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Interview: Leandro Ejnisman, MD · AHF Podcast

• 0:24
  Joseph M Schwab: Hello again and welcome back to the AHF Podcast.
• 0:28
  Joseph M Schwab: I'm your host, Joe Schwab.
• 0:30
  Joseph M Schwab: This week we head to Sao Paulo, Brazil.
• 0:33
  Joseph M Schwab: Where Dr.
• 0:34
  Joseph M Schwab: Leandro Ejnisman has been working hard to introduce anterior approach to his community for the past 10 years.
• 0:41
  Joseph M Schwab: He shares his insights on technology, surgeon entrepreneurship, and what the future of orthopedic surgery just might look like.
• 0:50
  Joseph M Schwab: And here's a hint.
• 0:51
  Joseph M Schwab: He's betting it'll involve robots.
• 0:54
  Joseph M Schwab: Let's join in on the conversation.
• 0:57
  Joseph M Schwab: Leandro, welcome to the AHF Podcast.
• 1:01
  Leandro Ejnisman: Thank you very much Joe.
• 1:02
  Leandro Ejnisman: It's an honor for me to be here.
• 1:04
  Leandro Ejnisman: Thank you very much.
• 1:04
  Leandro Ejnisman: And especially being the first one, I believe, from Latin America.
• 1:08
  Joseph M Schwab: That's right.
• 1:09
  Joseph M Schwab: So which, tell our listeners a little bit about you and a little bit about
• 1:13
  Leandro Ejnisman: I.
• 1:15
  Leandro Ejnisman: Sure.
• 1:16
  Leandro Ejnisman: So I'm from Sa Paulo Brazil, as you mentioned.
• 1:18
  Leandro Ejnisman: I was born here and I did all my training here.
• 1:21
  Leandro Ejnisman: I went to medical school at University of Sao Paulo, and for those who don't know, it's a very prestigious university here in, in South America.
• 1:28
  Leandro Ejnisman: It's considered, definitely one of the best here in Brazil, Latin America, but, but also it ranks really well, in world rankings.
• 1:37
  Leandro Ejnisman: a little thing that's different here in Brazil is that.
• 1:39
  Leandro Ejnisman: Usually if you are in a good way, in a good place where you did your medical school, people tend to stay in the same place for residency and fellowship.
• 1:47
  Leandro Ejnisman: So it's a little bit different than us.
• 1:48
  Leandro Ejnisman: What I see that most people go around in different places.
• 1:52
  Leandro Ejnisman: so I did my, medical school at University of Sao Paulo, my, my residency and my fellowship, which was in hip surgery.
• 2:00
  Leandro Ejnisman: also our practice here is like joint centered, so.
• 2:03
  Leandro Ejnisman: Most people like my practice as, as you asked, is basically hip surgery.
• 2:08
  Leandro Ejnisman: I do both hip replacements and hip preservation surgery.
• 2:12
  Leandro Ejnisman: So after my, my fellowship here in Brazil, I went to the west to do another fellowship.
• 2:18
  Leandro Ejnisman: I.
• 2:18
  Leandro Ejnisman: And in my, in my hospital, we didn't have much hip arthroscopy.
• 2:21
  Leandro Ejnisman: So I spent one year after my fellowship at, in Il, Colorado with Dr.
• 2:26
  Leandro Ejnisman: Philippon at the Stateman Clinic.
• 2:29
  Leandro Ejnisman: I went there as a, we have like a institution here that gives scholarships to Brazilians that want to go abroad.
• 2:35
  Leandro Ejnisman: It's called Institu technology, the S, so I went there and I have a wonderful year of Dr.
• 2:40
  Leandro Ejnisman: Philippon.
• 2:41
  Leandro Ejnisman: I learned a lot of laproscopy.
• 2:43
  Leandro Ejnisman: I did some research, which was really interesting, and then I came back, When I started my practice, I divided myself between public system here in Brazil and my private practice, the public system was at the University of Sao Paulo where I trained.
• 2:59
  Leandro Ejnisman: I also did my PhD there in, in hip surgery, especially studying, the relationship between labor affairs and, and, Angle measurements in CT scans, which was a very interesting study.
• 3:13
  Leandro Ejnisman: And after seven years, I decided that I wanted to study a little bit more and, and actually hone, yeah, even more my, my research skills.
• 3:21
  Leandro Ejnisman: So I spent one year, in 2018, I.
