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What Makes a Great Hip Surgeon? Lessons from Michael Solomon · AHF Podcast

• 0:21
  Joseph M. Schwab: Hello and welcome to the AHF Podcast.
• 0:24
  Joseph M. Schwab: I'm your host, Joe Schwab.
• 0:27
  Joseph M. Schwab: Today's guest is someone whose career spans continence, decades, and just about every facet of modern hip and knee surgery.
• 0:35
  Joseph M. Schwab: Dr.
• 0:36
  Joseph M. Schwab: Michael Solomon is widely recognized as one of Australia's and probably the world's leading surgeons in arthritis surgery, joint preservation, and complex hip and knee reconstruction.
• 0:48
  Joseph M. Schwab: After graduating from the University of Cape Town, he completed his orthopedic training in Sydney and went on to a traveling fellowship in the United States.
• 0:58
  Joseph M. Schwab: Focusing on hip and knee replacement, as well as hip preserving techniques.
• 1:03
  Joseph M. Schwab: Since then, he's performed more than 10,000 hip and knee replacements, averaging over 900 joint replacements each year.
• 1:12
  Joseph M. Schwab: His expertise ranges from anterior approach hip replacement to peri acetabular osteotomy, and his clinical work extends across all ages from pediatric to adult patients.
• 1:22
  Joseph M. Schwab: And his contributions to the field include extensive international lecturing.
• 1:27
  Joseph M. Schwab: Research and hands-on training for students, registrars and fellows.
• 1:32
  Joseph M. Schwab: But beyond the operating theater, Dr.
• 1:35
  Joseph M. Schwab: Solomon is known for his commitment to service.
• 1:38
  Joseph M. Schwab: He's operated and taught across the globe from the US and Canada to South Africa, India, China, and England.
• 1:46
  Joseph M. Schwab: And he regularly travels to Tonga to provide voluntary orthopedic care.
• 1:51
  Joseph M. Schwab: And if all that wasn't enough.
• 1:53
  Joseph M. Schwab: He's actually a pretty good guy and we're really lucky to have him with us today on the podcast.
• 2:00
  Joseph M. Schwab: Dr.
• 2:00
  Joseph M. Schwab: Michael Solomon.
• 2:01
  Joseph M. Schwab: Welcome to the AHF podcast.
• 2:05
  Michael Solomon: Thank you, Joe.
• 2:06
  Michael Solomon: Uh.
• 2:07
  Michael Solomon: That was quite an introduction, which I feel partly embarrassed about, but I, I appreciate, uh, you introducing me and I'm, I'm very happy to be here.
• 2:16
  Joseph M. Schwab: What initially drew you to pursue orthopedics and, and in particular hip surgery?
• 2:23
  Michael Solomon: So, as you mentioned in your introduction, I, I was born in South Africa.
• 2:28
  Michael Solomon: I went to medical school in South Africa and I left shortly afterwards.
• 2:33
  Michael Solomon: Um, but my father was an anesthetist or an theologist, as you would say, and he worked with a remarkable man called Desmond Dall.
• 2:46
  Michael Solomon: Um, and Des you may remember, there was a, uh, a cable system called the Dall Miles Cable Grip.
• 2:55
  Michael Solomon: Des was the Dall of the Dall Miles.
• 2:57
  Michael Solomon: And Miles was an, was Anthony Miles, who was an engineer who subsequently went to Bath in England.
• 3:04
  Michael Solomon: But my dad was des as anesthetist.
• 3:07
  Michael Solomon: So I would often, when I was a medical student, I would go to the operating room with my dad.
• 3:15
  Michael Solomon: Uh, and that way I would, uh, meet Des and, and I, and he was certainly one of my.
• 3:21
  Michael Solomon: Uh, mentors and inspirations, and that's how I got into thinking orthopedic surgery looks pretty cool.
• 3:29
  Joseph M. Schwab: So did you have mentors along the way who guided you and maybe shape your approach to surgery?
• 3:36
  Joseph M. Schwab: Tell me a little bit about that.
• 3:38
  Michael Solomon: So, so I would, um, I would, I would recognize three people in my career.
• 3:45
  Michael Solomon: I think the first thing to say is, as I said, my dad was an anesthetist.
• 3:50
  Michael Solomon: When I was a medical student, I was kind of thinking, what do I want to do when I finish medical school?
• 3:54
  Michael Solomon: And I was working on the process of elimination, uh, and I thought anesthetics was boring, but I'll come back to that later because I think in the end he might've been right.
• 4:03
  Michael Solomon: I thought anesthetics was boring.
• 4:06
  Michael Solomon: I, I thought general medicine, I just wasn't cut out to be a physician.
• 4:10
  Michael Solomon: Uh, surgery I found interesting, but I, uh, I figured I wasn't gonna become a fine tuning ophthalmologist or.
• 4:17
  Michael Solomon: ENT surgeon.
• 4:18
  Michael Solomon: But orthopedics was, I thought, really cool.
• 4:21
  Michael Solomon: And I remember as a medical school, at medical school, we did our first term in orthopedics and they taught us how to examine the hip.
• 4:26
  Michael Solomon: And I thought, this is so straightforward, you know, look, feel, move, uh, how hard can it be?
• 4:33
  Michael Solomon: And I came home that evening and I said to my dad, I found it.
• 4:36
  Michael Solomon: I know what I want to be.
• 4:37
  Michael Solomon: So actually from, it was a six year course in South Africa, and from that moment onwards in my third year of a medical school.
• 4:45
  Michael Solomon: This takes me back to 1983.
• 4:47
  Michael Solomon: I wanted to be an orthopedic surgeon.
• 4:49
  Michael Solomon: That was it.
• 4:50
  Michael Solomon: That was my, yeah.
• 4:51
  Michael Solomon: Focus in life.
• 4:52
  Michael Solomon: And I was fortunate again, like I'd mentioned to, to have met Des uh, Dall.
• 4:58
  Michael Solomon: And uh, and then when I immigrated to Australia, um, I, uh, I, yeah, met others of course, but.
• 5:08
  Michael Solomon: The, the two people aside from, uh, Des Dall who has, who had a profound effect on my career.
• 5:16
  Michael Solomon: Des was really right at the beginning, so I was still a medical student, but there were two people.
• 5:21
  Michael Solomon: Uh, one is an Australian surgeon by the name of John Steven, who was a pediatric surgeon.
• 5:27
  Michael Solomon: He's now retired.
• 5:28
  Michael Solomon: Um, pediatric spine surgeon.
• 5:30
  Michael Solomon: Uh, just the most amazing, uh, mentor.
• 5:35
  Michael Solomon: Um.
