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Interview: Charles M. Lawrie, MD · AHF Podcast

• 0:05
  Joseph M. Schwab: On today's episode of the AHF podcast, we have Dr.
• 0:08
  Joseph M. Schwab: Charles Lawrie, an orthopedic surgeon at Baptist Health in South Florida, and, thankfully for me, the vice president of the Anterior Hip Foundation and an excellent partner in helping run the AHF.
• 0:25
  Joseph M. Schwab: Charles, welcome.
• 0:27
  Charles M. Lawrie: Thanks, Joe.
• 0:27
  Charles M. Lawrie: Thanks for having me.
• 0:28
  Charles M. Lawrie: Good to see you this morning.
• 0:29
  Joseph M. Schwab: First of all, give me a little bit of background about your, education and training.
• 0:34
  Joseph M. Schwab: I think you did your fellowship at Wash U, is that right?
• 0:37
  Charles M. Lawrie: Yeah that's right.
• 0:39
  Charles M. Lawrie: I'm originally from Houston, Texas.
• 0:42
  Charles M. Lawrie: I did my medical school there at Baylor college of medicine.
• 0:45
  Charles M. Lawrie: I did residency in Miami, Florida, university of Miami, and then ended up in the Midwest at Washington university in St.
• 0:51
  Charles M. Lawrie: Louis, for fellowship.
• 0:53
  Charles M. Lawrie: had a fantastic year of training there, where I really got my bulk of my initial exposure to anterior approach.
• 1:01
  Charles M. Lawrie: and then I was lucky enough to be invited to stay on as faculty, which I did for a few years.
• 1:06
  Charles M. Lawrie: my wife and I couldn't tolerate the Midwest weather much longer.
• 1:11
  Charles M. Lawrie: after a couple of years there, we, headed back down to Miami, Florida, which is where I'm currently in practice.
• 1:16
  Joseph M. Schwab: So tell me a little bit about your exposure to answer your approach at Wash U, because was it mostly with Clohisy or who is it with?
• 1:24
  Joseph M. Schwab: And tell me a little bit about that.
• 1:26
  Charles M. Lawrie: Yes, I guess I should back up a little bit.
• 1:28
  Charles M. Lawrie: I did get a little bit of exposure, in residency at University of Miami, with, Michaela Schneiderbauer, as well as, Victor Hernandez, both of whom were doing predominantly off table anterior approach hips on a standard OR table.
• 1:43
  Charles M. Lawrie: but the exposure is pretty limited, as a resident, you're more seeing than doing, you don't really get a flavor for the real procedure in detail.
• 1:52
  Charles M. Lawrie: so in fellowship, like I said, it was when I really got my, bulk of my initial exposure, and that was through John Clohisy and he does the procedure, on a split pegboard and a lateral position, similar to like how someone would do a Watson Jones, ABMS type procedure.
• 2:09
  Charles M. Lawrie: but actually utilizing the, the modified Smith Peterson interval that we use for direct anterior approach.
• 2:15
  Charles M. Lawrie: so that's how I came out of fellowship training and started doing them in my practice.
• 2:20
  Charles M. Lawrie: and I realized, although it was, a very good procedure, it was very efficient to do it that way.
• 2:27
  Charles M. Lawrie: I think I was feeling I was missing out on some of the benefits of interior approach, which, in my opinion, are supine positioning of the patient, reliable pelvic positioning in that supine position.
• 2:39
  Charles M. Lawrie: Also, the supine positioning, allowing the use of fluoroscopy, and all the wonderful tools that lets us use.
• 2:47
  Charles M. Lawrie: and then, furthermore, the, traction table, of course, which we all love.
• 2:51
  Charles M. Lawrie: so I started exploring ways to, transition out of that lateral position into, the more mainstream, interior approach.
• 3:01
  Charles M. Lawrie: I tell people in training courses that I teach at, I've literally done anterior approach.
• 3:05
  Charles M. Lawrie: I think every single way you can do it.
• 3:07
  Charles M. Lawrie: I started in the lateral position.