• 3:25
  Leandro Ejnisman: California with Dr.
• 3:26
  Leandro Ejnisman: Mark Saffron at Stanford, which was a really interesting year.
• 3:29
  Leandro Ejnisman: I was able to do more research.
• 3:31
  Leandro Ejnisman: Again, I studied basically a lot of hip micro instability.
• 3:35
  Leandro Ejnisman: but it was also very interesting to get in, in like the mindset of the Silicon Valley.
• 3:39
  Leandro Ejnisman: Did a lot of courses on innovation and a lot of stuff on design thinking.
• 3:44
  Leandro Ejnisman: So it kind of changed my, my practice a little bit when I came back.
• 3:47
  Leandro Ejnisman: So I decided a lot to go.
• 3:49
  Leandro Ejnisman: I started to do a lot of stuff with innovation.
• 3:51
  Leandro Ejnisman: I actually found that I started up, I started doing some angel investments in, in health tech, related, companies.
• 3:59
  Leandro Ejnisman: I also did, started doing a lot of stuff with, technology in, in.
• 4:04
  Leandro Ejnisman: In medicine now we practice in orthopedics.
• 4:06
  Leandro Ejnisman: So I've been doing a lot of stuff with robotics, navigation, also some stuff with, augmented reality and virtual reality.
• 4:13
  Leandro Ejnisman: So definitely my experience in California changed me a a lot.
• 4:16
  Joseph M Schwab: So were most of in the area of orthopedics or more specifically in hip surgery or were the, was it a kind of across the gamut of medicine
• 4:26
  Leandro Ejnisman: I, I have a, I have vested in an engine investment in a company that does a lot of stuff with digital health in orthopedics.
• 4:33
  Leandro Ejnisman: So they have like a software that's nap, especially like for, for like a company that has like thousands of employees and have a lots of.
• 4:41
  Leandro Ejnisman: Problems with people getting absent because of back pain, this kind of stuff.
• 4:44
  Leandro Ejnisman: So it helps monitor their health.
• 4:46
  Leandro Ejnisman: And Oslo has some, like tele physiotherapy and Teleconsultation helped by ai, so that's a very interesting company.
• 4:54
  Leandro Ejnisman: I also helped a company that had stuff with 3D printing, but especially with Sprint, like for, ortho Posis and this kind of stuff.
• 5:02
  Leandro Ejnisman: And I also have, in a, I also have some investment in a company that does stuff of.
• 5:07
  Leandro Ejnisman: Medical education, they do like, especially for medical students, they do like clinical cases with actors.
• 5:15
  Leandro Ejnisman: So you have like a situation that, like you have an actor that presents himself with a symptom, let's say his coughing.
• 5:21
  Leandro Ejnisman: And then you have like, you have to ask, what's the exam that you want?
• 5:24
  Leandro Ejnisman: They show the exam.
• 5:25
  Leandro Ejnisman: Then you, you see the, you wanna see, tell what you're gonna do.
• 5:29
  Leandro Ejnisman: And it's a very interesting company actually going abroad as well.
• 5:31
  Leandro Ejnisman: So it's very popular.
• 5:33
  Leandro Ejnisman: Yeah.
• 5:34
  Joseph M Schwab: I mean, you really have your hands in a lot of different, areas of medicine it sounds like, as well as in technology and innovation.
• 5:41
  Joseph M Schwab: focusing a little bit on anterior approach, hip replacement, tell me about how common it is, either in Sao Paulo or, or in, you know, Brazil overall.
• 5:53
  Leandro Ejnisman: It is definitely growing.
• 5:55
  Leandro Ejnisman: So I don't have official numbers, but I would guess around 5% of doctors here would do anterior approaches, definitely less than US or Europe.
• 6:05
  Leandro Ejnisman: But I would say like until like five years ago, it would be.
• 6:07
  Leandro Ejnisman: Probably less than 1%.
• 6:09
  Leandro Ejnisman: So it's definitely growing really fast.
• 6:11
  Leandro Ejnisman: My, my first contact with the interior approach was when I still, when I was in, in Vail with Dr.
• 6:16
  Leandro Ejnisman: Philippon.
• 6:17
  Leandro Ejnisman: I've seen talks of Dr.
• 6:18
  Leandro Ejnisman: Matta and doing the interior approach of the HA table, but that was something that looked a little bit far from me'cause.