• 5:36
  Michael Solomon: A giant in Australian, uh, orthopedics.
• 5:39
  Michael Solomon: Uh, um, so being a pediatric orthopedic surgeon, they, they, they're sort of a different Yeah.
• 5:46
  Michael Solomon: Class, I think in the sense that they are really, uh, patient and family focused more than anything.
• 5:53
  Michael Solomon: Um, and, uh, John taught me, he, he broke his finger when he was young and he had this.
• 6:01
  Michael Solomon: He still has it because of course he's still, he's still around, but he had this bent fourth finger and he would, and he would talk like this, and you would be in the middle of a 10 hour, as he called it, click clack, front and back, you know, spine surgery.
• 6:15
  Michael Solomon: He wanted me to be a spine surgeon.
• 6:17
  Michael Solomon: I said, no waste.
• 6:18
  Michael Solomon: But he would, you know, when, when there's blood everywhere in the, you know, the spine monitors are going off, he would say, now listen, don't panic.
• 6:27
  Michael Solomon: Just don't panic.
• 6:29
  Michael Solomon: Like I'm the assistant, he's the operator, and he's telling me not to panic.
• 6:33
  Michael Solomon: You know, it's easy being an assistant anyway, but, but that, so John was, was an amazing mentor to me.
• 6:40
  Michael Solomon: Uh, in fact, one of my, you know, you always think about when you operate the early patients, you really kind of.
• 6:47
  Michael Solomon: A bit nervous about, and, and John asked me to replace his hip joints.
• 6:50
  Michael Solomon: Uh, he's got one posterior approach hip and one anterior approach hip, which I'll tell you about later in the interview.
• 6:57
  Michael Solomon: But I found that quite a stressful, uh, procedure.
• 7:00
  Michael Solomon: And in fact, after the first, uh, hip replacement, I normally get x-rays and recovery.
• 7:04
  Michael Solomon: And, and he was lying there.
• 7:06
  Michael Solomon: I went to see him afterwards and he had hold up the ex, he was holding up the x-ray and said, now listen.
• 7:10
  Michael Solomon: He said, it's a bit Russ.
• 7:13
  Michael Solomon: I said, what are you talking about?
• 7:14
  Michael Solomon: He says, it's varus.
• 7:16
  Michael Solomon: You've put it in varus.
• 7:19
  Michael Solomon: I said, it's okay.
• 7:20
  Michael Solomon: It's a blade stem.
• 7:21
  Michael Solomon: It'll work perfectly.
• 7:22
  Michael Solomon: And it, and it did.
• 7:24
  Michael Solomon: Um, so, so my three mentors would be Des John.
• 7:27
  Michael Solomon: And of course, um, I, you know, my, my career has, has been influenced so much in terms of my patient care by none other than Michael Millis, uh, from Boston.
• 7:40
  Michael Solomon: Uh, Michael I was fortunate to visit, so when I finished orthopedics in Australia, I wanted, we were pretty well trained in Australia.
• 7:47
  Michael Solomon: Uh, you know, our training scheme is a, is superb.
• 7:51
  Michael Solomon: We had a lot of hands-on, we had a lot of cutting experience as trainees, as as registrars or residents.
• 7:57
  Michael Solomon: Um, and a lot of people didn't even do fellowships in my time and they went straight into private practice or public practice because they were really, really reasonably well tracked.
• 8:07
  Michael Solomon: I decided to do a, um, what I called an over the shoulder ship because I, I was, I was in a hurry and I thought, look, I'm gonna go six months.
• 8:16
  Michael Solomon: I'm gonna go and spend a month in Chicago with Wayne Paprosky, a month in Toronto with Alan Gross.
• 8:22
  Michael Solomon: Uh, I'm gonna spend, uh, go to Exeter for a couple of weeks and, uh, I'm gonna go to Boston.
• 8:28
  Michael Solomon: They wanted me to do tumors.
• 8:30
  Michael Solomon: Because I was getting a pediatric job as well as an adult job, and I thought, no, I don't really want to do tumors, but you know, you don't wanna upset the, the people who you like.
• 8:38
  Michael Solomon: John Steven, who was one of your mentors.
• 8:39
  Michael Solomon: I said, okay, I'll go to Boston.
• 8:41
  Michael Solomon: And when I was in Chicago, uh, with a month that I spent with Wayne Paprosky, one of his fellows had just come back from a course in, uh, Toronto.
• 8:49
  Michael Solomon: I think it was, it was somewhere in Canada.
• 8:51
  Michael Solomon: And he came back and said, you know, I heard this guy talk, his name's Michael Millis.
• 8:55
  Michael Solomon: He's, he's changing the shape of hip joints.
• 8:58
  Michael Solomon: He's turning hips.
• 9:00
  Michael Solomon: In dysplastic hips, he's making them look normal and he's an amazing guy and you gonna Boston, you're gonna look this guy up.
• 9:06
  Michael Solomon: So I thought, okay, I'll look him up.
• 9:08
  Michael Solomon: And in fact, no, I'll go one better.
• 9:10
  Michael Solomon: I mean, the internet was still very in its infancy in that day.
• 9:13
  Michael Solomon: You know, we are talking about 1988 now.
• 9:16
  Michael Solomon: Now 89 or there?
• 9:18
  Michael Solomon: No, hang on, wait a minute.
• 9:18
  Michael Solomon: I'm losing time.
• 9:19
  Michael Solomon: Sorry.
• 9:19
  Michael Solomon: We were talking about 90, we're talking about 1995.
• 9:23
  Michael Solomon: Anyhow, I contacted Mike and he said, I said, look, I'm gonna be in Boston.
• 9:28
  Michael Solomon: Do you mind if I come to the children's hospital and just spend a bit of time looking how you do osteotomies and learning?
• 9:34
  Michael Solomon: And he said, with's the greatest, the pleasure.
• 9:35
  Michael Solomon: And I, and so I, when I was in Boston, I struck up an amazing friendship with Mike.
• 9:40
  Michael Solomon: Uh, and, uh.
• 9:43
  Michael Solomon: I went to his clinics, I went to his operating room.
• 9:46
  Michael Solomon: Uh, I wasn't allowed a scrub because I was only there for three months.
• 9:49
  Michael Solomon: Um, but his clinics were, were incredible because Mike has the ability to communicate with patients and patients' parents on a level that is, you have to be there to see it and to appreciate how much he's respected by the patients.
• 10:07
  Michael Solomon: Their parents and the clinics would often run late.
• 10:10
  Michael Solomon: Uh, and this was, everybody would go crazy, you know, Millis is running late again.
• 10:14
  Michael Solomon: But it's because he cared and because he spent so much time with people and because he could, he really went into what their concerns and worries were.