• 3:09
  Charles M. Lawrie: I started doing it off table with, without a hook.
• 3:12
  Charles M. Lawrie: I started doing it off table with one of those.
• 3:14
  Charles M. Lawrie: hooks you put on the table.
• 3:15
  Charles M. Lawrie: And then finally, I went to go see someone do it on a Hana table.
• 3:20
  Charles M. Lawrie: and it was just like, everything clicked all of a sudden.
• 3:22
  Charles M. Lawrie: And I said, this is the way I've got to do it.
• 3:24
  Charles M. Lawrie: I convinced the hospital to buy a table.
• 3:26
  Joseph M. Schwab: When you finally, obviously probably the evolution of your, performing anterior approach hip replacement is not done, right?
• 3:35
  Joseph M. Schwab: But when you went that dramatic change from the lateral position to the supine position, what would you say was the biggest challenge that you encountered?
• 3:43
  Joseph M. Schwab: And what was the biggest advantage that you encountered?
• 3:47
  Charles M. Lawrie: You know, the lateral position has its own struggles and own benefits just like doing any surgical procedure.
• 3:52
  Charles M. Lawrie: In particular, the lateral position was great for femoral exposure because you can really get a great angle especially if do a little bit of the hyperextension of the bed.
• 4:05
  Charles M. Lawrie: and it was like that on steroids when you were in the lateral position.
• 4:08
  Charles M. Lawrie: Cause you could, you could adduct the operative leg way behind the other leg and the femur would just pop right up.
• 4:15
  Charles M. Lawrie: Like I remember I'd go to meetings and hear people talk about, Oh, anterior approach, the femurs, the problem, the femoral exposure is so hard.
• 4:22
  Charles M. Lawrie: I was thinking to myself, what the heck are these people talking about?
• 4:25
  Charles M. Lawrie: like the femur is so easy from an anterior approach, but I didn't really get it until I started doing the procedure, on supine position on a regular table or Hana table where I was like, okay, you got to work just a little bit more to get that exposure that I was used to.
• 4:38
  Charles M. Lawrie: the downside of that was it.
• 4:40
  Charles M. Lawrie: Because you're adducting it so hard.
• 4:43
  Charles M. Lawrie: I felt like the tensor maybe took a little bit more of a beating, because you were really retracting hard on that muscle belly.
• 4:50
  Charles M. Lawrie: so I did notice that when I switched to a supine position, the tensor usually looked a little bit prettier, more pristine at the end of the approach,
• 4:57
  Joseph M. Schwab: And do you think the way you approached it from a supine position was affected by what you learned while, while doing it in the lateral position?
• 5:06
  Charles M. Lawrie: just learning the anatomy.
• 5:08
  Charles M. Lawrie: the basics of the approach, how to actually get down to the hip, anatomy of capsule releases.
• 5:14
  Charles M. Lawrie: all of that foundation was instilled in me by Dr.
• 5:17
  Charles M. Lawrie: Clohisy during my training.
• 5:19
  Charles M. Lawrie: So I was able to take that and translate it, into that more traditional way we do things.
• 5:24
  Charles M. Lawrie: Now.
• 5:25
  Charles M. Lawrie: I just had to turn my head sideways for a couple of months while I was looking at things.
• 5:29
  Joseph M. Schwab: I'm sure that was, had its own brand of disorientation to it.
• 5:33
  Joseph M. Schwab: So now you're down in Miami, you're doing a primarily a total joints practice down there.
• 5:38
  Joseph M. Schwab: Is that correct?
• 5:39
  Joseph M. Schwab: Hips and knees.
• 5:40
  Joseph M. Schwab: Yes.
• 5:40
  Charles M. Lawrie: Yeah.
• 5:41
  Charles M. Lawrie: I'm about 50, 50, total hip, total
• 5:43
  Joseph M. Schwab: Okay.
• 5:44
  Joseph M. Schwab: And primary and revision or, mostly sticking to primaries.
• 5:47
  Joseph M. Schwab: How does that shake out in your practice?