• 6:24
  Leandro Ejnisman: Brazil.
• 6:24
  Leandro Ejnisman: It's an interesting country'cause it's a land of disparities.
• 6:27
  Leandro Ejnisman: I would say, you know, because you have like lots of wealth here.
• 6:30
  Leandro Ejnisman: So the, the hospital that I do that, that I work now, it's called Albert Einstein Hospital.
• 6:35
  Leandro Ejnisman: It's a Jewish hospital.
• 6:36
  Leandro Ejnisman: I'm very proud of that here in Sao Paulo.
• 6:38
  Leandro Ejnisman: And it's considered, the, definitely the best hospital in Latin America, but it also ranks in as 22nd in the wards, a really prime institution.
• 6:47
  Leandro Ejnisman: But they have lots of other hospitals here that are not, so there's not.
• 6:52
  Leandro Ejnisman: The infrastructure that Einstein has has, and even like being in such a good place, like for me as a ledge surgeon, asking for like a special table that costs so much, it looks like a far thing, you know, for me.
• 7:05
  Leandro Ejnisman: So I decided to do the interior approach.
• 7:07
  Leandro Ejnisman: I, I saw Dr.
• 7:08
  Leandro Ejnisman: Christoph Carin from Belgium doing the interior approach off table in a meeting.
• 7:13
  Leandro Ejnisman: And I went to him and I said that that's when something clicked to me, you know, saying that's something that I can do in my practice, you know?
• 7:19
  Leandro Ejnisman: So I went to visit him in 2016, and that's when my journey began.
• 7:23
  Leandro Ejnisman: So almost 10 years now I have the opportunity to visit him again.
• 7:27
  Leandro Ejnisman: I think 2000.
• 7:28
  Leandro Ejnisman: 2000 and.
• 7:29
  Leandro Ejnisman: In 22, I think he, I was the first visitor after the pandemic with him'cause he had to, to block his visitors for a while because of the pandemic.
• 7:37
  Leandro Ejnisman: So since 2016 I started doing interior approach off table and it's been amazing.
• 7:42
  Leandro Ejnisman: You know, it's, I decided to,'cause I was listening to other, other, other, orthopedic surgeons here at the podcast telling that some people decided to go like, full, full.
• 7:53
  Leandro Ejnisman: Food directly to the anterior approach and do a hundred percent of their cases.
• 7:56
  Leandro Ejnisman: Interior.
• 7:57
  Leandro Ejnisman: I took another, approach.
• 7:59
  Leandro Ejnisman: I started like changing gradually.
• 8:01
  Leandro Ejnisman: So at the beginning I was very picky, like doing the easy cases, like thin patients, very vgo snacks.
• 8:08
  Leandro Ejnisman: And then I started slowly growing, like doing more difficult cases.
• 8:11
  Leandro Ejnisman: And last year, 2024, I did, I think like 92% of my cases were interior approach.
• 8:16
  Leandro Ejnisman: You know, so I'm, I'm basically converted now.
• 8:20
  Leandro Ejnisman: I still don't feel like confident.
• 8:21
  Leandro Ejnisman: I don't, I don't say confident, but I, I still rather not do a hundred percent of them.
• 8:25
  Leandro Ejnisman: 'cause especially like the.
• 8:27
  Leandro Ejnisman: What I feel is that like as I'm in an environment where, where anterior approach is not the norm yet, I feel like if I do a patient that it's like more complicated.
• 8:35
  Leandro Ejnisman: Like if you do a really obese patient that has a higher rate of infection, independent of the approach, if I do an anterior approach and he gets infected, it's because of the approach.
• 8:44
  Leandro Ejnisman: If I do a posterior approach and gets infected, was was a tough case.
• 8:48
  Leandro Ejnisman: You know?
• 8:48
  Leandro Ejnisman: So I think, I feel I have to protect myself and the approach, you know.
• 8:51
  Joseph M Schwab: So do you find that's one of the biggest challenges you have in sort of performing or growing anterior approach in your area?
• 8:59
  Joseph M Schwab: Or what, what are the biggest challenges you see of greater adoption in Brazil?
• 9:06
  Joseph M Schwab: I,
• 9:07
  Leandro Ejnisman: It is changing.
• 9:08
  Leandro Ejnisman: You know, like I, I would say the, the first meeting I, I, I, I think I heard of in Brazil of interior approach was in 2017.