• 10:23
  Michael Solomon: And so I would put Mike as probably my defining mentor, uh, because it's all very well being a good surgeon, but you've gotta be a good doctor to patients.
• 10:33
  Joseph M. Schwab: Yeah.
• 10:33
  Joseph M. Schwab: So having mentors like that, especially the way you describe your relationship with Michael, you go back to Australia, you're starting your career, so very early on are there, are you running into challenges or finding.
• 10:49
  Joseph M. Schwab: Uh, that you are encountering mistakes that sort of teach you some important early lessons that maybe, um, you, you, you wish you would've learned from your mentors?
• 11:01
  Michael Solomon: It's a great question.
• 11:02
  Michael Solomon: And Joe, you know, I think you come back from a fellowship and you suddenly think, oh, it's great.
• 11:07
  Michael Solomon: I'm gonna get into it.
• 11:08
  Michael Solomon: Uh, and it's like, well, where's all the work?
• 11:11
  Michael Solomon: You know, I, I, I've been seeing, yeah, why, why am I not, why are people not sending me patience?
• 11:15
  Michael Solomon: You know, because nobody knows about you.
• 11:17
  Michael Solomon: And no matter how good you've been and what you've learned and what skills you learned, you're, you know, you're not getting the work.
• 11:22
  Michael Solomon: So in Australia, I think having the ability to, um, be on at a public hospital system.
• 11:29
  Michael Solomon: You get a, a good kickstart because you start, you're on the on-call roster and you start getting some patients and you can start doing things, but at the same time, you kind of recognize that, look, you've gone overseas, you've seen all these joint replacements done.
• 11:43
  Michael Solomon: You, you've learned how to do pelvic osteotomies by watching, but not do.
• 11:47
  Michael Solomon: Yeah.
• 11:47
  Michael Solomon: And now you wanna do them.
• 11:49
  Michael Solomon: And so, uh, sometimes I think in my early career, I was guilty of spreading myself too thinly, uh, to try and get a start.
• 11:57
  Michael Solomon: Um, I.
• 11:59
  Michael Solomon: I, I certainly, um, I remember when I did my first pelvic osteotomy, there was nobody in Sydney doing pelvic osteotomy surgery.
• 12:07
  Michael Solomon: And, and when I went and spent three months in Boston, I would've spent about two and a half months with Mike Millis.
• 12:13
  Michael Solomon: I never scrubbed because I wasn't allowed to scrub.
• 12:16
  Michael Solomon: I was watching and I was taking notes, and now I'm suddenly in the thick of it top and the sweat's starting to pour.
• 12:22
  Michael Solomon: And in fact, with my first osteotomy, I got John Steven to scrub who'd never seen one.
• 12:26
  Michael Solomon: He'd done Salter osteotomies, but he had never done Ganz osteotomies.
• 12:30
  Michael Solomon: Um, and so I'm just telling him, okay, this is how we gotta do it, you know, and, and he's keeping a calm factor on me.
• 12:37
  Michael Solomon: Um, so I think, you know, I think pacing myself was important.
• 12:41
  Michael Solomon: Uh, and I learned that sometimes the hard way.
• 12:45
  Michael Solomon: Um, because in the end, you know, patients value, clarity, and reassurance and kind of a sense of partnership and, and you've just, you've gotta take away from the fact that you've learnt all this stuff.
• 12:56
  Michael Solomon: You actually gotta think, okay, well there's a patient on the other side here and what do I feel I'm skilled at doing?
• 13:00
  Michael Solomon: And how can I, how can I go into it and help them?
• 13:03
  Michael Solomon: And I, you know, initially I was consulting in about four different locations and I suddenly realized, this is crazy.
• 13:09
  Michael Solomon: Just, you know, slow down, get back to one place, let the patients come to you, start doing your work.
• 13:15
  Michael Solomon: You know, if you do good work, word gets out there.
• 13:18
  Michael Solomon: And that's what I did.
• 13:19
  Joseph M. Schwab: So how did you balance that, the sort of technical skill that you were honing?
• 13:24
  Joseph M. Schwab: With and your clinical judgment with things like patient communication that you had observed from a Michael Millis, for instance.
• 13:34
  Michael Solomon: Well, I, I had a, and I won't call her a, a mentor, but she's my greatest supporter in life, and that's my wife.
• 13:42
  Michael Solomon: And the reason I bring her into this is.
• 13:44
  Michael Solomon: My wife Lucille has bad rheumatoid and she, she got rheumatoid.
• 13:48
  Michael Solomon: In fact, I think you met her when we, uh, we were in London
• 13:51
  Joseph M. Schwab: Yeah.
• 13:52
  Michael Solomon: She, she got rheumatoid when she was 20, when before all these disease modifying agents were present.
• 13:58
  Michael Solomon: And the reason I, I, I mentioned her is because you ask, how do I balance skill?
• 14:03
  Michael Solomon: And judgment with patient communication because Lucille's had multiple operations.
• 14:07
  Michael Solomon: Some have been okay and some have been awful in terms of outcomes.
• 14:11
  Michael Solomon: And I, I'd say to her, listen, I think we, I think you need to have this done.
• 14:15
  Michael Solomon: You need an osteotomy to straighten your leg.
• 14:17
  Michael Solomon: I mean, not obviously by me.
• 14:19
  Michael Solomon: And she would say to me, but why?
• 14:21
  Michael Solomon: You know, I'm not in pain and I'm thinking ahead, thinking B, yes.
• 14:23
  Michael Solomon: But I know what's gonna happen in years to come because of the angles they are.
• 14:27
  Michael Solomon: Um, so clinical judgment should be, uh.
• 14:33
  Michael Solomon: Should be, uh, should incorporate a, a really in-depth discussion with patients about their expectations and their fears.
• 14:42
  Michael Solomon: And I think that's, you know, you need to have a clear plan.
• 14:45
  Michael Solomon: You know, when I see a patient, whether they're having surgery or not, they need to leave my consulting room with a clear plan on the problem they came to be with.
• 14:55
  Michael Solomon: And, and the plan may not be what they like, um, but you, but you've got to, you, you know, you, you've gotta give somebody a clear plan.
• 15:02
  Michael Solomon: Because that instills some confidence in, in, in them and, and saying, okay, you know, he's been, you know, you're not sitting on a fence.
• 15:10
  Michael Solomon: Oh, we could do this, we could do that.
• 15:12
  Michael Solomon: You're actually saying, look, this is what I think your problem is.
• 15:14
  Michael Solomon: This is a way I think you should treat it or should be treated.
• 15:18
  Michael Solomon: Um, and, and I, and I use that sort of the sublimate thinking of experience that my wife's been through, thinking, is it gonna really make a big difference to their lives?
