Latest / AHF Podcast / Advancing Anterior Hip Excellence in Latin America with Francisco J. Gómez Torres, MD

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Advancing Anterior Hip Excellence in Latin America with Francisco J. Gómez Torres, MD · AHF Podcast

• 0:23
  Joseph M. Schwab: Hello and welcome again to the A HF Podcast Live.
• 0:28
  Joseph M. Schwab: Today on the Anterior Hip Foundation podcast, we're gonna be joined by Francisco Gomez Torres, an orthopedic surgeon and innovator, and a passionate voice for Latin American orthopedics.
• 0:43
  Joseph M. Schwab: And interestingly enough, there was an earthquake today, not too long ago in Mexico, and that caused a little bit of our delay to the broadcast.
• 0:51
  Joseph M. Schwab: So we're happy to know that, uh, Dr.
• 0:54
  Joseph M. Schwab: Gomez Torres is safe.
• 0:56
  Joseph M. Schwab: That he's gonna be joining us here momentarily.
• 1:00
  Joseph M. Schwab: Dr.
• 1:01
  Joseph M. Schwab: Torres from founding Osteo FITT in Mexico City to shaping the next generation through mentorship and global collaboration, he's redefining what it means to lead with both skill and heart.
• 1:15
  Joseph M. Schwab: Whether in the or behind a podcast, Mike or climbing a mountain, he's on a mission to restore movement, inspire others, and elevate equity in surgery worldwide.
• 1:29
  Joseph M. Schwab: Dr.
• 1:30
  Joseph M. Schwab: Torres, welcome.
• 1:32
  Joseph M. Schwab: I hope you're okay.
• 1:33
  Joseph M. Schwab: Is everything okay in Mexico where you're at?
• 1:37
  Francisco Gomez Torres: Hello.
• 1:38
  Francisco Gomez Torres: Yo, it is really nice to hear from you I'm so sorry to be this late, but guess what?
• 1:45
  Francisco Gomez Torres: Welcome to Mexico City.
• 1:46
  Francisco Gomez Torres: There was just, an earthquake and the whole hospital was um, downstairs.
• 1:52
  Francisco Gomez Torres: We are up here right now.
• 1:53
  Francisco Gomez Torres: It's so good to, uh, greet you, again.
• 1:57
  Francisco Gomez Torres: Thank you, again for invitation.
• 1:59
  Francisco Gomez Torres: How are you?
• 1:59
  Joseph M. Schwab: I, I'm, well, I'm just happy to hear that you, are safe and, and well, and, uh, hopefully your, your patients and your staff and, and your family are safe as well.
• 2:09
  Joseph M. Schwab: So, thank you for joining me
• 2:12
  Francisco Gomez Torres: I, thanks to you Joe.
• 2:15
  Francisco Gomez Torres: I would like to start just, um, telling you, do you, don't you miss these kind of experiences back in Switzerland?
• 2:28
  Joseph M. Schwab: It's been a while since we felt an earthquake here.
• 2:30
  Joseph M. Schwab: Yeah, no.
• 2:32
  Joseph M. Schwab: Um, but I really wanna
• 2:35
  Francisco Gomez Torres: you, you are missing it.
• 2:36
  Joseph M. Schwab: yeah, yeah.
• 2:37
  Joseph M. Schwab: I'm sure.
• 2:38
  Joseph M. Schwab: I, I'm really interested in hearing, we had a chance to talk briefly at the a HF meeting in Nashville in June.
• 2:46
  Joseph M. Schwab: And, um, but I'm interested for you to, to, kind of tell me about and share with our audience a little bit about what inspired you, um, to pursue orthopedics and specifically how did you end up, uh, getting involved in hip surgery and in anterior hip surgery?
• 3:04
  Joseph M. Schwab: We, we learned it's quite uncommon in Mexico.
• 3:09
  Francisco Gomez Torres: Yeah.
• 3:09
  Francisco Gomez Torres: Yeah, you're totally right.
• 3:11
  Francisco Gomez Torres: Well, I would like to start, um, telling you that since I was a kid, well, I was really exposed to medicine because both of my parents are doctors.
• 3:21
  Francisco Gomez Torres: So my, my mother is a family doctor and my father was a surgeon.
• 3:26
  Francisco Gomez Torres: Uh, since there, I do remember to be the whole time with them, I was raised with another two brothers who are not at all doctors.
• 3:39
  Francisco Gomez Torres: They see blood and they get dizzy.
• 3:41
  Francisco Gomez Torres: So I was the one, they were just smuggles.
• 3:47
  Francisco Gomez Torres: So after, after I, uh, was exposed to this, I kind of like it.
• 3:52
  Francisco Gomez Torres: Um, I studied medicine back in Mexico State.
• 3:57
  Francisco Gomez Torres: I even, um, got, um, this, I was like the president of my, um, class.
• 4:06
  Francisco Gomez Torres: So I, I was always.
• 4:09
  Francisco Gomez Torres: Pursuing, um, this kind of living.
• 4:12
  Francisco Gomez Torres: Um, and from there, when I was on the, on my internship, I had the chance to have these rotations, uh, through general surgery, orthopedics, internal medicine, pediatrics and stuff.
• 4:29
  Francisco Gomez Torres: And I saw that orthopedics was like the most, um, how you say it decisive.
• 4:36
  Francisco Gomez Torres: You, you, you perform, somebody got broken, you perform a surgery and it's healed a month later, which is something like, for example, internal medicine doesn't have to, you know, you know how to treat, uh, diabetic.
• 4:53
  Francisco Gomez Torres: Maybe you can control their issues, but it'll take years.
• 5:00
  Francisco Gomez Torres: Well, I mean, it's not even, uh, there's not even a treatment right now.
• 5:04
  Francisco Gomez Torres: No, maybe soon.
• 5:04
  Francisco Gomez Torres: But that, that was the way I choose orthopedics.
• 5:09
  Francisco Gomez Torres: And then I got a doctor who, on a vacation, he told me, you should come to me, uh, to the, to the surgery room.
• 5:21
  Francisco Gomez Torres: We can see if you like it.
• 5:23
  Francisco Gomez Torres: And damn, I saw, uh, uh, hip surgery that day.
• 5:28
  Francisco Gomez Torres: I say, yes, this is the thing.
• 5:31
  Francisco Gomez Torres: So I studied for my, um, specialty exam.
• 5:37
  Francisco Gomez Torres: I was the number 16th of the whole country.
• 5:41
  Francisco Gomez Torres: So I
• 5:42
  Joseph M. Schwab: Oh wow.
• 5:42
  Francisco Gomez Torres: the chance to choose.
• 5:44
  Francisco Gomez Torres: And after that, well, the rest is history.
• 5:47
  Francisco Gomez Torres: I studied in a, in, um, ims, which is like the biggest public service in Mexico.
• 5:55
  Francisco Gomez Torres: I'm from there.
• 5:56
  Francisco Gomez Torres: After COVID, I started, um, to create these kind of congresses for, uh, students and to join some leading voices about orthopedics.
• 6:09
  Francisco Gomez Torres: And a doctor, Dr.
• 6:12
  Francisco Gomez Torres: Victoria Manuel, I was one of my guests.
• 6:17
  Francisco Gomez Torres: He was delighted because of the effort, and I think that's, that was the way he invite me to join his team as a fellow surgeon at the national, uh, rehabilitation Institute here in Mexico, where I learned hip and knee reconstruction surgery with him.
• 6:36
  Francisco Gomez Torres: He's like a mentor to me, and I, I do appreciate the way he taught, uh, teach taught us, uh, on that time.
• 6:48
  Francisco Gomez Torres: But, um, as.
• 6:51
  Francisco Gomez Torres: Here is where the story starts.
• 6:53
  Francisco Gomez Torres: Uh, uh, some, some months ago I was reading, um, this, this book Dr.
• 7:01
  Francisco Gomez Torres: Ma signed for us at Nashville, and I saw that he, yeah, yeah, I saw, I saw he have a mentor of him, of his, who was performing surgeries, uh, in a posterior way or maybe a lateral approach.
• 7:20
  Francisco Gomez Torres: And when he decided that this wasn't the most natural way, uh, it was because he have the chance to hear fromelles, you know,
• 7:31
  Joseph M. Schwab: Mm-hmm.
• 7:32
  Francisco Gomez Torres: he, he.
• 7:35
  Francisco Gomez Torres: Writes on his book that the first time he saw him, it was because Dr.
• 7:39
  Francisco Gomez Torres: Letell was doing, uh, a tabular fracture through a anterior approach.
• 7:45
  Francisco Gomez Torres: But then he decided to join him in Paris, where Dr.
• 7:50
  Francisco Gomez Torres: Letell was performing, um, anterior approaches to, for hip prosthetics, and that he even had, uh, a table for it.
• 8:00
  Francisco Gomez Torres: So it was like for me, maybe 30 years later, but it's the, the same history here in Mexico.
• 8:10
  Francisco Gomez Torres: I don't know if it's a cultural matter, but the anterior approach is, might be, it might be not the most, um, acceptable, um, approach for the leading surgeons today.
• 8:28
  Francisco Gomez Torres: I
• 8:29
  Joseph M. Schwab: In Mexico specifically.
• 8:31
  Joseph M. Schwab: yeah, And we'll get into a little bit about, uh, I'm gonna wanna learn a little bit about why you think that is and how you think that might change, but we'll get to that.