• 5:50
  Charles M. Lawrie: I'm about a 15 percent revision.
• 5:54
  Charles M. Lawrie: that's mostly what I call it kind of bread and butter type provisions, headliner exchanges for wear loose cups.
• 6:01
  Charles M. Lawrie: occasionally a loose subsided stem, we're really just not seeing, massive, revisions like we used to.
• 6:08
  Charles M. Lawrie: And I think that's been borne out in a couple of papers that have been published recently as well.
• 6:12
  Joseph M. Schwab: Yeah.
• 6:13
  Joseph M. Schwab: And so tell me how you got ended up getting connected with the Anterior Hip Foundation or what's your journey there.
• 6:19
  Charles M. Lawrie: Sure.
• 6:20
  Charles M. Lawrie: I've been passionate about anterior approach, really since I learned it.
• 6:25
  Charles M. Lawrie: the first time I saw it, there was this aha moment at the end of the procedure where, you take all the retractors out and the tensor muscle belly falls back where it should be.
• 6:36
  Charles M. Lawrie: And the skin closes together nicely, and it just felt so much more anatomic and so much less invasive as a surgeon, that a posterior approach did.
• 6:46
  Charles M. Lawrie: So I knew that was going to be my approach moving forward.
• 6:49
  Charles M. Lawrie: and then when I was at WashU in practice, going through my learning curve, once I was out of fellowship.
• 6:56
  Charles M. Lawrie: I was still doing a little bit of posterior approach, still doing, some anterior approach.
• 7:00
  Charles M. Lawrie: And my nurse one day came up to me and said, Dr.
• 7:02
  Charles M. Lawrie: Lawrie why are you still doing posterior approach?
• 7:05
  Charles M. Lawrie: Those patients just don't do as well.
• 7:07
  Charles M. Lawrie: So at that point I said, this is it, I have to do anterior approach.
• 7:12
  Charles M. Lawrie: and I committed myself to it.
• 7:15
  Charles M. Lawrie: and once I, we're in the approach, I was comfortable with just some meetings, with the anterior hip foundation once, I said, I think I want to be more involved in this.
• 7:23
  Charles M. Lawrie: it's been such a gift to be in my patients.
• 7:25
  Charles M. Lawrie: I really want to get back, and teach and train.
• 7:28
  Charles M. Lawrie: So lucky enough, I've been able to do that through industry, teaching some courses through them, which is where I met Jonathan Yerasimides, who we developed a, a close relationship.
• 7:39
  Charles M. Lawrie: we teach at the courses together, hang out afterwards.
• 7:41
  Charles M. Lawrie: And I know he was very involved in Anterior Hip Foundation president last year.
• 7:45
  Charles M. Lawrie: so I was lucky enough that he invited me to get involved, through his involvement in the organization.
• 7:50
  Joseph M. Schwab: And so this year you've got the role of vice president and tell me a little bit about what that includes and what projects you're working on.
• 7:57
  Joseph M. Schwab: And what areas you focus on.
• 7:59
  Charles M. Lawrie: Sure.
• 8:00
  Charles M. Lawrie: So the vice president role, I guess I should back up, this is the, first year, and I want to thank you for doing this and we have, more official officer titles.
• 8:11
  Charles M. Lawrie: I think in the past, it's been a little bit more of a, smaller group.
• 8:17
  Charles M. Lawrie: I don't want to call it rag tag, a smaller group of, of misfits perhaps.
• 8:24
  Charles M. Lawrie: that, all had their individual roles and responsibilities, maybe that were, not clearly delineated, self understood, but now, thanks to you, we're shaping up to be more of a big organization, which is appropriate as we've grown so much.
• 8:41
  Charles M. Lawrie: so the vice president role, really spun out of being, the, lab chief for the manager of the lab, which Tania Ferguson was last year.
• 8:50
  Charles M. Lawrie: So my primary role in the organization is organizing and coordinating the cadaver lab component of the annual meeting, which, of course, we know how important hands on training is when you're learning a surgical approach.