• 9:15
  Leandro Ejnisman: It was, organized by mad.
• 9:17
  Leandro Ejnisman: So a, a lot of pe, a lot of people that do interior approach here in Brazil, they use the med system with their table.
• 9:23
  Leandro Ejnisman: 'cause the HANA table, we are getting some here in Brazil.
• 9:26
  Leandro Ejnisman: I know in Sao Paulo of two places they have it, but not many.
• 9:30
  Leandro Ejnisman: So.
• 9:32
  Leandro Ejnisman: I went there and like people were telling about the interior approach and, and me, so one thing that's a problem here in Brazil is because our health system is a little bit different and dependent, depending on the insurance of the patient and the hospital that are doing surgery, sometimes it's not easy for the surgeon to choose the implant that he wants.
• 9:51
  Leandro Ejnisman: So one thing that I, when I decided to do an interior approach, the, the thing that convinced me of doing it off table was because I didn't want to get, stuck.
• 10:00
  Leandro Ejnisman: To, to a table, because I thought in, in Brazil, our practice, even though I'm most of the time at Albert Einstein Hospital, I still do surgeries in other places.
• 10:08
  Leandro Ejnisman: So I felt like if I'm, if I'm, I'm attached to the table and I can only do the surgery with the HANA table, if I go to another place that doesn't have it, I won't be able to do the approach that I want.
• 10:18
  Leandro Ejnisman: And the same thing happened with, it was my, my, my mindset with mea.
• 10:21
  Leandro Ejnisman: I felt like, well, if I can do like most of my cases with mea, that's good.
• 10:25
  Leandro Ejnisman: I can do the interior approach.
• 10:26
  Leandro Ejnisman: But if some insurance or some hospital.
• 10:28
  Leandro Ejnisman: Doesn't allow me to use their implant, that I'm gonna be not able to do the approach.
• 10:32
  Leandro Ejnisman: You know?
• 10:33
  Leandro Ejnisman: And I feel like as some, a lot of surgeons here in Brazil still linked the anterior approach, or to the MEA system or to the the H table.
• 10:42
  Leandro Ejnisman: They're kind of like, whoa, I cannot do this because I wanna be able to do in every case.
• 10:46
  Leandro Ejnisman: But I feel like, Now, especially the past three or four years, I feel like the mindset is changing and I've here, I feel like two, five years ago, I knew every surgeon here in Brazil that do the interior approach.
• 10:58
  Leandro Ejnisman: And now I don't, like every once in a while I get patients, patients know.
• 11:01
  Leandro Ejnisman: I get surgeons that come talk to me in meetings.
• 11:03
  Leandro Ejnisman: Oh, I've been doing interior approach, I've been doing off table.
• 11:05
  Leandro Ejnisman: I've been doing on table.
• 11:07
  Leandro Ejnisman: So it's spreading and I feel like the, the grow, it's been, the growth, it's been leading by the patients themselves, you know?
• 11:15
  Leandro Ejnisman: So I was talking to you that, yeah, I, I feel like my practice, when I began my practice in 2011, that's when it began.
• 11:22
  Leandro Ejnisman: It was like in the public system, was mainly, hip replacements.
• 11:27
  Leandro Ejnisman: I didn't do many.
• 11:28
  Leandro Ejnisman: Hip preservation there.
• 11:29
  Leandro Ejnisman: But in my private practice, I would say probably 70% was hip preservation.
• 11:34
  Leandro Ejnisman: But since I started doing, the interior approach, it's been changing a lot.
• 11:38
  Leandro Ejnisman: So I would say probably now 20 to 30% of my practice is, is, hip preservation and the rest is interior approach, because I've been getting referrals.
• 11:48
  Leandro Ejnisman: by, by another, by patients themselves, by physiotherapists to see a lot of difference.
• 11:52
  Leandro Ejnisman: The TER approach.
• 11:53
  Leandro Ejnisman: It's funny, you know, like a couple of years ago I operated on, the mom of a physiotherapist here.
• 12:00
  Leandro Ejnisman: She's really known here.
• 12:01
  Leandro Ejnisman: She has a great practice.
• 12:03
  Leandro Ejnisman: Like she, she, she treated one of my patients like she was.
• 12:06
  Leandro Ejnisman: Pled by like the, the, the recovery and the speed recover.