• 8:41
  Francisco Gomez Torres: Sure, sure.
• 8:42
  Francisco Gomez Torres: I, I'm your guest today, so I'm so happy to answer your questions as well.
• 8:49
  Francisco Gomez Torres: I do have some questions for you
• 8:51
  Joseph M. Schwab: Yeah, of course.
• 8:52
  Francisco Gomez Torres: I, I can, I can see you as, as a mentor also.
• 8:58
  Francisco Gomez Torres: I, I think I do have a lot of, um, to learn from you and the whole a HF uh, uh, crew.
• 9:07
  Joseph M. Schwab: Yeah.
• 9:07
  Joseph M. Schwab: Well, I think the a HF itself is a community of learning, so we all learn from each other and there's, there's a lot that we can learn by having these sorts of conversations, both locally, nationally, and, and internationally.
• 9:20
  Joseph M. Schwab: Yeah.
• 9:22
  Francisco Gomez Torres: Yeah.
• 9:22
  Francisco Gomez Torres: For, for example, I would like to know if the anterior approach was all, uh, the beginning for you or if you have to.
• 9:32
  Francisco Gomez Torres: Make this switch between approaches when you first started.
• 9:37
  Joseph M. Schwab: Well, most of my, uh, residency training was in posterior approach and direct lateral approach.
• 9:44
  Joseph M. Schwab: And, um, I first saw anterior approach at a course when I was, uh, later in my residency years.
• 9:52
  Joseph M. Schwab: And I thought it was very interesting.
• 9:53
  Joseph M. Schwab: I got to meet Dr.
• 9:54
  Joseph M. Schwab: Matta, he taught the course.
• 9:56
  Joseph M. Schwab: And, um, uh, when I came back into practice after doing my fellowship in Switzerland, where I saw some anterior approach towards the end, um, I decided that I wanted to start my practice doing all anterior approach.
• 10:13
  Joseph M. Schwab: So when I began my practice, I just started doing anterior approach right away from the get go.
• 10:19
  Joseph M. Schwab: So my training was, uh, a little haphazard.
• 10:23
  Joseph M. Schwab: It's different than it was, than it is nowadays, uh, for sure.
• 10:27
  Joseph M. Schwab: Um, but uh, but we, we made it there.
• 10:30
  Joseph M. Schwab: So that's, that's how I ended up with anterior approach.
• 10:32
  Joseph M. Schwab: But that leads me to a question.
• 10:34
  Joseph M. Schwab: Was there, you talked about how you, uh, kind of found a mentor in, in hip and knee reconstruction surgery.
• 10:42
  Joseph M. Schwab: was, there A particular case or patient or conversation that you had during that training that made you feel, this is exactly where I'm supposed to be, this is what I'm supposed to be doing, and that confirmed the decision you had made?
• 11:00
  Francisco Gomez Torres: For sure.
• 11:01
  Francisco Gomez Torres: I must say that, for example, in this, in this practice I had as a fellow surgeon, it's always in the very same.
• 11:11
  Francisco Gomez Torres: Now you, you can't change the approach because you want to, you have to follow strict rules because this is the school we teach in, in this institute.
• 11:23
  Francisco Gomez Torres: Or for example, as I told you before, I was, um.
• 11:28
  Francisco Gomez Torres: A couple of months ago, I was trying to, uh, I was working in a, in IMS where they do have their own school.
• 11:39
  Francisco Gomez Torres: They do, uh, hips laterally, mainly, mainly, and I heard from this colleague, a doctor who have learned the interior way, um, in the us He was performing his cases, uh, under the water, as we say here, because he wasn't allowed to, well, this doctor even got punished.
• 12:03
  Francisco Gomez Torres: He, they took his consultation and he was changed, uh, to another service.
• 12:10
  Francisco Gomez Torres: So I think this, uh, the, the way I have been in touch with the anterior approach is mostly with colleagues of mine, friends who, which I do perform hip surgeries, but in.
• 12:26
  Francisco Gomez Torres: Our own.
• 12:27
  Francisco Gomez Torres: We have our own patients, our private, private patients, and we gather, you know, we gather a doctor from Central Mexico City, a doctor for, from Bolivia, who now works here in Mex, Mexico City.
• 12:43
  Francisco Gomez Torres: And I myself, and we do perform the entire hip surgery in on, on in our own way.
• 12:50
  Francisco Gomez Torres: You know, as the way we learned.
• 12:52
  Francisco Gomez Torres: One of my friends learned at the Hip Institute with Dr.
• 12:56
  Francisco Gomez Torres: Uh Dom, for example, and this other friend of mine learned in Magdalena De La Salinas, which is a hospital here in Mexico City, and I did my own thing learning through them.
• 13:11
  Francisco Gomez Torres: And through you, for example, and you know, like this, like drop water drops.
• 13:18
  Francisco Gomez Torres: I have been learning on my own, as you said before, I'm kind of an entrepreneur, but I'm looking for my practice everywhere.
• 13:27
  Francisco Gomez Torres: I even went to Switzerland, uh, at Pass Basil where I had the chance to perform with Dr.
• 13:34
  Francisco Gomez Torres: Carl Stoffel, which I do, I admire a lot.
• 13:38
  Francisco Gomez Torres: He taught me some tips.
• 13:40
  Francisco Gomez Torres: I went to the AO courses, uh, at tables at Luer.
• 13:45
  Francisco Gomez Torres: So it's all kind of a mix.
• 13:48
  Francisco Gomez Torres: You have to look for your own way and more than look for it.
• 13:52
  Francisco Gomez Torres: Create it in some, some way.
• 13:55
  Francisco Gomez Torres: Yeah.
• 13:56
  Joseph M. Schwab: It.
• 13:56
  Joseph M. Schwab: Give me a little bit of an idea of what the, what's the, medical care system like in, in, at least in Mexico City, and is it the same all throughout Mexico?
• 14:07
  Joseph M. Schwab: Is there nationalized healthcare?
• 14:10
  Joseph M. Schwab: Is it private?
• 14:11
  Joseph M. Schwab: Is it a mixture of public and private?
• 14:13
  Joseph M. Schwab: Tell, tell our listeners a little bit about how healthcare is delivered in Mexico so we can understand the environment you're working in.
• 14:23
  Francisco Gomez Torres: Sure.
• 14:25
  Francisco Gomez Torres: in Mexico we have, uh, two different ways of doing things.
• 14:29
  Francisco Gomez Torres: The, the first one is the, um, the public one, which is divided mostly into three institutions, which, which are IMS is there, and, uh, which is, um, health in general.
• 14:47
  Francisco Gomez Torres: These three services are the public ones.
• 14:51
  Francisco Gomez Torres: Yeah.
• 14:51
  Francisco Gomez Torres: so we are, um, how do you say, uh.
• 14:56
  Francisco Gomez Torres: We do have, uh, um, we're stuck to the, to the money the government gave us to perform surgeries.
• 15:07
  Francisco Gomez Torres: So, for example, to do an anterior approach, you know, better than me, that maybe we do, we need special, um, instrumentation to place this, this, um, uh, how do you say prosthetics?
• 15:26
  Francisco Gomez Torres: So it's kind of hard for the, the government to, to pay No.
• 15:32
  Francisco Gomez Torres: And through the public to the private one.
• 15:35
  Francisco Gomez Torres: Well, we do have the, the insurances, which do mostly in the biggest hospitals like this, like hospital Al.
• 15:45
  Francisco Gomez Torres: But there is also a way where people can pay on their own without having, uh, an insurance.
• 15:53
  Francisco Gomez Torres: So.
• 15:55
  Francisco Gomez Torres: There are three kinds.
• 15:56
  Francisco Gomez Torres: No public, private, or a hybrid one.
• 16:00
  Francisco Gomez Torres: Yeah.
• 16:01
  Joseph M. Schwab: Self play.
• 16:02
  Joseph M. Schwab: Self pay are there.
• 16:03
  Joseph M. Schwab: So when we had, um, a Richard Field from the UK came and gave a talk at the Anterior Hip Foundation about, uh, anterior hip replacement in the uk, which is only about 1% of, uh, of hip replacements between one and 2%.
• 16:21
  Joseph M. Schwab: Um, Mexico is similar in its percentage, but he also described there's the public system, there's the private system, there's the self pay, and then there's also the public system that, for lack of a better term, contracts out certain types of, uh, cases to that they are, are not able to handle within the public hospitals, to private institutions who will take public patients.
• 16:50
  Joseph M. Schwab: Does that also exist in Mexico, or is that aspect not a, is that not similar?
• 16:57
  Francisco Gomez Torres: yeah, yeah.
• 16:58
  Francisco Gomez Torres: It does exist, but it's not like the biggest, uh, way of doing things.
• 17:03
  Francisco Gomez Torres: It's mostly because the hospitals are very crowded, so they choose to deliver the, this kind of patients to, uh, specific, um, center.
• 17:17
  Francisco Gomez Torres: You know?
• 17:17
  Francisco Gomez Torres: But I have only hear of that maybe here in Mexico City and maybe in Monterey and Guadalajara.
• 17:23
  Francisco Gomez Torres: So it's not like the most common thing.
• 17:26
  Francisco Gomez Torres: But I think things are going to that way because the public service, it's full, it's overcrowded, uh, awfully.
• 17:35
  Francisco Gomez Torres: Yeah, we do have that problem here.