• 9:05
  Charles M. Lawrie: But in addition to that, I see myself as well as the education chief.
• 9:12
  Charles M. Lawrie: coordinating the educational program with you developing an educational curriculum, that we're going to have the lab attendees do before the meeting, and taking that 1 step further and hopefully developing.
• 9:25
  Charles M. Lawrie: some great online content accessible to all surgeons that they can use either to learn anterior approach, or to hone their skills on more advanced topics that we choose to cover.
• 9:36
  Joseph M. Schwab: And so the lab portion of the AHF, which has been around for a few years, primarily focuses on, early learners, right?
• 9:45
  Joseph M. Schwab: Residents and fellows.
• 9:47
  Joseph M. Schwab: tell me a little bit about how that makes, the AHF lab, maybe different than what you've seen elsewhere or, how that adds value from your perspective.
• 10:01
  Charles M. Lawrie: So a lot of labs that you go to, training courses, conferences.
• 10:06
  Charles M. Lawrie: They just lump everyone together when they go to the cadaver lab, you have everyone from, second year residents all the way through surgeons who are end of career trying to learn something new.
• 10:17
  Charles M. Lawrie: and I think the learning needs for each of those different groups are completely different, right?
• 10:22
  Charles M. Lawrie: someone who is a very experienced surgeon, maybe even has some experience working around the hip and the pelvis.
• 10:29
  Charles M. Lawrie: learning anterior approach is going to need a little bit different handholding through the lab than someone who's in training and has been exposed to a lot of anterior approach but hasn't really gotten the hands on practice.
• 10:42
  Charles M. Lawrie: So I think segregating those groups out when we're actually going to the lab and teaching, is important and it really helps us as the faculty do a better job of shaping the lab to meet the needs of each of those groups.
• 10:58
  Charles M. Lawrie: if you look at Anterior Hip Foundation lab, we've chosen to have a Thursday lab, which is pre course, pre main didactic program that's only available to residents and fellows.
• 11:11
  Charles M. Lawrie: and what that allows us to do again is really shape that content, shape the curriculum for the lab, as well as the experience toward those learners.
• 11:21
  Charles M. Lawrie: on top of that, I think, as surgeons, we all learn from each other, and that starts early on and residency and fellowship.
• 11:28
  Charles M. Lawrie: So it was really rewarding.
• 11:30
  Charles M. Lawrie: last year, I remember.
• 11:31
  Charles M. Lawrie: You walk into the lab, we had a ton of AHF faculty in there, but the real teaching and learning was happening from, chief resident to third or fourth year resident or fellow from one program telling a fellow from another program, Hey, we do it this way.
• 11:46
  Charles M. Lawrie: Try that.
• 11:47
  Charles M. Lawrie: so it was really just nice to see that cross pollination of ideas already happening.
• 11:51
  Charles M. Lawrie: At that level, I think in a way that you wouldn't see if you had, second year residents at the same table as a, guy in the 60s, who's been doing this for 20 years, trying to learn a new approach.
• 12:05
  Joseph M. Schwab: and tell me a little bit about how, how that lab works with industry to provide a good experience.
• 12:15
  Charles M. Lawrie: So we truly couldn't do it without our industry partners.
• 12:19
  Charles M. Lawrie: so this past year, we were lucky enough to have Zimmer Biomet as our Thursday lab sponsor.
• 12:25
  Charles M. Lawrie: and we call them the Thursday lab sponsor, but they're really so much more than that to us.
• 12:30
  Charles M. Lawrie: they sponsor the travel, they sponsor the registration fee.
• 12:34
  Charles M. Lawrie: They basically sponsor, attendance at the whole meeting for the residents and fellows that are going to attend that Thursday lab.
• 12:42
  Charles M. Lawrie: and beyond that, they really allow us to have the freedom to shape that lab, to be what we want.
• 12:50
  Charles M. Lawrie: you go to most industry courses, the industry is in charge of curriculum..
• 12:55
  Charles M. Lawrie: some of those labs can come off, a little bit more sales forward, trying to get you to use their product, of course, which is appropriate in that setting because they're putting the lab on.