• 12:10
  Leandro Ejnisman: So like two months after she sent me her mom to operate on and she like, she knows a lot of guys here and like I was very honored.
• 12:17
  Leandro Ejnisman: But it shows to me how the physiotherapist see the difference.
• 12:19
  Leandro Ejnisman: Like when during your approach, you know.
• 12:21
  Joseph M Schwab: the growth has really been word of mouth through the patients, it sounds
• 12:24
  Leandro Ejnisman: Word of mouth.
• 12:25
  Leandro Ejnisman: Yeah.
• 12:26
  Leandro Ejnisman: One other thing that's that's big in Brazil is social media.
• 12:30
  Leandro Ejnisman: So the, the, like many doctors have like social media pages and Instagram, YouTube, LinkedIn, in all the, you know, the, the places.
• 12:38
  Leandro Ejnisman: And also I have one myself, and there's lots of patient education and it's something like then when the patient starts.
• 12:45
  Leandro Ejnisman: Studying, quote unquote, about the, the procedure.
• 12:47
  Leandro Ejnisman: And they hear there's a procedure that's muscle, more muscle sparing, there's less invasive, they're, they're really convinced, you know, so lots of patients come to me, they, they come to me and the first thing they, they ask is like, you, you do inter approach.
• 12:58
  Leandro Ejnisman: Right?
• 12:59
  Leandro Ejnisman: Because that's what I want.
• 13:00
  Leandro Ejnisman: You know?
• 13:00
  Leandro Ejnisman: So that's something interesting.
• 13:02
  Joseph M Schwab: So, so you've been doing it for about 10 years, plus or minus.
• 13:06
  Joseph M Schwab: And if, if you could go back to the beginning, really, there one thing that you wish you would've known, or you wish you would've approached differently when you were starting to learning anterior approach?
• 13:23
  Leandro Ejnisman: I wish I had more, more structure than I had in the beginning.
• 13:25
  Leandro Ejnisman: So like the companies, the, the medical companies wasn't, weren't like too, too red, weren't ready for the interior approach.
• 13:33
  Leandro Ejnisman: So when I started I didn't have like offset handles.
• 13:36
  Leandro Ejnisman: I.
• 13:36
  Leandro Ejnisman: For doing the interior approach I had, to by myself, the retractors that I used, you know, so it was very, like, sometimes when I think of the beginning, I would think, I feel like I was very brave doing it, you know?
• 13:47
  Leandro Ejnisman: 'cause I was doing, like, I wouldn't recommend people to do it the way I did.
• 13:51
  Leandro Ejnisman: 'cause like, I didn't have like the, the right instrumentation.
• 13:54
  Leandro Ejnisman: I was in the public system doing, with residents, like junior people to not help me very much, you know?
• 14:01
  Leandro Ejnisman: So it was the, the beginning was.
• 14:02
  Leandro Ejnisman: Tough, but I'm, I'm, I'm really happy that I did it, you know?
• 14:06
  Leandro Ejnisman: 'cause now I'm really happy with the interior approach.
• 14:08
  Leandro Ejnisman: One thing that I did that some people do not recommend, but I still think like it was a good call.
• 14:13
  Leandro Ejnisman: I did in the beginning many hip fractures.
• 14:15
  Leandro Ejnisman: 'cause I do a lot of femoral neck fractures and I've seen some people telling people like to stay off of femoral femoral fractures in the beginning.
• 14:24
  Leandro Ejnisman: And that's not my feeling because people are worried about the femoral fracture, like getting, doing like a, a calco fracture or something.
• 14:30
  Leandro Ejnisman: That's something that I, I didn't have.
• 14:32
  Leandro Ejnisman: In the beginning, and I feel like usually there are older patients, like very, with very soft tissues.
• 14:37
  Leandro Ejnisman: I very lax, so getting like the proper releases and getting the femoral exposure, I feel like it's very easy in, in femoral fractures.
• 14:45
  Leandro Ejnisman: And I still do a lot of those.
• 14:47
  Leandro Ejnisman: And it's interesting, some people say, oh, but it's e femoral fracture is an elderly patient.
• 14:51
  Leandro Ejnisman: You don't need like to be less invasive.
• 14:53
  Leandro Ejnisman: But that's something that I totally disagree.
• 14:55
  Leandro Ejnisman: I feel like they, they do really well.