• 15:29
  Michael Solomon: What I'm recommending?
• 15:30
  Michael Solomon: That's the important.
• 15:31
  Joseph M. Schwab: Hmm.
• 15:32
  Joseph M. Schwab: As.
• 15:33
  Joseph M. Schwab: Um, you move from being sort of a, let, let's just say a competent surgeon to a master surgeon.
• 15:41
  Joseph M. Schwab: Are there any key habits or routines that you think you developed that sort of made that difference?
• 15:49
  Joseph M. Schwab: Something that you could tell sort of younger surgeons or trainees?
• 15:53
  Joseph M. Schwab: This was something I really keyed into that took me to that next level.
• 16:00
  Michael Solomon: I think the first thing I would say is don't take shortcuts.
• 16:03
  Michael Solomon: No matter how simple it is, stick to the routine because if you stick to the routine, you, you will make less mistakes.
• 16:12
  Michael Solomon: 'cause we all make mistakes.
• 16:13
  Michael Solomon: Um, I had a, a, a resident registrar, um, who I've become very friendly with over the years.
• 16:20
  Michael Solomon: Uh, an amazing guy.
• 16:22
  Michael Solomon: And, uh, the guy like six foot four.
• 16:28
  Michael Solomon: He was in his final year, finished his exam and I was doing a hip replacement with him and I was the junior consultant and I thought he was gonna break the leg.
• 16:34
  Michael Solomon: Like he was powerful and he was banging away and I'm thinking, my God, I just like, I, so I said, I should mention his name because only he will know.
• 16:44
  Michael Solomon: I said, Al, you gotta, you gotta feel the tissues, yet we don't wanna break this femur.
• 16:49
  Michael Solomon: You could easily break this femur.
• 16:51
  Michael Solomon: I mean, he's so powerful.
• 16:52
  Michael Solomon: So this is what I try and teach the, the younger generation that surgery.
• 16:57
  Michael Solomon: You've gotta learn surgical skill and you've gotta feel the tissues and understand that a little old lady with soft bone is not gonna be the same as a, you know, a 50-year-old athlete with strong bone.
• 17:10
  Michael Solomon: And you've just got to kind of appreciate that.
• 17:14
  Michael Solomon: I think the, and I'll bring another, uh, sort of family, uh, member into this, but my son, um.
• 17:22
  Michael Solomon: Was very fortunate to represent Australia at two Olympic games in the 400 meters.
• 17:28
  Michael Solomon: And he started running when he was 16.
• 17:32
  Michael Solomon: But what, when I watched how he approached life and the dedication and the consistency, and he would go to bed early, oh, I don't go to bed earlier, but be what I'm saying is he, he's, he tackled and he tackled his task with a plan.
• 17:50
  Michael Solomon: He stuck to that plan.
• 17:52
  Michael Solomon: And I think, I think in orthopedics, even if you're doing something simple, there is a roadmap, there is a plan, and you tackle the task according to your plan.
• 18:02
  Michael Solomon: And you don't take shortcuts.
• 18:04
  Michael Solomon: You feel the tissues, you respect your OR team, uh, and you, you know, you progress for the benefit of the patient.
• 18:12
  Michael Solomon: I remember I made one, I'll tell you what else I learned when I was, I was still a registrar, so I was still in training.
• 18:18
  Michael Solomon: And I had a lady with an ankle fracture who came in who needed fixing, and her daughter was a medical student and said, oh, can I come and watch?
• 18:26
  Michael Solomon: And I naively said, yeah, sure, no problem.
• 18:29
  Michael Solomon: And of course, during the operation things weren't going smoothly, and I was now sweating a bit because I knew she was in the background watching me fix her grandmother's ankle, which was, bone was as soft as anything.
• 18:41
  Michael Solomon: And I'm thinking, this is not good.
• 18:42
  Michael Solomon: I, she should not be in this theater.
• 18:44
  Michael Solomon: So that was the first and last time I ever led a relative.
• 18:47
  Michael Solomon: Happen to be in, in the, as a medical student into the operating area.
• 18:50
  Michael Solomon: But it, but you know, it's a message to young people that it's all being well, being competent, but you've gotta stick to your routine.
• 18:59
  Michael Solomon: Don't change your routine.
• 19:02
  Joseph M. Schwab: So talking about changing routines, at some point in your career you decided to migrate to anterior approach hip replacement, and you have this history, this legacy of, of gravitating towards innovation.
• 19:17
  Joseph M. Schwab: Talk to me a little bit about that journey.
• 19:18
  Joseph M. Schwab: Of course, you mentioned, uh, your mentor upfront who you did two hip replacements on, one posterior, one anterior.
• 19:25
  Joseph M. Schwab: Um, tell me a little bit more about that journey.
• 19:30
  Michael Solomon: So a number of years, well, in Australia now, probably it's about 15 or 16 years ago, so I, I was familiar with.
• 19:38
  Michael Solomon: And, you know, with the Smith Peterson approach and, and with the Ganz approach for pelvic osteotomy.
• 19:44
  Michael Solomon: So the territory was familiar to, um, then in, in Australia a company introduced, uh, better tools.
• 19:54
  Michael Solomon: A, a, uh, a leg holder or traction table, whatever you wanna call it.
• 19:58
  Michael Solomon: Um, and a teaching program.
• 20:01
  Michael Solomon: And, you know, I thought I should have a look at this and so.
• 20:06
  Michael Solomon: Adopting new techniques.
• 20:08
  Michael Solomon: I, you know, so I did a, i I went to listen to a lecture.
• 20:11
  Michael Solomon: They had a visiting surgeon who came out and I thought, yep, this looks interesting.
• 20:15
  Michael Solomon: And of course, you see slides and it looks, oh, it looks easy, but of course it isn't easy when you're starting off.
• 20:20
  Michael Solomon: So I made an effort to go and, and learn from experts.
• 20:24
  Michael Solomon: I, I, I flew to, uh, Europe and, uh, visited two surgeons there who I, who I thought were superb in, in their surgeries.
• 20:32
  Michael Solomon: Uh, I watched some videos.
• 20:34
  Michael Solomon: I did some cadaver labs.
• 20:36
  Michael Solomon: I had a, uh, one or two when they were in Australia visit me and scrub with me so I could, you know, say, look, I've been struggling with this particular problem.
• 20:46
  Michael Solomon: You know, how do I get around?
• 20:47
  Michael Solomon: Uh, do I get around it?
• 20:49
  Michael Solomon: So I think when you adopt something new, learn from the experts, watch videos, do cadaver labs.