• 17:37
  Francisco Gomez Torres: Yeah.
• 17:38
  Joseph M. Schwab: Yeah, the o the overcrowding problem.
• 17:41
  Joseph M. Schwab: Um, how much do patients in the public system in Mexico, how much do they have input into how they want their care to be delivered?
• 17:52
  Joseph M. Schwab: So could somebody in the public system say, I, I want an anterior approach, hip replacement, all as uncommon as that might be in Mexico?
• 18:01
  Joseph M. Schwab: Could somebody say that and expect that that's what they would get?
• 18:08
  Francisco Gomez Torres: I must say the patient doesn't have, uh, an option when they are through the public service.
• 18:16
  Francisco Gomez Torres: It's mostly, uh, the decision of the service, maybe the decision of their surgeons.
• 18:22
  Francisco Gomez Torres: Uh, but no, as far as I know, the patient doesn't have their right to choose, but they can talk with their doctor, and if he does now the entire approach maybe.
• 18:36
  Francisco Gomez Torres: It's a possibility.
• 18:37
  Francisco Gomez Torres: Like in that hospital, I told you before, the doctor that was doing his own, uh, anterior approaches, but he got, I mean he got, uh, he got punished.
• 18:50
  Francisco Gomez Torres: It's crazy.
• 18:51
  Joseph M. Schwab: Yeah.
• 18:51
  Joseph M. Schwab: Well, and and that leads me to my next question.
• 18:54
  Joseph M. Schwab: If you could change one thing about how anterior approach hip surgery is either perceived or practiced or it sounds like it's not taught much in Latin America, in Mexico, um, what would that be?
• 19:14
  Joseph M. Schwab: What would be the first thing you would change?
• 19:17
  Francisco Gomez Torres: Yeah.
• 19:18
  Francisco Gomez Torres: Well, I think there is a cultural problem because of doctors that are not willing to change their approach.
• 19:26
  Francisco Gomez Torres: I think that's the biggest thing.
• 19:28
  Francisco Gomez Torres: The big names, the names that have been with us a lot of time, they are accept or they does not, do not want to change this kind of, uh, technique.
• 19:41
  Francisco Gomez Torres: Mostly because, well, they don't want to lose their.
• 19:45
  Francisco Gomez Torres: Power position.
• 19:47
  Francisco Gomez Torres: you know, as we saw in Nashville, as I have been watching through the days, during my, uh, surgeries, the surgeries of my friends or co or colleagues, and we see this kind of better results.
• 20:02
  Francisco Gomez Torres: I, I don't remember a doctor who told me in, in Nashville, the worst, uh, plant is the one that doesn't want to see, and that was Dr.
• 20:13
  Francisco Gomez Torres: Mar.
• 20:14
  Francisco Gomez Torres: So it's crazy how we are so, so ret to say, no, no, keep it lateral.
• 20:22
  Francisco Gomez Torres: Keep it posteriorly because it's the bear.
• 20:24
  Francisco Gomez Torres: I even had a discussion with a friend of mine, I mean, a friend of mine told me the posterior way is the way.
• 20:31
  Francisco Gomez Torres: I was saying like, dude, you are like a shoulder surgeon.
• 20:36
  Francisco Gomez Torres: Why are you talking about hip surgery?
• 20:39
  Francisco Gomez Torres: That that's the way it's like discussing about the football.
• 20:43
  Francisco Gomez Torres: You know, football is something big here in Mexico and people gets, it breaks relationships.
• 20:50
  Francisco Gomez Torres: It was the same with this guy.
• 20:52
  Francisco Gomez Torres: He was saying, why are, yeah.
• 20:55
  Francisco Gomez Torres: Yeah.
• 20:55
  Francisco Gomez Torres: Go lambster.
• 20:56
  Joseph M. Schwab: I, I, I, no, that's okay.
• 20:57
  Joseph M. Schwab: I was gonna say maybe it'll take a famous, uh, footballer from Mexico to get an anterior approach, hip replacement someday to change the
• 21:06
  Francisco Gomez Torres: you're talking.
• 21:07
  Francisco Gomez Torres: Yeah, yeah, yeah.
• 21:09
  Francisco Gomez Torres: I, I do remember having a football coach.
• 21:12
  Francisco Gomez Torres: Um, he was already retired, but he was a very famous, uh, football player back in the day.
• 21:19
  Francisco Gomez Torres: He have anterior approach and he's doing great.
• 21:23
  Francisco Gomez Torres: He's still playing football.
• 21:25
  Francisco Gomez Torres: You know, he, he tells me that when he's playing football nowadays he plays, but when the other, um, teammate comes to closer, he just drops the ball.
• 21:38
  Joseph M. Schwab: yeah.
• 21:39
  Francisco Gomez Torres: But he's playing football.
• 21:41
  Francisco Gomez Torres: It's crazy.
• 21:41
  Francisco Gomez Torres: He shoots and he scores from far away.
• 21:46
  Francisco Gomez Torres: He has it still, but, you know, it's crazy.
• 21:48
  Francisco Gomez Torres: And people, people doesn't, uh, maybe they don't know that yet.
• 21:54
  Francisco Gomez Torres: I think another
• 21:55
  Joseph M. Schwab: know that.
• 21:56
  Joseph M. Schwab: Yeah.
• 21:56
  Joseph M. Schwab: That he's had a hip replacement.
• 21:57
  Joseph M. Schwab: Yeah.
• 21:58
  Francisco Gomez Torres: Yeah.
• 21:59
  Francisco Gomez Torres: Yeah.
• 21:59
  Francisco Gomez Torres: Maybe the thing I will try to change will be, um, making this info even more, um, available for people that wants to, to get better results.
• 22:15
  Francisco Gomez Torres: Not, I'm not talking about patients because patients do come and they ask for the AMI approach, but I mean, through another colleagues, you know, through doctors, through another hip surgeons That are stuck because they learn that way as the way I learned back for years ago when I was doing orthopedic surgery, but not a following hip replacement.
• 22:42
  Joseph M. Schwab: So talk to me a little bit more about the group of orthopedic leaders within, um, the Mexican community who have, um, maybe some, uh, some oversight over what They, perceive to be quality and what they perceive to be the right way to do things.
• 23:03
  Joseph M. Schwab: Is this a formal structure within the Mexican orthopedic community, or is it, is it a bit more informal and um, uh, you know, is this, is this the elder statesman, so to speak, or stateswomen of the, of the orthopedic community who are telling you, quote unquote, the right way to do things?
• 23:25
  Francisco Gomez Torres: Yeah, well, I think mostly of them.
• 23:29
  Francisco Gomez Torres: It's not like a formal, um, group.
• 23:32
  Francisco Gomez Torres: It's this.
• 23:34
  Francisco Gomez Torres: Bunch of groups that have been through a lot of time.
• 23:38
  Francisco Gomez Torres: They, they, for example, they do work a lot with the insurance, uh, companies.
• 23:44
  Francisco Gomez Torres: They have been there forever and they keep growing because they do accept more fellows, more, more, uh, doctors to join their team as they are the voices that resonate between us.
• 23:58
  Francisco Gomez Torres: Um, they are the ones that have to change, I guess.
• 24:04
  Francisco Gomez Torres: I mean, not very easy for me to raise the voice and to make people hear me, but little by little as what a lady was telling me yesterday, uh, we have an, uh, an interview with, um, a social activist who told us, don't you ever give up.
• 24:24
  Francisco Gomez Torres: Just if you can change a person a day, it's okay.
• 24:29
  Francisco Gomez Torres: I think.
• 24:30
  Francisco Gomez Torres: We have to keep pushing with this kind of efforts.
• 24:34
  Francisco Gomez Torres: I don't know, uh, Joe, if you will have the metrics of this speak layer, but I would like to know if Latin America is listening because we did have a lot of, uh, talks with our friends back in Brazil, Chile.
• 24:51
  Francisco Gomez Torres: Uh, I don't, I even have a discussion with, uh, uh, research team in Egypt, uh, who is committed, was committed to hear this talk.
• 25:02
  Francisco Gomez Torres: I think we have to keep pushing to, to make people's mind change, especially these ones, these big guys, uh, that have been there forever and that are negative about the anterior hip.
• 25:19
  Francisco Gomez Torres: But just because they have, they don't know it.
• 25:21
  Francisco Gomez Torres: Maybe they are, they don't want to change.
• 25:24
  Francisco Gomez Torres: I mean, 20 years doing the same procedure the very same way.
• 25:29
  Francisco Gomez Torres: I do understand that.
• 25:31
  Francisco Gomez Torres: Um, they might be in a comfort zone, but for example, Dr.
• 25:36
  Francisco Gomez Torres: Sa also talks about, uh, his transition through the, from posterior to anterior, which is something crazy for me.
• 25:44
  Francisco Gomez Torres: I, I, I, I, it's kind of remarkable for me because it's, uh, 180 degrees, uh, change.
• 25:53
  Francisco Gomez Torres: It's totally different.
• 25:55
  Francisco Gomez Torres: But I can say Dr.
• 25:56
  Francisco Gomez Torres: S is having great results, and he even talks about it in his book also.
• 26:01
  Francisco Gomez Torres: So.
• 26:02
  Joseph M. Schwab: Yeah.
• 26:03
  Joseph M. Schwab: And, uh, just to, um, just to, uh, address one of your, uh, comments there.
