of setting up randomized controlled trials but the inherent difficulties of doing so, especially with surgical interventions. We also look at future directions, amongst other things.

In this episode, I talk with Rick Gardner, a pediatric orthopedic surgeon at SickKids in Toronto. Gardner's rich experience spans various countries, notably with Cure International in Africa, providing surgical care and support to children in underserved communities. We explore our similar motivations for pursuing medicine and commitment to pediatric care, discussing topics such as effective altruism, the importance of scalability and sustainability, and the role of collaboration with local providers, governments, and NGOs. Additionally, we cover the empowerment of local healthcare professionals through training and education, the significance of conducting research with shared resources, and examine the potential for global impact through future collaborations and partnerships in pediatric orthopedic care.

This week marks the 10th episode in this podcast, and today’s episode is different; I thought this would be a good time to take stock of the first nine episodes and discuss future directions. I also thought it would be a good time to catch up on some questions that have come to me through different platforms. I'm very grateful to listeners who have sent in questions related to some of the topics we've brought up and please let me know about topics you'd like to hear about on the podcast.

This week I speak with Emily Schaefer PhD a researcher with the university of British Columbia in Vancouver. 

We discuss a paper that she and her team recently published which details the development and implementation of a care pathway for developmental dysplasia of the hip in India.

Li J, Aroojis A, Mulpuri K, Shea KG, Schaeffer EK. Development of a DDH Care Pathway for India: A Study Methodology to Guide Similar Efforts in Other Countries and for Other Conditions. Indian J Orthop. 2021 Oct 22;55(6):1549-1558. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8533670/pdf/43465_2021_Article_534.pdf

We discuss the difficulties in developing a pathway and even greater ones when implementing it. We discuss how they involve different stakeholders and got their input and then how to control quality to maintain this project going.

The care pathway was published in the Indian journal of Pediatrics:

Anne RP, Li J, Schaeffer E, Aroojis A, Mulpuri K, Murki S. Care Practices of Indian Pediatricians for the Screening and Diagnosis of Developmental Dysplasia of the Hip. Indian J Pediatr. 2022 Sep;89(9):911-915. doi: 10.1007/s12098-022-04200-5. Epub 2022 Jun 22. PMID: 35731501

https://link.springer.com/article/10.1007/s12098-022-04200-5

We discussed tailoring the pathways to adapt to different settings and the future of collaborative efforts worldwide.

This week, I am speaking with Eduardo Novais, MD. Associate Professor of Orthopedic Surgery at Harvard Medical and part of the Orthopedic Center and the Child and Young Adult Hip Preservation Program at Boston Children’s Hospital

We discuss a paper that he recently coauthored:

Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction

We discuss whether it is possible to predict residual acetabular dysplasia based on post-reduction MRI after closed or open reduction for developmental dislocation of the hip, the logistics of obtaining MRI immediately after a procedure, outcomes and the future of research for hip dysplasia.

 In this episode, I engage in a conversation with Dr. Kaya Kvarme Jacobsen, an MD PhD from the University of Bergen, Norway, about genetic epidemiology and hip dysplasia. Our discussion delves into her recent co-authored paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10820335/

a contribution to a large-scale population study from Trøndelag, Norway. Specific single nucleotide polymorphisms associated with hip dysplasia were identified. We explore the intricacies of whole genome sequencing, the significance of SNPs, potential genetic and epigenetic factors influencing hip dysplasia, the evolving landscape of personalized medicine, and the myriad of unanswered questions within the realm of hip dysplasia genetics.

In this week's episode, I speak with Estefania Birrer from Valdivia, Chile; she coauthored a paper that showed the effectiveness of a screening program for hip dysplasia in Chile. We talk about the practical and economic realities of screening.

Here is a link to the paper: https://journals.sagepub.com/doi/full/10.1302/1863-2548.15.200240?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org