• 20:56
  Michael Solomon: I think one of the, and it's something that's current now because in Australia they just, um, introduced the ceramic resurfacing as a, as a, uh, bearing and an option.
• 21:05
  Michael Solomon: And I've been doing resurfacing for many years, but there are a whole, there's a new group of resurfaces who are now wanting to do ceramics and we've got a WhatsApp group.
• 21:16
  Michael Solomon: That incorporates maybe 20 surgeons, which is a fantastic tool because people post what their problems are and there are senior surgeons and there are junior surgeons on this WhatsApp group and the junior, even the senior surgeons post.
• 21:30
  Michael Solomon: And we just, you know, we, we kind of listen to each other and advice and experience.
• 21:35
  Michael Solomon: So I think all these things are critical because we have tools nowadays where we can adopt new technology and learn from our colleagues and peers in a very efficient manner.
• 21:46
  Michael Solomon: One of which is a WhatsApp group.
• 21:48
  Michael Solomon: So, you know, innovation is good, but innovation without judgment can be dangerous.
• 21:53
  Michael Solomon: I did a, a paper that was published with Richard Destiga many years ago.
• 21:56
  Michael Solomon: We looked at the adoption of the anterior approach in Australia and the learning curve and how many you needed to do to become proficient.
• 22:04
  Michael Solomon: We gotta remember that a learning curve comes at a patient's expense, essentially.
• 22:09
  Michael Solomon: Uh, and, and, and one has to be open and upfront and honest with a patient saying, you know, this is my experience.
• 22:15
  Michael Solomon: This is what I've done.
• 22:16
  Michael Solomon: I feel comfortable in doing your case.
• 22:18
  Michael Solomon: Uh, importantly, you don't start doing an anterior approach on a complex femoral deformity.
• 22:24
  Michael Solomon: You start with the simple cases.
• 22:26
  Joseph M. Schwab: Yeah.
• 22:27
  Joseph M. Schwab: Uh, from your perspective, when you're thinking about patients undergoing hip replacement, are there, um, sort of routine education points for patients that you think are.
• 22:38
  Joseph M. Schwab: Um, underemphasized preoperatively, but so patients undergoing either let's say hip replacement or hip preservation, are there things that you feel patients aren't getting routinely educated about that they would, uh, benefit from?
• 22:53
  Michael Solomon: I think if I had to, if I had to summarize that question, patient expectations are the hardest thing for a surgeon to, and a patient to grasp because what a patient may be expecting and what, you know, you can deliver may be two different things, and you need to impart that expectation, or, or sorry, your knowledge of what you can deliver.
• 23:20
  Michael Solomon: Onto them so they don't cloud their expectations.
• 23:23
  Michael Solomon: So I think patient expectations, uh, is important.
• 23:26
  Michael Solomon: You know, it's easy when you get somebody who can barely walk.
• 23:30
  Michael Solomon: They just wanna be able to walk.
• 23:31
  Michael Solomon: That's easy.
• 23:32
  Michael Solomon: But when you get somebody who is very sporty but is getting more pain and wants to do all these things, you've gotta temper it a little bit saying, look, you're getting a joint replacement.
• 23:41
  Michael Solomon: Uh, it's not your own hip and this is what you can do.
• 23:44
  Michael Solomon: And the majority will be able to do it.
• 23:46
  Michael Solomon: So I think patient expectations.
• 23:48
  Michael Solomon: I think the other thing which is a real, uh, it's a disaster if it happens, of course, is a deep joint infection.
• 23:56
  Michael Solomon: And I think, you know, even if I tell a patient, look, you've got a 0.3% chance of getting a deep joint infection, we all brush off.
• 24:04
  Michael Solomon: You know, I'm not gonna get a complication.
• 24:05
  Michael Solomon: We always think on the positive side is a patient, but when that patient gets a deep joint infection and it happens.
• 24:12
  Michael Solomon: It's a, it's a, it is a disaster for everybody in this, you know, it keeps you up at night.
• 24:17
  Michael Solomon: Uh, it's enormous amount of time trying to address the problem and, and every, all the ramifications, patient's, work, ramifications, family, et cetera.
• 24:26
  Michael Solomon: So I try and, you know, when I, when I tell them the important complications that can occur, I do emphasize that the deep joint infection is a serious problem.
• 24:37
  Michael Solomon: It's rare.
• 24:39
  Michael Solomon: You've gotta understand and we hope it's not gonna happen, but if you do get it, it's a long road ahead.
• 24:45
  Michael Solomon: So we gotta make sure that you are at the point where actually surgery is required.
• 24:50
  Michael Solomon: Um, and then, uh, you know, and then with, and on the, on the hip preservation side, again, it comes to expectations a bit, but also recovery.
• 24:59
  Michael Solomon: I find, you know, my PAOs take, take a long time to recover.
• 25:04
  Michael Solomon: Uh, it's not, you know, you're dealing with generally.
• 25:06
  Michael Solomon: Teenagers and young, 20-year-old, mostly females, uh, and they gotta understand that this is not an overnight success.
• 25:13
  Michael Solomon: They're gonna be on crutches for two months, maybe a little longer.
• 25:16
  Michael Solomon: It's gonna be a slow process.
• 25:19
  Joseph M. Schwab: Yeah.
• 25:20
  Joseph M. Schwab: Were to,'cause I know we have a number of patients who, who listen to these types of, uh, these types of podcasts.
• 25:27
  Joseph M. Schwab: If you were to give advice to a patient who's about to undergo a hip surgery, um, for instance, if you were to give them one question you could encourage them to ask their surgeon, that often gets overlooked, what might that be?
• 25:44
  Michael Solomon: You know, I would be telling a patient the question they need to ask the surgeon is to honestly answer if they were knowing what they know now about the patient's history and your examination.
• 25:57
  Michael Solomon: Would you recommend I undergo this operation if I was you or if I was one of your relatives?
• 26:04
  Michael Solomon: Because I think if the surgeon is honest, that is the key because, uh, you know, I, I recall a patient who was 97 who couldn't even come to my office.
• 26:15
  Michael Solomon: She was in so much pain.
• 26:17
  Michael Solomon: Her relatives came to my office.
• 26:19
  Michael Solomon: Her name was Fritz.
• 26:20
  Michael Solomon: A wonderful woman.
• 26:21
  Michael Solomon: And I said to the relatives, I said, which one's the patient?
• 26:23
  Michael Solomon: They had the x-ray.
• 26:23
  Michael Solomon: I said, no, no.
• 26:24
  Michael Solomon: They said, it's not us, it's our relative.
• 26:26
  Michael Solomon: She can't get out of the apartment.
• 26:28
  Michael Solomon: She's in so much pain.