• 26:08
  Joseph M. Schwab: We've got live about 15 people watching us right now, which is for a first live podcast episode.
• 26:15
  Joseph M. Schwab: I'll take it.
• 26:15
  Joseph M. Schwab: And I wanna remind those users on YouTube and on LinkedIn that in the latter half of this discussion, if you have questions, uh, for Dr.
• 26:25
  Joseph M. Schwab: Gomez Torres or for myself.
• 26:27
  Joseph M. Schwab: Um, we've got our producer Lila, behind the scenes and she is feeding us the best comments and questions, um, that you leave.
• 26:35
  Joseph M. Schwab: So please feel free to be a part of the conversation.
• 26:38
  Joseph M. Schwab: We would love to have you.
• 26:41
  Joseph M. Schwab: I wanted to uh, sort of follow up because one of the things that you seem to have done or seem to have put together in your quest to bring anterior approach to Mexico and to Latin America is you have really, uh, made a lot of international connections or made international global outreach something, um, that something that's part of how you learn, but also how you connect.
• 27:12
  Joseph M. Schwab: Um, how do you stay engaged with the orthopedic community internationally?
• 27:18
  Joseph M. Schwab: How do you cross borders like that?
• 27:23
  Francisco Gomez Torres: Well, I, can, I would like to say that since I was a kid, I was like a really friendly guy.
• 27:29
  Francisco Gomez Torres: you know, I, I don't know.
• 27:33
  Francisco Gomez Torres: Why is it easy for me to talk to people and to, you know, I.
• 27:37
  Francisco Gomez Torres: To know if we can be friends or no, you know, it's okay if we don't agree in everything, but I do like this kind of communication.
• 27:46
  Francisco Gomez Torres: I don't want to be flat with the people.
• 27:49
  Francisco Gomez Torres: I want to know a little bit of them and if they want to know for me it's okay.
• 27:53
  Francisco Gomez Torres: So I think it's my, the way I do friendships with people that took me.
• 27:59
  Francisco Gomez Torres: I, I took it internationally.
• 28:00
  Francisco Gomez Torres: I say, I am making friends all around Mexico.
• 28:04
  Francisco Gomez Torres: Let's try in Switzerland.
• 28:05
  Francisco Gomez Torres: Let's see if I can make some friends there.
• 28:09
  Francisco Gomez Torres: I did make some friends and they were, um, for lucky, lucky me.
• 28:14
  Francisco Gomez Torres: They were a officers.
• 28:17
  Francisco Gomez Torres: So then I got, uh, engaged with the AO Foundation, and I do love that.
• 28:22
  Francisco Gomez Torres: I am working nowadays with them also.
• 28:26
  Francisco Gomez Torres: Uh, for example, uh, when I went to Nashville, I did find this group of very enthusiast, uh, colleagues, which are the Berkeley fellows.
• 28:36
  Francisco Gomez Torres: I can tell you that everybody has a special talent, uh, especially for example, Dr.
• 28:43
  Francisco Gomez Torres: Amed Omar from Egypt.
• 28:45
  Francisco Gomez Torres: He, as soon as I got, uh, in touch with them, with him, we, we had a click and.
• 28:52
  Francisco Gomez Torres: I was invited to participate in his research group, which is, um, an author of, of More Than 50 Research, for example.
• 29:04
  Francisco Gomez Torres: No.
• 29:05
  Francisco Gomez Torres: And, and he is encouraging, encouraging his students to, to do a do as he to publish and publish and publish.
• 29:17
  Francisco Gomez Torres: So I can see that that's the true benefit of having friendships that matters.
• 29:23
  Francisco Gomez Torres: You know, it's not just being friends, it's trying to work, uh, together.
• 29:29
  Francisco Gomez Torres: Um, in, in back in Nashville, for example, I was looking for maybe any chance to, to get, uh.
• 29:40
  Francisco Gomez Torres: Uh, traveling Fellowship info.
• 29:42
  Francisco Gomez Torres: That was another thing I was looking for.
• 29:45
  Francisco Gomez Torres: It's not just talking for talking, it's with a purpose.
• 29:50
  Francisco Gomez Torres: No.
• 29:50
  Francisco Gomez Torres: To get in touch with people, maybe searching for, um, the exchange of benefits.
• 29:57
  Francisco Gomez Torres: If I can do that, the entire hip foundation, uh, put some attention of them in Latin America.
• 30:05
  Francisco Gomez Torres: I think that's something invaluable for the whole region.
• 30:10
  Francisco Gomez Torres: If some, uh, doctors, some teachers of mine are listening to, listening to this and they see that maybe podcasts are nowadays the way, um, television evolved, for example, or, you know, the broadcasting, um, it's a new wave, well, a new way of communication, and I think it's.
• 30:34
  Francisco Gomez Torres: The interior approach is the future of communicate.
• 30:38
  Francisco Gomez Torres: If not, I will then be able to talk to you from Switzerland to Mexico with in California.
• 30:44
  Francisco Gomez Torres: It's crazy, but I do love it.
• 30:46
  Francisco Gomez Torres: Uh, that's the way I, I am doing podcast post podcasting right now.
• 30:52
  Francisco Gomez Torres: Uh, the last year was amazing to get in touch with a lot of people, uh, friends from New York, friends from new uh Belgium, some doctors from Asia, for example.
• 31:05
  Francisco Gomez Torres: I was invited to give a talk next, uh, February on the apo, the Asia Pacific, uh, orthopedic Association.
• 31:14
  Francisco Gomez Torres: So maybe I will be there for next February.
• 31:18
  Joseph M. Schwab: Mm-hmm.
• 31:19
  Francisco Gomez Torres: It's, it's the way things are happening.
• 31:22
  Francisco Gomez Torres: I'm not just sitting and with, uh, arms crossed.
• 31:27
  Francisco Gomez Torres: I'm looking forward to connect with people, as you say, but.
• 31:33
  Francisco Gomez Torres: That's, that's the way things are happening.
• 31:35
  Francisco Gomez Torres: I am.
• 31:37
  Joseph M. Schwab: So you, you clearly have an interest in technology and you have an interest in using that technology to not, not only to learn, but also to teach and to engage.
• 31:49
  Joseph M. Schwab: I'm curious about your use of technology in the operating room and let's, I just wanna start with a basic question about your your setup.
• 31:58
  Joseph M. Schwab: Um, do you have a technology enabled or setup?
• 32:03
  Joseph M. Schwab: Is it pretty basic?
• 32:04
  Joseph M. Schwab: Is it more advanced?
• 32:05
  Joseph M. Schwab: Can you walk me through what features kind of matter most to you in, in terms of your or setup?
• 32:14
  Francisco Gomez Torres: Yeah.
• 32:14
  Francisco Gomez Torres: Well first of all, I would like to say that, uh, I did learn to perform hip and knee surgeries in the traditional way to begin with, you know, at the very first I wasn't able to, uh, manage their robotic arm.
• 32:33
  Francisco Gomez Torres: But nowadays we can do, we do have access through this kind of technology, especially in the private sector about the public sector is a little bit hard because of the economics.
• 32:47
  Francisco Gomez Torres: But now that we do have this kind of, um, liberty to, of freedom to choose.
• 32:55
  Francisco Gomez Torres: Well, we do perform with a robotic surgery in a site.
• 32:59
  Francisco Gomez Torres: Uh, we do have a, a tech guy, uh, who is taking care of it.
• 33:05
  Francisco Gomez Torres: Um, when we are performing some, um, surgeries, we do have this kind of, um, how do you say, like the, like the belly system, you know, to, to match the pre the prayer and the postop, even with a pre, uh, trans, um, uh, visualization of if we are okay.
• 33:30
  Francisco Gomez Torres: Uh, so I can say it's not like the most equipped, um, um, or, but it's not also like the most basic one.
• 33:41
  Francisco Gomez Torres: I think we do the, the f ourselves.
• 33:44
  Francisco Gomez Torres: Uh, I think there are doctors who are more, um, in a need of having everything, uh, but.
• 33:54
  Francisco Gomez Torres: I, I'm kinda, I don't want to get so, so used to this kind of technology that then I don't, I, I kind of forget how to make them traditionally because, well, another thing I would like to say is that apart from Mexico City, I do perform surgeries across the country.
• 34:16
  Francisco Gomez Torres: So I try to go, I don't know, maybe California, sometimes mores, maybe South Mexico.
• 34:24
  Francisco Gomez Torres: We do try to help in different ways, uh, to the people.
• 34:29
  Francisco Gomez Torres: Sometimes I do work, I perform surgeries with another, uh, surgeons who asked for my help.
• 34:36
  Francisco Gomez Torres: Were, were, um, kind of a, um, a Mexican, um, how do you say?
• 34:45
  Francisco Gomez Torres: We try to communicate to make things possible, but that's
• 34:48
  Joseph M. Schwab: Sure
• 34:49
  Francisco Gomez Torres: the way I don't have a robot
• 34:51
  Joseph M. Schwab: within the, okay.
• 34:53
  Joseph M. Schwab: Interesting.
• 34:54
  Francisco Gomez Torres: I do collaborate a lot.
• 34:56
  Joseph M. Schwab: do, do you, um, find difference in access to, to implants, different quality of implants depending on the place that you're operating at, whether it's public or private, or do you pretty much have the same type of implants available wherever you are?
• 35:15
  Francisco Gomez Torres: Unfortunately, I, I don't know if that's unfortunate, but no, I do have like a, a whole options of, um, implants.