• 13:05
  Charles M. Lawrie: at Anterior Hip Foundation they understand our goal is truly education.
• 13:08
  Charles M. Lawrie: So they sponsor, the travel, they sponsor the meeting attendance.
• 13:13
  Charles M. Lawrie: They bring all their implants and instruments, and they really just take a step back and say, Hey, you guys go have fun in the lab.
• 13:19
  Charles M. Lawrie: we're going to let you do your thing, and we're just going to be here to help you out, which has been wonderful.
• 13:24
  Joseph M. Schwab: If you had a wish list for the AHF over the next couple of years, two, three, five years, what would be on that list?
• 13:33
  Joseph M. Schwab: Give me a couple of things.
• 13:34
  Joseph M. Schwab: Okay.
• 13:35
  Charles M. Lawrie: I think number one would be, truly becoming the F of AHF, right?
• 13:41
  Charles M. Lawrie: right now, Anterior Hip Foundation.
• 13:45
  Charles M. Lawrie: To the outside world is basically a meeting that we put on once a year, right?
• 13:50
  Charles M. Lawrie: I would love to see that grow into more of a year round organization, similar to Academy or AAHKS where we have membership in the organization, that would create a real sense of community around anterior approach surgery, not just at this meeting.
• 14:10
  Charles M. Lawrie: it would allow us to develop that online educational content that people would have access to.
• 14:15
  Charles M. Lawrie: potentially webinars and things throughout the year.
• 14:19
  Charles M. Lawrie: that would be number one on my list is becoming, the Anterior Hip Foundation as a true year round organization that people could interact with, and have multiple events throughout the year.
• 14:31
  Charles M. Lawrie: the second one, selfishly, I know you're, based over in Switzerland now.
• 14:35
  Charles M. Lawrie: So it would be wonderful for us to develop a little bit more of a international presence.
• 14:41
  Charles M. Lawrie: and I think it'd be great to do that through having, meetings, maybe in Europe every other year, whether that would be an augment to, or in place of the Anterior Hip Foundation meeting in the U S, to be determined.
• 14:53
  Charles M. Lawrie: But, I would love to come over to Switzerland and have more of a European influence because, seeing, European surgeons do anterior approach is totally different than surgeons in the U S I know you guys are more off table, you're less, fluoroscopy based, but, certain aspects of the approach are different.
• 15:12
  Charles M. Lawrie: Some of the implants are different.
• 15:13
  Charles M. Lawrie: So really having the two different ideological camps meeting together in one place.
• 15:19
  Charles M. Lawrie: I think it would be really cool to see, and I guess number three, no one's discussed the, the organizational structure, and how, succession plans go.
• 15:30
  Charles M. Lawrie: But of course, being vice president.
• 15:32
  Charles M. Lawrie: two year term here.
• 15:33
  Charles M. Lawrie: I'm hoping that, two years from now I get the promotion to be the big president, we'll see
• 15:41
  Joseph M. Schwab: Charles, this has been great.
• 15:42
  Joseph M. Schwab: I really appreciate the opportunity to talk with you and have you, Share some of your thoughts with us, especially about, your involvement with the Anterior Hip Foundation, where you'd like to see it go and, what we can expect for 2025.
• 15:57
  Joseph M. Schwab: This has been great.
• 15:57
  Joseph M. Schwab: Thanks for joining me.
• 15:59
  Charles M. Lawrie: Yeah.
• 15:59
  Charles M. Lawrie: Thanks Joe.
• 16:00
  Charles M. Lawrie: Really exciting to see, what's coming in 2025.
• 16:03
  Charles M. Lawrie: I hope to see everyone at the big meeting this year.
• 16:06
  Joseph M. Schwab: thank you for joining me for another episode of the AHF podcast.
• 16:10
  Joseph M. Schwab: If you want more information, you can check us out on Facebook, LinkedIn, or X, or you can visit us at our website, anteriorhipfoundation.
• 16:19
  Joseph M. Schwab: com.