• 26:29
  Michael Solomon: At the end of my day, it was a Friday afternoon, I went to her, a partner visited her and she was this large woman.
• 26:35
  Michael Solomon: Her name was Fritz, and I said, and she could, arthritis was so bad.
• 26:39
  Michael Solomon: She was in agony, constant.
• 26:42
  Michael Solomon: A a, a silly doctor had.
• 26:44
  Michael Solomon: Actually decided to get an MRI scan.
• 26:46
  Michael Solomon: I mean, she, the, the struggle to even get in the scan was crazy.
• 26:49
  Michael Solomon: She, the x-ray showed it all.
• 26:51
  Michael Solomon: But the reason I'm telling you the story is that I said to her, I said, Fritz, you've got two choices.
• 26:55
  Michael Solomon: You can have your hip replaced or you can live like this, but nothing else is gonna work.
• 27:00
  Michael Solomon: She said, when can you do it?
• 27:02
  Michael Solomon: I phoned my anesthetist.
• 27:04
  Michael Solomon: I said, Richard, I've got a lady.
• 27:06
  Michael Solomon: She's 97.
• 27:07
  Michael Solomon: She, she's in agony.
• 27:08
  Michael Solomon: She needs a hip done.
• 27:09
  Michael Solomon: He said, if she's 97, she's indestructible.
• 27:12
  Michael Solomon: We did her the following week.
• 27:14
  Michael Solomon: She lived to 105 pain-free.
• 27:18
  Michael Solomon: And so the point that I'm making is that there are clear times, you know, it is like you think, how do these people put up with it that you, you, you say you, you, I say sometimes I'm not leading.
• 27:29
  Michael Solomon: You leave this office until you say, I'm gonna have this operation.
• 27:32
  Michael Solomon: You can't live life like this.
• 27:33
  Michael Solomon: Okay.
• 27:34
  Michael Solomon: Because they're so bad.
• 27:36
  Michael Solomon: But then there are many other patients.
• 27:38
  Michael Solomon: You can see they're coping or they're anxious or they're hesitant.
• 27:41
  Michael Solomon: You know, arthritis is not gonna kill them.
• 27:42
  Michael Solomon: And I say, look, you'll know when you're ready, so come back when you feel you're ready.
• 27:47
  Michael Solomon: Uh, and yeah.
• 27:49
  Joseph M. Schwab: So we, uh, obviously we met at the European anterior hip meeting, but now you're also a part of the Anterior Hip Foundation on one of the international committees, uh, representing the, the basically Oceania and the Asia Pacific, uh, region.
• 28:05
  Joseph M. Schwab: Um, how did you transition, or, or what made you transition from being, let's say, a learner of anterior approach to a leader in the anterior approach?
• 28:16
  Joseph M. Schwab: Uh, uh, groups that are the, the advocate groups that are out there basically for anterior approach.
• 28:24
  Michael Solomon: Okay, so Hal, I'll start by telling you I'm not a zealot.
• 28:29
  Michael Solomon: I don't do a hundred percent anterior approach.
• 28:32
  Michael Solomon: Okay?
• 28:33
  Michael Solomon: And in fact, when I started 16 years ago, I was doing 20% or 30%.
• 28:39
  Michael Solomon: Now, I, I'm reckon I'm probably 85 to 90% because I do the approach that is best for the patient.
• 28:46
  Michael Solomon: Okay?
• 28:47
  Michael Solomon: Now I do feel, you know, so it, I, what I've, the, the steps I say is, does.
• 28:54
  Michael Solomon: Does this tech, does the approach or technology, does it improve outcomes that matter to the patient?
• 29:01
  Michael Solomon: So the anterior approach to me ticks that box because I think, you know, anterior approach patients recover earlier at the beginning.
• 29:12
  Michael Solomon: I don't think it makes a difference when you get to like four or five months.
• 29:15
  Michael Solomon: I think you, I can get two hip replacements walking into my office.
• 29:19
  Michael Solomon: One's had anterior, one's had posterior.
• 29:20
  Michael Solomon: If I'm blinded, I wouldn't know the difference.
• 29:22
  Michael Solomon: But I actually do think the early recovery, uh, it does make a difference.
• 29:27
  Michael Solomon: I tell patients, you know, if I have a patient who's morbidly obese, who needs a, like, you know, my patient, uh, dear old Fritz, there was no ways I was gonna struggle through an anterior approach with a stomach apron that was coming down almost to the mid thigh.
• 29:42
  Michael Solomon: It was just no point.
• 29:44
  Michael Solomon: I could turn it on a side, I could do a posterior approach.
• 29:47
  Michael Solomon: Quite slickly.
• 29:48
  Michael Solomon: She just needed to be out of pain.
• 29:50
  Michael Solomon: I could have put a doorknob in her hip and she would've been out of pain.
• 29:53
  Michael Solomon: You know, that's how much bad arthritis was.
• 29:55
  Michael Solomon: And so she got a posterior approach, and, and, and it wasn't about her getting a quicker recovery or getting outta hospital quicker.
• 30:02
  Michael Solomon: So, so, and there are patients who've got complex femoral deformities that I won't do an anterior approach.
• 30:07
  Michael Solomon: I, so I try and take a very sensible approach, but I would do it on the majority, and I would tell patients.
• 30:13
  Michael Solomon: If you don't fit my criteria, don't be alarmed.
• 30:16
  Michael Solomon: You're still gonna get a good outcome in the end because hip replacement's a great operation.
• 30:20
  Michael Solomon: You may not recover quite as quickly.
• 30:22
  Michael Solomon: I might give you some hip precautions, uh, initially, but you will be fine.
• 30:26
  Michael Solomon: So it's about educating the patient, what's best for them.
• 30:30
  Michael Solomon: So, you know, I, of course I like the approach and it is my favorite approach.
• 30:35
  Michael Solomon: And, you know, I'm very lucky, uh, in part of my operating team to have.
• 30:41
  Michael Solomon: An amazing, uh, rep who, uh, effectively runs the table.
• 30:47
  Michael Solomon: I do, I do use a leg holder who knows every move I do.
• 30:50
  Michael Solomon: And she's, and I work at three different hospitals and she's, uh, I'll give her a shout out.
• 30:55
  Michael Solomon: Her name's Bronwyn.
• 30:56
  Michael Solomon: She's unbelievable.
• 30:57
  Michael Solomon: And, and, and has, has just made me efficient, uh, care careful during the surgery.
• 31:06
  Michael Solomon: So you need a team, you need a great team.
• 31:08
  Michael Solomon: Um, and.
• 31:10
  Michael Solomon: So adopting new technology, you know, does it make the patient, is it better for the patient?
• 31:14
  Michael Solomon: Does it improve outcomes?