• 35:25
  Francisco Gomez Torres: Uh, I do, I would like to say that I do have my favorites.
• 35:30
  Francisco Gomez Torres: You know, I do perform mostly with three kind of uh, implants But you know, if I am back in Mexico State and they got these, these prosthetics because of the budget, let's make it, you know, uh, so I think.
• 35:49
  Francisco Gomez Torres: That we do have to be also very, um, versatile with these kind of mires.
• 35:56
  Francisco Gomez Torres: If you get used to a single thing, um, it can be, you can get into a trouble later.
• 36:03
  Francisco Gomez Torres: Um, and maybe it's the time for me, maybe later, um, when, when I, uh, you know, um, base totally my, my practice into a single uh, thing, then I will start doing with only one implant, one kind of implant.
• 36:24
  Francisco Gomez Torres: But nowadays I'm trying from everything.
• 36:29
  Joseph M. Schwab: We, we have a question from one of our users on LinkedIn, um, about, specifically about implants, but about custom 3D titanium implants.
• 36:39
  Joseph M. Schwab: Wanting to know if you have any, um, experience with those implants, and if so, if you've encountered any challenges with them.
• 36:49
  Francisco Gomez Torres: Well, we do have a friend of us who is mostly into this.
• 36:54
  Francisco Gomez Torres: Um, with this technology, the thing that we have found is that after you have the cuts with have to be really specific through a TC for a C for example.
• 37:06
  Francisco Gomez Torres: Um, even when you perform.
• 37:11
  Francisco Gomez Torres: Very good.
• 37:11
  Francisco Gomez Torres: The surgery, um, you can't expect, you can expect everything because as it is a per a treat, d personalized, uh, a personalized, uh, system, you depend a lot in the activities this person is doing.
• 37:28
  Francisco Gomez Torres: We don't have the record of how this implant is going to work because it might be, it's so personalized that you can't have like rep reproducibility, um, of, of, um, how you say, um, cases before.
• 37:48
  Francisco Gomez Torres: No.
• 37:48
  Francisco Gomez Torres: So every case is different.
• 37:50
  Francisco Gomez Torres: We even have one day this, this person that, uh, the implant just came off from the, from IAC bone and we have to, to reenter and to, to fix it with more material, but you know.
• 38:09
  Francisco Gomez Torres: That was an experience we don't want to have again.
• 38:13
  Francisco Gomez Torres: And we have had more, um, a little bit more of experience with the trabecular implants that, um, you know, these, these, um, I, I did forgot the, the name, but we do have more, more practice with monds, with almonds.
• 38:34
  Francisco Gomez Torres: It's mostly more than 3D printed.
• 38:38
  Francisco Gomez Torres: Besides that it's expensive as well.
• 38:41
  Francisco Gomez Torres: The 3D printing thing.
• 38:43
  Francisco Gomez Torres: Yeah, I.
• 38:44
  Joseph M. Schwab: Um, we do have one, uh, user who commented on LinkedIn.
• 38:48
  Joseph M. Schwab: Um, and I'll, I'll just read the comment that I have here.
• 38:50
  Joseph M. Schwab: It says, I believe that the reality of the Mexican healthcare system is so similar to the rest of Latin America.
• 38:58
  Joseph M. Schwab: And so different from the American healthcare system where decisions often depend not on what the patient wants or what the surgeon prefers, but on what is available at the time of surgery in each case.
• 39:11
  Joseph M. Schwab: Is that your experience?
• 39:15
  Francisco Gomez Torres: Well, I have to say Joe, that I have heard that a lot of times.
• 39:21
  Francisco Gomez Torres: What about you?
• 39:22
  Francisco Gomez Torres: Do you find it like, uh, something crazy because yeah, it's a reality in the public service here in Mexico.
• 39:30
  Francisco Gomez Torres: Yeah.
• 39:30
  Francisco Gomez Torres: but I don't know.
• 39:31
  Francisco Gomez Torres: I don't know that maybe in Colombia is very different.
• 39:34
  Francisco Gomez Torres: Columbia is kind of more private thing.
• 39:38
  Joseph M. Schwab: Um, my, so my only experience operating in Latin America was in Nicaragua, um, where we had an opportunity to go, um, as an educational, um, exchange when we were residents and what I recall from the.
• 39:56
  Joseph M. Schwab: Uh, cases that.
• 39:58
  Joseph M. Schwab: we did in in Nicaragua, at least at the place where we did them, um, the patients had to buy the implants out of, out, basically out of pocket.
• 40:08
  Joseph M. Schwab: And so it was, you put in whatever they could afford, um, and if they couldn't afford, you took whatever you had that was, you know, on the shelf if there was something available or that could be donated by a company.
• 40:22
  Joseph M. Schwab: Um, but it was a, an exceptionally different situation than what I've experienced in the US healthcare system and certainly different than in the, in the Swiss healthcare system.
• 40:32
  Joseph M. Schwab: But it also sounds like it, that's a bit different.
• 40:34
  Joseph M. Schwab: Yeah, a bit different than what you experience in Mexico City.
• 40:39
  Francisco Gomez Torres: Yes, yes.
• 40:40
  Francisco Gomez Torres: I can say that.
• 40:42
  Francisco Gomez Torres: Well, here as, as the p as the population is growing, um, like never before.
• 40:50
  Francisco Gomez Torres: The, the, the population is still growing as fast as 30 years ago, maybe a little bit more.
• 40:57
  Francisco Gomez Torres: Um, the, the institutions, They get, uh, stuck into trouble.
• 41:03
  Francisco Gomez Torres: We even had, uh, like 15 years ago, the, how do you say, the pensions, the jubilations.
• 41:09
  Joseph M. Schwab: Yeah,
• 41:11
  Francisco Gomez Torres: They were, took off the, of the federal budget because it wasn't, um, possible affordable for the government to keep those payments.
• 41:21
  Francisco Gomez Torres: So nowadays, uh, we don't have jubilations anymore.
• 41:25
  Francisco Gomez Torres: It's something crazy.
• 41:26
  Francisco Gomez Torres: You will have to work until you, you, you are incapable of.
• 41:33
  Francisco Gomez Torres: But it's mostly because we don't have the budget already.
• 41:36
  Francisco Gomez Torres: So imagine if that's the way, uh, things are happening.
• 41:41
  Francisco Gomez Torres: You can expect anything from a public service, uh, to give you on, on a prosthetics.
• 41:48
  Francisco Gomez Torres: Yeah,
• 41:49
  Joseph M. Schwab: We have some great.
• 41:50
  Joseph M. Schwab: questions coming in.
• 41:51
  Joseph M. Schwab: I wanna read this one from Ancon,
• 41:53
  Francisco Gomez Torres: that's great.
• 41:54
  Joseph M. Schwab: orthopedic surgeon.
• 41:55
  Joseph M. Schwab: Um, what common mistakes do you see surgeons make early on in their anterior journey, and how can they avoid them?
• 42:04
  Joseph M. Schwab: What have you seen?
• 42:06
  Francisco Gomez Torres: Well, I would like to tell you, uh, uh, even I do feel like I am an, uh, I am a young surgeon on this.
• 42:15
  Francisco Gomez Torres: I'm not the most experimented, uh, but I am on my cure already.
• 42:22
  Francisco Gomez Torres: I think one of the biggest mistakes was not, Um, not, not to locate the right, um, intermuscular, um, segment.
• 42:35
  Francisco Gomez Torres: You know, sometimes I was a little bit anteriorly, a little bit more, or in the, in the later cases I was creating a little bit posterior.
• 42:47
  Francisco Gomez Torres: So nowadays I do have like this kind of metric, uh, not only with hands, but also with the feeling.
• 42:54
  Joseph M. Schwab: Mm-hmm.
• 42:55
  Francisco Gomez Torres: And I do, um, now I, I can initiate my approach just right in the way, in the place I wanted to.
• 43:05
  Francisco Gomez Torres: To make a little flip of the fascia.
• 43:08
  Francisco Gomez Torres: That's the way to be.
• 43:10
  Francisco Gomez Torres: I don't know you if you have any trouble, um, because I think the approach is the 60% of the surgery, you know, the implants, you know, when they are well located, uh, to exposure, expose the femoral is another thing I would like to discuss.
• 43:29
  Francisco Gomez Torres: But, uh, I think mostly it's the approach.
• 43:32
  Francisco Gomez Torres: You have to be real secure in the approach and then the surgery will just flow as you want it to.
• 43:38
  Joseph M. Schwab: The, I would say the biggest mistake that I see early learners, um, make in anterior approach is, um, some of them, some of them don't understand how many people have come before them and have made the exact same mistakes they've made.
• 43:56
  Joseph M. Schwab: And they feel like with, as successful as anterior approach is that if they talk about anything they're having trouble with or that they're, uh, you know, a mistake that they've made or a difficulty that they've encountered, that they would somehow be looked down on when, what I have found, at least with the anterior hip foundation.
• 44:15
  Joseph M. Schwab: Is a community of people who have made every single mistake that you can make with an anterior approach and would love to talk to anybody who is struggling, um, so that they can help them through it.
• 44:28
  Joseph M. Schwab: Um, and it, it's the, the idea that you need to hide things that, um, are difficult for you, um, until you just get enough cases under your belt and they get better.
• 44:38
  Joseph M. Schwab: Um, there are people who, who are out there who can help you.