• 31:15
  Michael Solomon: Is it consistent for surgeons?
• 31:18
  Michael Solomon: Can many surgeons do this?
• 31:20
  Michael Solomon: Is this, or is this something that's kind of unique that only one or two skill people can do?
• 31:24
  Michael Solomon: So it's if you've got something that's good for the patient and anterior tick that box early on, uh, that's reproducible once you've been trained, uh, and it's not complex and that it helps in, uh, post-op outcomes.
• 31:37
  Michael Solomon: I think that's, yeah, that's why I adopt it.
• 31:41
  Joseph M. Schwab: So how did you go from your evaluation of that technique to being part of some of these advocacy groups like the European Anterior Hip meeting?
• 31:48
  Joseph M. Schwab: The Anterior Hip Foundation.
• 31:53
  Michael Solomon: Well, I gotta blame you for the anterior hip foundation because you dove me in.
• 31:59
  Michael Solomon: But
• 31:59
  Joseph M. Schwab: All right.
• 32:00
  Joseph M. Schwab: Guilty.
• 32:02
  Michael Solomon: I, um, look, when anterior approach started in Australia, it was a little bit of a taboo.
• 32:09
  Michael Solomon: Um, there were.
• 32:11
  Michael Solomon: Senior surgeons and, and of course well-established posterior approach surgeons who, um, I think they were more, uh, and, and, and to be fair, there was a commercial element in its introduction in Australia.
• 32:27
  Michael Solomon: The company that brought it into Australia had a different angle.
• 32:31
  Michael Solomon: You know, I went from being a posterior approach guy using a blade stem to an anterior approach guy using a fully coded.
• 32:40
  Michael Solomon: Uh, stem and the only re not that there was anything wrong with the blade stem or the approach, it's because I thought this technique, because I was familiar with the, uh, approach with my osteotomy experience, was a good technique and sounded intuitively the right way to go.
• 32:57
  Michael Solomon: But it's introduction into Australia was clouded with, um, sort of surgeon.
• 33:04
  Michael Solomon: Uh, there were some surgeons who went out on a limb to advertise.
• 33:08
  Michael Solomon: In fact, my wife told me one day, I, I'm, I'm sitting on this computer, and, uh, she said, who's the surgeon?
• 33:15
  Michael Solomon: I said, what are you talking about?
• 33:17
  Michael Solomon: You've never even heard of him.
• 33:18
  Michael Solomon: I said, I know, but in the local newspaper, there's a big advert here that says Anterior Approach surgery and the happy patients, you know, in Australia, you're not allowed to have patient testimonials on websites or, or advertising, but this was clear patient testimonials, but, but the effect was there.
• 33:34
  Michael Solomon: You know, this guy had advertised.
• 33:36
  Michael Solomon: Suddenly it was out there and every Tom, Dick and Harry wanted an anterior approach.
• 33:40
  Michael Solomon: It, it was a bit like when resurfacing started in Australia, you know, you've got 90 year olds turning up wanting a resurfacing because they'd seen something on the television about resurfacing.
• 33:50
  Michael Solomon: So it was so, so the start of anterior approach in Australia.
• 33:54
  Michael Solomon: Uh, was clouded with a bit of commercial advertising, which is, we are, we are more of a, sort of an English traditional type orthopedic society.
• 34:02
  Michael Solomon: Um, and, uh, so the beginnings were tough and everybody, the posterior approach guys were looking to see where's the problem gonna be.
• 34:11
  Michael Solomon: And of course, our joint registry, which is a superb, uh, document that comes out every year, is now in its 25th year.
• 34:19
  Michael Solomon: The joint registry showed that one particular implant.
• 34:23
  Michael Solomon: Had a higher revision rate and it was for fracture, uh, and loosening.
• 34:29
  Michael Solomon: And when they delved into it, of course this was the implant that was primarily used in the anterior approach because the anterior approach was brought in by a company.
• 34:36
  Michael Solomon: Um, and the surgeons using it were low, going through their learning curve.
• 34:40
  Michael Solomon: And as such, they were, the posterior guys were, oh, you see, it's a di it's a disaster approach.
• 34:46
  Michael Solomon: Look, you're gonna get the, the patient's home.
• 34:47
  Michael Solomon: You're gonna fracture, you're gonna get loose.
• 34:49
  Michael Solomon: So that was the start of it all, but actually at the joint registry.
• 34:52
  Michael Solomon: Over time started to show that in fact, the implant performed just like any other implant after two months.
• 34:59
  Michael Solomon: So there was a clear, there was a clear learning curve.
• 35:01
  Michael Solomon: It wasn't the implant, it was the technique.
• 35:03
  Michael Solomon: And once you learn the technique, you know those problems that went away.
• 35:07
  Michael Solomon: So now the anterior approach in Australia, we have about 35% are done an.
• 35:13
  Joseph M. Schwab: Yeah.
• 35:13
  Joseph M. Schwab: Was this the impetus for you doing the, the um, uh, the learning curve paper that you talked about at the beginning?
• 35:23
  Michael Solomon: Correct, because what was interesting about that paper, um, and just, you know, you gotta do 50 cases to get, to get Yeah.
• 35:31
  Michael Solomon: Skilled.
• 35:32
  Michael Solomon: But what we did in that paper is we compared experienced surgeons who started the anterior approach to new surgeons, as in they just come out of their orthopedic residency.
• 35:46
  Michael Solomon: Who started the anterior approach and looked at their revision rates and the rate the joint registries de-identified.
• 35:52
  Michael Solomon: But, uh, because I was doing the approach and I knew the company that provided the majority of the implants, we could kind of work out on the joint registry, um, volume based on experience, and then we could see, you could see where the learning curve was coming and where the, where the difficulties were.
• 36:10
  Michael Solomon: And as people got better.
• 36:13
  Michael Solomon: Uh, and their volume got up, went up, so their, so their revision rate went down.
• 36:19
  Michael Solomon: So, so, uh, you know, I, so I went from learning myself to, to becoming what I felt to be competent in terms of what I was doing, but also being strict with my patient selection, uh, and then teaching the approach.
• 36:33
  Michael Solomon: Um, and then I guess, uh, you know, I've given talks in various places.
• 36:39
  Michael Solomon: Um, about technique and how I do the anterior approach.
• 36:43
  Michael Solomon: Um, based on experience,
• 36:47
  Joseph M. Schwab: So as you kind of look back at your career where it's gotten you to so far, is there a piece of advice you wish someone had given you when you were just starting out as a young hip surgeon?
• 37:06
  Michael Solomon: get well trained.
• 37:09
  Michael Solomon: Don't be in a hurry.
• 37:12
  Michael Solomon: Treat patients well.