• 44:41
  Joseph M. Schwab: And, um, you're an example of how you do this.
• 44:45
  Joseph M. Schwab: You reach out and you, you you know, You cross boundaries, you cross borders, you cross, uh, uh, cultures and, um, you try and find answers to the problems that you're encountering and the questions that You have.
• 44:59
  Joseph M. Schwab: Um, another question came in.
• 45:01
  Joseph M. Schwab: What specifically, specifically do you think needs to happen for anterior approach hips to become more common and even widespread across all of Mexico?
• 45:17
  Francisco Gomez Torres: What will be?
• 45:18
  Francisco Gomez Torres: Hmm.
• 45:19
  Francisco Gomez Torres: I do think that, you know, an actualization in education, it's a must because if you, if you, you enter a fellow, okay.
• 45:31
  Francisco Gomez Torres: You enter into a hip reconstructive fellow, okay?
• 45:35
  Francisco Gomez Torres: But the teachers are doing lateral approach.
• 45:39
  Francisco Gomez Torres: And then the fellow ask, can we do maybe one anteriorly?
• 45:46
  Francisco Gomez Torres: But your, the practitioner doesn't, doesn't even know it.
• 45:51
  Francisco Gomez Torres: Or maybe they have here only bad, um, bad, uh, reviews about the anterior approach, and they are not trying to excel this myth.
• 46:01
  Francisco Gomez Torres: No, I hear that.
• 46:02
  Francisco Gomez Torres: It was like a crazy approach.
• 46:05
  Francisco Gomez Torres: Oh, no, it's not, it's not any better than the lateral or the posterior, just because they heard from somebody that heard.
• 46:14
  Francisco Gomez Torres: So I think that's the most, the mo the very most important, um, issue is to make an actualization or, or to improve, um, to make it put it on the table as an option.
• 46:31
  Joseph M. Schwab: The education, specifically the education.
• 46:34
  Joseph M. Schwab: So how, how it does, and I'm gonna ask a little more detail about this, because one, I
• 46:41
  Francisco Gomez Torres: What?
• 46:41
  Francisco Gomez Torres: One thing.
• 46:42
  Francisco Gomez Torres: One thing?
• 46:43
  Francisco Gomez Torres: Yeah.
• 46:43
  Francisco Gomez Torres: Yeah.
• 46:44
  Francisco Gomez Torres: I got you.
• 46:44
  Francisco Gomez Torres: I got you.
• 46:45
  Francisco Gomez Torres: Just to add a little bit, maybe for example, I am, I am, unfortunately, I don't have like, uh, a program to teach now or maybe the friends of mind who are working as freelancers or their own bosses.
• 47:04
  Francisco Gomez Torres: We don't have, like this program, a specific program of, of fellows, but we have, we we're avid to learn the entire week.
• 47:14
  Francisco Gomez Torres: Well, I think this has to be into a program.
• 47:20
  Francisco Gomez Torres: There are no programs where the entire approach is teach.
• 47:24
  Francisco Gomez Torres: I think that's the.
• 47:27
  Francisco Gomez Torres: Most important thing, the, the, the time one teacher starts performing Ontario, people will go there and try to learn, you know, as I did in Nashville, as I, as we are all doing.
• 47:42
  Joseph M. Schwab: And I remember early on, so nowadays in, in the US and certainly both in the US and in Europe, it's quite common for any of the fellowships that, you go to to learn hip surgery, you're gonna learn anterior approach.
• 47:58
  Joseph M. Schwab: That's very common at, at many, many fellowships.
• 48:00
  Joseph M. Schwab: But when I was learning, there were not as many fellowships that were offering that as a regular opportunity.
• 48:07
  Joseph M. Schwab: And the education was mostly coming from partnership with industry.
• 48:12
  Joseph M. Schwab: Is that something that you can do in Mexico before the, the, the, teachers, so to speak?
• 48:19
  Joseph M. Schwab: Um, take it on as can industry be a help in that?
• 48:23
  Francisco Gomez Torres: Of course, I think that, uh, every time I do approach with a, with a rep, uh, and they just start talking me about, uh, their new hip system, it's okay, hey, oh, it's really great.
• 48:38
  Francisco Gomez Torres: This, it has, uh, trabecular metal, it hydroxy appetite, it has, uh, beamin, um, uh, how you say Polyol?
• 48:49
  Francisco Gomez Torres: And I say, is it possible to make it anteriorly or do you have any special instruments to make it a pro, um, anteriorly?
• 48:59
  Francisco Gomez Torres: And they say no, or they say yes.
• 49:02
  Francisco Gomez Torres: You know?
• 49:03
  Francisco Gomez Torres: So I think that's.
• 49:05
  Francisco Gomez Torres: The way I, I think the reps can get into this to making, um, the, the tools perfect for their implants or, or to make them unter.
• 49:17
  Francisco Gomez Torres: I do now have, for example, I was talking with, uh, nowadays with a, a new rep I haven't here before, and they are bringing a Korean, Korean, I think it is, uh, hip prosthetics, uh, that has its own instrumental to do with anteriorly.
• 49:36
  Francisco Gomez Torres: It's the first one I haven't, I have here, uh, hurt that is not American, for example.
• 49:42
  Francisco Gomez Torres: So, or, or, or like the bad, I dunno if we are, are able to talk, uh, about
• 49:50
  Joseph M. Schwab: Hip Foundation, we are, we are free to use, uh, product names and in fact, we encourage it.
• 49:58
  Francisco Gomez Torres: great.
• 49:58
  Francisco Gomez Torres: That's great because
• 49:59
  Joseph M. Schwab: is, how's anyone gonna know what you're using?
• 50:01
  Joseph M. Schwab: If you say, ah, I use this, and then they find something that looks like that.
• 50:06
  Joseph M. Schwab: But maybe, I mean, use the name, it makes sense.
• 50:09
  Francisco Gomez Torres: Yeah.
• 50:09
  Francisco Gomez Torres: Yeah.
• 50:10
  Francisco Gomez Torres: For example, I, yeah,
• 50:12
  Joseph M. Schwab: you, I was gonna say, you're c we know, we received a comment, uh, as you were speaking from, uh, David Ktu Morales, who says, um, exactly the point that you were making.
• 50:21
  Joseph M. Schwab: We need more surgeons performing this approach so that the implant companies start requesting the necessary implants and tools, even if they requested them today, the Mexican FDA, which he says Kofa PRIs, if that's, if I'm pronouncing that correctly, takes between three to five years to approve them.
• 50:43
  Joseph M. Schwab: So, just to give an example, trabecular metal only became available in Mexico about five or six years ago.
• 50:49
  Joseph M. Schwab: So if we want to have.
• 50:51
  Joseph M. Schwab: For instance, the Actis stem, uh, collared implants, it'll likely take another three to five years before they arrive.
• 50:58
  Joseph M. Schwab: So that sounds like exactly the point you were making.
• 51:01
  Joseph M. Schwab: There needs to be this, um, relationship with industry to get the technology in And the implants in to facilitate the approach.
• 51:10
  Joseph M. Schwab: So, so working with industry seems to make a ton of sense.
• 51:15
  Francisco Gomez Torres: Yeah, I do remember, I do remember we had a talk, uh, a couple of weeks, uh, before, on a Saturday,
• 51:24
  Joseph M. Schwab: Mm-hmm.
• 51:24
  Francisco Gomez Torres: a Sunday.
• 51:25
  Francisco Gomez Torres: I was, I was talking to you that, uh, a Johnson and Johnson, uh, rep came to me to say, Hey, you have a great time at, at, uh, Palm Beach.
• 51:35
  Francisco Gomez Torres: Right?
• 51:36
  Francisco Gomez Torres: Uh, we met you there.
• 51:37
  Francisco Gomez Torres: Yeah.
• 51:38
  Francisco Gomez Torres: And he was talking, we were talking about the, the, I invite him to the, to the office and he showed me the implants he have and stuff.
• 51:48
  Francisco Gomez Torres: And as I was talking with him, because.
• 51:53
  Francisco Gomez Torres: I attend to a palm beach in a neo course where we had some kind of tech, you know, some kind of hip replacements, some kind of knee replacements, which were very similar but different to the ones we used in Nashville, for example, in Nashville with, we use the Sise.
• 52:14
  Francisco Gomez Torres: He was asking me is the number one and or number two, and then we research.
• 52:19
  Francisco Gomez Torres: But for example, and I, I, I asked him, why don't we have Sise in Mexico?
• 52:25
  Francisco Gomez Torres: And he says, he said like, Ooh, doctor First and Mexico, you should, you should seek for Chile or Brazil, where the FDA from those countries is not as bureaucratic as the Mexican one is.
• 52:43
  Francisco Gomez Torres: So he.
• 52:44
  Francisco Gomez Torres: If, if that was his first comment is because it's a very, uh, hard thing to make to introduce these implants into a country.
• 52:56
  Francisco Gomez Torres: So he said you are like 10 years behind.
• 53:00
  Francisco Gomez Torres: Chile might be five, Brazil may be three, and then it's Mexico.
• 53:05
  Francisco Gomez Torres: Uh, you know, so, so you should start looking what's happening in Colomb or Chile to see what's coming to Mexico.
• 53:11
  Francisco Gomez Torres: It's like really?
• 53:13
  Francisco Gomez Torres: Do they have king size there now?
• 53:14
  Francisco Gomez Torres: So king size is coming maybe in 20, I don't know, but
• 53:18
  Joseph M. Schwab: it's, yeah.
• 53:18
  Francisco Gomez Torres: like some kind of
• 53:20
  Joseph M. Schwab: It's kinda like you have a little bit of time machine you get to see into the future a little bit.
• 53:24
  Joseph M. Schwab: It's just, uh, it's unfortunately the present for others.
• 53:27
  Joseph M. Schwab: But, um, and so I know I, I do, uh, we've been, um, talking for, uh, for almost 50 minutes now, which is great, and I, I, but I want to see, I know you had mentioned you had some questions for me and so I wanted to be respectful of your time and I'm happy to answer any questions that you might have.
• 53:47
  Francisco Gomez Torres: Thanks a lot Joe.
• 53:49
  Francisco Gomez Torres: I mean, I don't want to to extend this that much, but I would really like to ask you as a leader you are because, well, people that follows the HF already know that you are.
• 54:04
  Francisco Gomez Torres: Now you are the ex-president of, of past president from the a HF, but I would like to know how was your, um, how would you say, mandate, what did you, how did you feel with your mandate for an institution?
• 54:20
  Francisco Gomez Torres: Well, uh, uh, foundation that it's, um, kind of junk as we might say, without with these, um, eight years nowadays is having the EHF and if you have some, uh, issues through it, or how was it possible that you, you got to be a president?
• 54:43
  Joseph M. Schwab: Yeah.
• 54:44
  Joseph M. Schwab: Um, well, so you know, the question about the mandate and, and the, the organization itself and its youth, youth and inexperience in an organization comes with some benefits and some drawbacks.
• 54:59
  Joseph M. Schwab: And the benefits are, are great.
• 55:02
  Joseph M. Schwab: You don't know what you don't know.
• 55:03
  Joseph M. Schwab: And so you oftentimes take on things that, um, uh, maybe somebody who's a little more experienced or a little wiser would say, I wouldn't do that.
• 55:13
  Joseph M. Schwab: But you do it and it ends up, uh, you know, sometimes being a, a big success.
• 55:18
  Joseph M. Schwab: Um, we have always focused, um, our main thrust, uh, for the A HF has always been the annual, uh, meeting, um, which every year continues to, to grow and grow in popularity, in size, in, um, offerings.
• 55:36
  Joseph M. Schwab: And that's, you know, my mandate for this year was to continue that trajectory.
• 55:42
  Joseph M. Schwab: Um, and the one thing I'll say that all of us in the leadership, uh, team of the A HF, and we have so many fantastic people, um, you know, helping us.
• 55:54
  Joseph M. Schwab: Uh, and I mean, I can, I, I can embarrass them all by name, but they know who they are, um, who do amazing things to put that, that meeting on.
• 56:04
  Joseph M. Schwab: Um, but you know, the goal of continuing that meeting, growing it, um, and trying something a little bit new or a little bit different every year, um, this is the first, I would say within the last two years is the first time that the entire leadership.
• 56:25
  Joseph M. Schwab: Team has felt like, um, whether we do anything or not, the a HF will continue.
• 56:32
  Joseph M. Schwab: Like it's, it has, it's not a mature organization, but it's gotten to the point of maturity where it's a, it's a train that's moving along the track and it would take some effort to stop it at this point.
• 56:44
  Joseph M. Schwab: So we, we all feel very comfortable with where we're moving.
• 56:47
  Joseph M. Schwab: As an organization, um, I am exceptionally proud of the fact that we get to hand over the reins to Dr.
• 56:54
  Joseph M. Schwab: Charles Lowry, who is my vice president.
• 56:57
  Joseph M. Schwab: Um, he's an incredibly skilled, uh, gifted surgeon.
• 57:02
  Joseph M. Schwab: He's an incredible person.
• 57:03
  Joseph M. Schwab: He's an incredible visionary.
• 57:06
  Joseph M. Schwab: Um, and I, I couldn't think of a better person to hand the organization off to.
• 57:11
  Joseph M. Schwab: And it, it's, it next year is only gonna get better.
• 57:14
  Joseph M. Schwab: And I don't know how, and I don't know why, and I don't know, I don't know when, but it's going, it's gonna just keep getting better and better.
• 57:22
  Joseph M. Schwab: So it's, it's been a, it's been one of my professional highlights, um, of my career is to, to be honored to, to work with the people at the Anterior Hip Foundation.
• 57:34
  Francisco Gomez Torres: That's so great to, to hear the, the ne The next question will be, uh, what did you see for the future of the A HF?
• 57:44
  Francisco Gomez Torres: Where is it pointing?
• 57:45
  Francisco Gomez Torres: Because we did have, uh, like this European meeting last month, so I would like to know, how do you say, do you, would you see the a HF maybe in the next five years or any point you would like to, you know, figure
• 58:03
  Joseph M. Schwab: Well, the, the good news about being the, the immediate past president is I get to say all sorts of wild and crazy things that we could do in the next five years.
• 58:12
  Joseph M. Schwab: And I have to, I get to rely on a whole other group of people to make it happen.
• 58:16
  Joseph M. Schwab: But, um, you know,
• 58:18
  Francisco Gomez Torres: not pressure, but
• 58:19
  Joseph M. Schwab: there's no pressure.
• 58:21
  Joseph M. Schwab: I, I mean, we, we have a, we have a vision to, to, um.
• 58:27
  Joseph M. Schwab: You know, kind of take a page from you and expand, uh, our outlook internationally.
• 58:33
  Joseph M. Schwab: Um, and whether that's through direct collaborations or support of other organizations or, um, whether it's through, you know, directly creating organizations in different regional areas.
• 58:45
  Joseph M. Schwab: Um, we haven't quite figured that out yet.
• 58:47
  Joseph M. Schwab: But, you know, there were a number of us from the leadership team at the A HF who were at the European anterior hip meeting, um, and participated as the faculty.
• 58:57
  Joseph M. Schwab: It was, um, a great experience talking with the European surgeons.
• 59:02
  Joseph M. Schwab: It was a great, um, it felt very much like the same sort of, um, collegial family environment that we, uh, put on for the A HF.
• 59:12
  Joseph M. Schwab: Um, I know there's interest in doing this in, in Latin America, in South America, there's been tremendous interest from the ocean region and Australia and New Zealand.
• 59:23
  Joseph M. Schwab: Um, and, you know,
• 59:25
  Francisco Gomez Torres: The Australians are, for example, a big, big, uh, team, right?
• 59:31
  Francisco Gomez Torres: Uh, the entire, uh, approach is happening a lot in Australia, as I can see.
• 59:35
  Joseph M. Schwab: they're almost 40% anterior approach.
• 59:38
  Joseph M. Schwab: Yeah.
• 59:39
  Joseph M. Schwab: Um, and you know what, I know I'm answering questions, but I just got one that came in on LinkedIn that I, I'm curious to hear your thoughts on.
• 59:47
  Joseph M. Schwab: Do you have experience, I'm doing anterior approach through a bikini incision, and, uh, that's question, that's the first part of the question.
• 59:55
  Joseph M. Schwab: And the second part is, can you give from your perspective, um, uh, an outlook on computer assisted or computer navigated a hip replacement surgery in Mexico and Latin America?
• 1:00:09
  Joseph M. Schwab: So bikini incision and computer assisted computer navigated
• 1:00:15
  Francisco Gomez Torres: Well, I can tell you, that about talking about the, the bikini incision.
• 1:00:19
  Francisco Gomez Torres: I even had got a, a earlier discussion through LinkedIn with you where we were discussing should it be, you know, like horizontal, uh, vertical, uh, you know, angulated with a, a Glip.
• 1:00:35
  Francisco Gomez Torres: So as you, I would like to, to pick this, uh, quest.
• 1:00:40
  Francisco Gomez Torres: These, um, words you told me that is not what the incision is creating is that you have to understand that there has been plenty of patients, a lot, millions, if not, that are having better results in any kind of incision is not the incision for start.
• 1:01:06
  Francisco Gomez Torres: Now if you are asking about, um, the issues one or the, or the other, have, we can say that the, the vertical incision, it, uh, break more longer hands lines.
• 1:01:20
  Francisco Gomez Torres: So there might, there you can expect a little bit more of, uh, healing tissue issues, but doing it, uh, through a bikini incision, it might be, you know, you might attend to that question, but, um, the bikini incision is not, uh, extent of having, uh, cutaneous problems also, you know, but it might be a little bit more aesthetic because you are close to the, to the, the part where the skin, uh, faults.
• 1:01:56
  Francisco Gomez Torres: But I mean, it's not the most important, uh, part of the surgery and.
• 1:02:03
  Francisco Gomez Torres: To, to, to close that question, I would like to say that you have to be comfortable with the, the work you are having.
• 1:02:10
  Francisco Gomez Torres: You have to, to think in what's happening inside or even deeper.
• 1:02:17
  Francisco Gomez Torres: And the bikinis just, well, the signature, you know, that you will keep performing bare day by day.
• 1:02:24
  Joseph M. Schwab: You, you have to know what you're doing under the skin and to make the, the quality of the incision be the deciding factor about
• 1:02:33
  Francisco Gomez Torres: yeah,
• 1:02:34
  Joseph M. Schwab: or not.
• 1:02:34
  Joseph M. Schwab: yeah.
• 1:02:34
  Joseph M. Schwab: I agree.