• 37:15
  Michael Solomon: Treat staff well.
• 37:17
  Michael Solomon: Be generous to your staff.
• 37:18
  Michael Solomon: And I'm talking about office staff, operating room staff reps who help re um, you know, stay humble because ultimately cream rises to the top.
• 37:29
  Michael Solomon: And if you follow basic, you know, just be human.
• 37:34
  Michael Solomon: Just have some humanity and uh, and that's something you learn over time, uh, which is your mentors that help you mold you and your patients, help you mold you, and, and, and experience helps you mold you.
• 37:49
  Joseph M. Schwab: Along those lines, what does it mean to you to be a great hip surgeon?
• 37:54
  Joseph M. Schwab: You know, if, if you were to do.
• 37:55
  Joseph M. Schwab: Describe a, a colleague or a mentor or a friend as a great hip surgeon, what does that mean to you?
• 38:02
  Michael Solomon: You know, I think you've gotta balance the science and skill of surgery with, uh, the humility of patient care.
• 38:13
  Michael Solomon: And, and you've gotta treat your team with generosity and respect, because that's.
• 38:18
  Michael Solomon: I, I think if the, you know, and it's, it can sound cliche like, but truly we are here for, for our patients in the end, okay, yes, we can earn a good living, but actually we here for our patients.
• 38:31
  Michael Solomon: And so you get, you develop skills, you use science, you develop, you, you use innovation.
• 38:38
  Michael Solomon: But, but we've gotta impart that on our patients when we feel it is gonna be to their benefit.
• 38:45
  Michael Solomon: And you've gotta listen to your patients.
• 38:47
  Michael Solomon: You've gotta remain humble and you've gotta, you can't do it without a team.
• 38:51
  Michael Solomon: And you've gotta, you have to respect your team.
• 38:54
  Michael Solomon: And, and, you know, I would often do extra lists on a Saturday just to catch up.
• 38:59
  Michael Solomon: And, and the theater, you know, they put up a list, Solomon's doing a list on a Saturday.
• 39:04
  Michael Solomon: It gets filled with staff immediately because we have a fun time in theater.
• 39:08
  Michael Solomon: People like coming to the operating room.
• 39:11
  Michael Solomon: The, you know, we play tempo music, we don't play Tchaikovsky.
• 39:15
  Michael Solomon: So you know, when you do a joint replacement things, it's step and we stick to the same step.
• 39:20
  Michael Solomon: So they know, you know, this is step one, step two.
• 39:22
  Michael Solomon: So I tell my an to put the right music on, we gotta keep going.
• 39:29
  Joseph M. Schwab: Um, and given that you've seen sort of the changes or the growth or the, um, evolution, let's say of.
• 39:37
  Joseph M. Schwab: Of medicine in general over your career.
• 39:40
  Joseph M. Schwab: Is there any advice or encouragement that you'd give to specifically the young surgeons, maybe our learners or registrars who are listening today who are interested in making an impact to orthopedics?
• 39:55
  Michael Solomon: Yeah.
• 39:56
  Michael Solomon: You know, I, I, I still think it, it, it's a marathon.
• 40:00
  Michael Solomon: It's not a sprint.
• 40:01
  Michael Solomon: Okay?
• 40:01
  Michael Solomon: So don't, don't come out of your fellowship and suddenly say, I'm gonna do this, this, and this actually.
• 40:08
  Michael Solomon: Stick to what you've learned Well, and start doing what you've learned well, and as you've developed further skills surgically, you can then branch out with, with new things.
• 40:20
  Michael Solomon: But don't be in a hurry to try different things.
• 40:24
  Michael Solomon: Just start off simple and it, and it, you know, I'm guilty of not doing this, but it, it's, in hindsight, I look back and I'm thinking, okay, yeah, I was in like consulting in four different locations and I was.
• 40:37
  Michael Solomon: I was on call at three different hospitals.
• 40:39
  Michael Solomon: Actually, you don't have to do all that.
• 40:42
  Michael Solomon: Uh, just just stick to what you learned well, and do what you learned well, and patients will come because they will tell their friends that you're a good guy, you treated them well, and you did a good operation, and that's how your practice will grow.
• 40:57
  Michael Solomon: And I always tell pa uh, the residents and the new ones, it's gonna take seven, eight years to develop a practice.
• 41:02
  Michael Solomon: It's not gonna happen overnight.
• 41:04
  Joseph M. Schwab: yeah.
• 41:06
  Joseph M. Schwab: Well, I think that's fantastic advice, and Michael, I've really appreciated having you, um, share some of your perspective, share your history and, uh, and, and share your, your, your personality with our guests here today on the AHF Podcast.
• 41:23
  Michael Solomon: Well, Joe, it's a pleasure and, and I, I have to compliment you, and I hope you put this into the, this podcast.
• 41:29
  Michael Solomon: But, but your podcasts are fabulous.
• 41:33
  Michael Solomon: Uh, and it's not just Yeah, this interview, but I've listened to many and I've listened to many people you've interviewed and, and some of them are really inspiring.
• 41:40
  Michael Solomon: And so I'd encourage you to keep going.
• 41:42
  Michael Solomon: You've got a wonderful manner of interviewing your style, and I, uh, I think it's terrific.
• 41:47
  Michael Solomon: And so, uh, you know, congratulations to you because I think you do a great job.
• 41:51
  Joseph M. Schwab: That's very kind and of course you're welcome back on the podcast now at any point.
• 41:55
  Joseph M. Schwab: Just, just for having said that.
• 41:57
  Michael Solomon: That's
• 41:59
  Joseph M. Schwab: No, Michael, that's excellent.
• 42:01
  Joseph M. Schwab: Thank you so much.
• 42:02
  Joseph M. Schwab: I look forward, I hope to get to see you in Australia sometime in the near future.
• 42:06
  Joseph M. Schwab: And, uh, thank you so much for being with us today,
• 42:11
  Michael Solomon: Thank you Joe.
• 42:11
  Michael Solomon: And uh, and thank you for everybody who listened in.
• 42:14
  Joseph M. Schwab: and thank you for joining me for this episode of the AHF podcast.
• 42:20
  Joseph M. Schwab: As always, please take a moment to like and subscribe so we can keep the lights on and keep sharing great content just like this.
• 42:28
  Joseph M. Schwab: Please also drop any topic ideas or feedback in the comments below.
• 42:33
  Joseph M. Schwab: You can find the AHF 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.
• 42:47
  Joseph M. Schwab: All one word, episodes of the AHF Podcast come out on Fridays.
• 42:52
  Joseph M. Schwab: I'm your host, Joe Schwab, asking you to keep those hips and patients happy and healthy.