• 1:02:36
  Joseph M. Schwab: Uh, and how about computer navigation?
• 1:02:38
  Francisco Gomez Torres: Yeah.
• 1:02:39
  Francisco Gomez Torres: Well, I do, I, I, I haven't been able to, to perform a robotic assisted surgery with a direct anterior approach, but I do have some colleagues that are doing it right now with the Macco system.
• 1:02:52
  Francisco Gomez Torres: I can't even tell you that.
• 1:02:54
  Francisco Gomez Torres: Uh, a month ago, the, first Rosa Hip, uh, surgery was performed at the very next door of a surgery I was having.
• 1:03:03
  Francisco Gomez Torres: So, and it was another colleague of mine who I do anterior approaches with him sometimes, but, um, I, I do know the patient is going excellent through with that system and with that direct anterior approach, it is possible about doing, um, uh, navigation.
• 1:03:26
  Francisco Gomez Torres: Surgeries.
• 1:03:26
  Francisco Gomez Torres: I haven't done it, done them.
• 1:03:29
  Francisco Gomez Torres: I think, um, I don't know.
• 1:03:31
  Francisco Gomez Torres: Well, my generation is not looking forward a lot into navigating, but we do are, we are having the whole attention to the robotics, um, issue.
• 1:03:47
  Francisco Gomez Torres: Maybe I even have well in, in between my eyes.
• 1:03:53
  Francisco Gomez Torres: The case of Dr.
• 1:03:54
  Francisco Gomez Torres: Za and the team in use, he is, uh, developing to, instead of having like this whole robotic arm, you just have your machine gun in the hands and perform the surgery.
• 1:04:09
  Joseph M. Schwab: Do.
• 1:04:09
  Joseph M. Schwab: Uh, I'm curious, do you think it's more likely that an implant company or that a, a company like a Johnson and Johnson or Zimmer Biomet, um, would be more likely to bring down a robot to Mexico than they would a new set of implants?
• 1:04:25
  Joseph M. Schwab: Um, it it just because of the size, uh, and impact that, that might have.
• 1:04:31
  Joseph M. Schwab: Because I, I'm curious to hear that you have Rosa, but you don't have concise, and you just got trabecular metal five years ago.
• 1:04:38
  Joseph M. Schwab: You know, that's, that's interesting.
• 1:04:39
  Joseph M. Schwab: Right?
• 1:04:41
  Francisco Gomez Torres: Yeah, that's the way the cocky crumble is as somebo, somebody said.
• 1:04:47
  Francisco Gomez Torres: But, uh, I think, I think, uh, I would like to take your words again, doctor, because I, as I told you before, you are like a mentor in a center certain, certain remote way.
• 1:04:59
  Francisco Gomez Torres: I think the most important thing must be to have a centered approach, uh, uh, centered patient approach.
• 1:05:08
  Francisco Gomez Torres: It's not about the tech.
• 1:05:10
  Francisco Gomez Torres: It's not about the market.
• 1:05:12
  Francisco Gomez Torres: It's not about the new robot, the new hip, the, the new implant.
• 1:05:16
  Francisco Gomez Torres: It's if the patient is having better results, we should do it.
• 1:05:22
  Francisco Gomez Torres: If it's just because there is a new robot on the market.
• 1:05:28
  Francisco Gomez Torres: That's not the objective or, or the reason why the robots should come here or the new set of implants.
• 1:05:37
  Francisco Gomez Torres: If we have the evidence that is working.
• 1:05:40
  Francisco Gomez Torres: Okay.
• 1:05:41
  Francisco Gomez Torres: There is a, there is a reason to, but if you're having the robot and your results are being just even uglier than the traditional approach, well maybe it's not what you have to be looking for.
• 1:05:56
  Francisco Gomez Torres: Right?
• 1:05:57
  Francisco Gomez Torres: So,
• 1:05:58
  Joseph M. Schwab: Interesting.
• 1:05:59
  Joseph M. Schwab: Well,
• 1:06:00
  Francisco Gomez Torres: yeah.
• 1:06:01
  Joseph M. Schwab: Dr.
• 1:06:01
  Joseph M. Schwab: Gomez Torres, I wanna thank you for, for really actually being kind of our test subject right on doing, uh, a live a HF podcast and engaging, uh, with a live audience.
• 1:06:15
  Joseph M. Schwab: We've had, uh, you know, a pretty steadily, about 15 to 20 people watching us.
• 1:06:21
  Joseph M. Schwab: We've had, I think, some excellent comments and questions, uh, from our users.
• 1:06:26
  Joseph M. Schwab: And, um, I, I just want to encourage you, everything you've been doing to engage with the international orthopedic community, uh, I want to say you're an inspiration to, to other surgeons, and I would encourage you to keep doing what you're doing keep fighting the good fight.
• 1:06:45
  Francisco Gomez Torres: Thanks a lot Joe.
• 1:06:46
  Francisco Gomez Torres: It's such an honor to be part of your guests.
• 1:06:50
  Francisco Gomez Torres: Guests.
• 1:06:51
  Francisco Gomez Torres: Now, I can't say, um, that maybe having a podcast and do these international, uh, meetings, um, you know, to get some friends and stuff will take me to this place now, now.
• 1:07:06
  Francisco Gomez Torres: I wouldn't imagine that.
• 1:07:08
  Francisco Gomez Torres: So I'm really, um, thankful with you, with, uh, Lila, with all the whole a HF for the Oracle Fellowship, everything, because these things happened.
• 1:07:21
  Francisco Gomez Torres: Just because you are not seated waiting for the date to pass, you have to keep pushing forward.
• 1:07:27
  Francisco Gomez Torres: So I do, um, would like to say once, once again, thank you for hearing and thank you for having a feedback, a feedback for me and well, Latin America.
• 1:07:38
  Francisco Gomez Torres: I hope they, they hear your words.
• 1:07:41
  Joseph M. Schwab: I, I, I hope they hear your words, and I'm gonna take a moment to bring Lila on.
• 1:07:46
  Joseph M. Schwab: Um, just to thank her for, uh, doing this in the background.
• 1:07:51
  Joseph M. Schwab: Lila, thank you for, uh, for, uh, being on the, the podcast.
• 1:07:57
  Joseph M. Schwab: Oh.
• 1:07:57
  Joseph M. Schwab: Have you muted yourself?
• 1:07:58
  Joseph M. Schwab: Uh, excellent.
• 1:08:00
  Joseph M. Schwab: Um,
• 1:08:02
  Lilah Menashe: Can you hear now?
• 1:08:03
  Joseph M. Schwab: now we can hear
• 1:08:04
  Lilah Menashe: Oh yeah.
• 1:08:04
  Lilah Menashe: Hi.
• 1:08:07
  Lilah Menashe: It was such a pleasure working together and, you know, looking for different topics to discuss today.
• 1:08:12
  Lilah Menashe: Uh, you were very committed, Dr.
• 1:08:14
  Lilah Menashe: Gomez Torres, so I really appreciate it.
• 1:08:17
  Lilah Menashe: So, for all our listeners, it took a little bit of work and effort from all us to put it together.
• 1:08:22
  Lilah Menashe: So I, I just hope you enjoyed it.
• 1:08:25
  Joseph M. Schwab: and we
• 1:08:26
  Francisco Gomez Torres: Even, the earthquake,
• 1:08:27
  Joseph M. Schwab: to do it again.
• 1:08:28
  Joseph M. Schwab: Yeah.
• 1:08:29
  Joseph M. Schwab: Even through an earthquake.
• 1:08:30
  Joseph M. Schwab: Oh my gosh.
• 1:08:31
  Joseph M. Schwab: I hope everybody's okay.
• 1:08:33
  Joseph M. Schwab: All right.
• 1:08:35
  Joseph M. Schwab: Thank
• 1:08:35
  Francisco Gomez Torres: was the announcement that the HIV was happening right now.
• 1:08:39
  Joseph M. Schwab: That's created the earthquake.
• 1:08:41
  Joseph M. Schwab: Well, thank you Dr.
• 1:08:42
  Joseph M. Schwab: Gomez Torres.
• 1:08:43
  Joseph M. Schwab: Thank you, Lila.
• 1:08:45
  Joseph M. Schwab: Um, I'm gonna, yeah, we'll do this here.
• 1:08:48
  Joseph M. Schwab: And, um, I just want to say thank you, all of you, uh, for joining us for this live episode of the A HF podcast.
• 1:08:58
  Joseph M. Schwab: And if you can please take a moment to like and subscribe.
• 1:09:03
  Joseph M. Schwab: You'd be helping us find more people just like you to share this type of content with.
• 1:09:09
  Joseph M. Schwab: And if you have any ideas for a future episode or topics you wanna see us discuss from any portion of the world, drop it in the comments below.
• 1:09:19
  Joseph M. Schwab: You can find our normal episodes of the a HF podcast on Apple Podcasts, Spotify, or in any of your favorite podcast apps, as well as in video form on YouTube slash at anterior hip foundation.
• 1:09:35
  Joseph M. Schwab: All one word.
• 1:09:37
  Joseph M. Schwab: New episodes of the A HF Podcast come out on most Fridays.
• 1:09:42
  Joseph M. Schwab: I'm your host, Joe Schwab, asking you to help keep the hips in Latin America and wherever you are happy and healthy.
• 1:09:50
  Joseph M. Schwab: I.