• 14:57
  Leandro Ejnisman: They recover faster, they bleed less and they're really happy, you know, so that's something that I kind of disagree with many people that I've heard of.
• 15:04
  Joseph M Schwab: No, I, I completely agree with you.
• 15:05
  Joseph M Schwab: I think hip fractures are a great place to learn anterior approach, for the reasons that you mentioned and the fact that you want to do everything you can to get those patients functional and minimize their amount of.
• 15:19
  Joseph M Schwab: Pain, so that they avoid things like dementia or delirium and things like that.
• 15:24
  Joseph M Schwab: So in your journey, I mean, you mentioned, for instance, Kristoff Corten as a, as, as a mentor.
• 15:31
  Joseph M Schwab: What was it that you felt you got from those sort of mentorship relationships?
• 15:35
  Joseph M Schwab: Was it really specific ways to do things or was it introduction to different technologies, or was it just sort of a, a, a whole picture of efficiency?
• 15:45
  Joseph M Schwab: What do you felt like you learned from your mentors?
• 15:47
  Joseph M Schwab: I.
• 15:49
  Leandro Ejnisman: I feel from him, I learned like the most important thing definitely is the, the technique itself.
• 15:53
  Leandro Ejnisman: You know?
• 15:54
  Leandro Ejnisman: 'cause, like doing the proper releases, like being, when I spent the first time I went there, I think like three days with him in the, or the second time, two days.
• 16:05
  Leandro Ejnisman: He has a great volume.
• 16:06
  Leandro Ejnisman: So like being the, the first time I think I saw.
• 16:09
  Leandro Ejnisman: 30 plus surgeries and I was able to scrub in of him.
• 16:13
  Leandro Ejnisman: It's a big difference, like from when we visit the us you know,'cause I've did lots of visitation with surgeons, which it's just a great way to, to learn from people.
• 16:22
  Leandro Ejnisman: And usually when you go to the US you cannot scrub in.
• 16:24
  Leandro Ejnisman: And especially if you're like, learning, the interior approach is kind of deep, you know, it's really hard to see from the outside, you know.
• 16:30
  Leandro Ejnisman: So being able to scrub in with him was great.
• 16:33
  Leandro Ejnisman: He was also a mentor for me.
• 16:35
  Leandro Ejnisman: Like I, I remember like I had.
• 16:36
  Leandro Ejnisman: In the be beginning of my learning curve, I had one case of femoral nerve palsy, which I, I got really, really scared.
• 16:42
  Leandro Ejnisman: So I was able to, to send an email to him like, did this ever happen?
• 16:46
  Leandro Ejnisman: It's gonna get better.
• 16:47
  Leandro Ejnisman: And he's like, calm me down.
• 16:48
  Leandro Ejnisman: Say it gets better.
• 16:49
  Leandro Ejnisman: Just the pulse.
• 16:49
  Leandro Ejnisman: And actually it did get better really fast, so it was really great.
• 16:53
  Leandro Ejnisman: And the technology also.
• 16:54
  Leandro Ejnisman: So like I have access to the gripper, the technology that he developed.
• 16:58
  Leandro Ejnisman: It's great.
• 16:59
  Leandro Ejnisman: I still struggle in Brazil because of the cost, so I'm not able to use it in every surgery.
• 17:04
  Leandro Ejnisman: It's a pity, I would love to use it, but I feel like he's a guy that's kind of pushing like our technology and everything, and I really look up to him for that and appreciate that, you know.
• 17:15
  Joseph M Schwab: based on your experience, based on your time with mentors, your time studying, have you made any adjustments to your instrumentation, to your positioning or to your team coordination, to work on essentially efficiency in your ORs or how, how are things working for you currently?
• 17:34
  Leandro Ejnisman: Unfortunately, efficiency is not the best thing here.
• 17:36
  Leandro Ejnisman: You know, like our, I would say like I've, I've visited some places like in Belgium, in the us like the turn, the turnover of the, the rooms, the time, like the amount of surgeries that guys can do like in a day, something that, unfortunately it's not my reality.
• 17:50
  Leandro Ejnisman: So most of the days I'll do like.
• 17:52
  Leandro Ejnisman: Two cases, three at most, you know, and, and I kind of mix like in the morning or the surgeries in the afternoon, or the clinic or, or the other way, you know, so efficiency, unfortunately it's not that great here.
• 18:04
  Leandro Ejnisman: so like, I'm like, especially like, let's say I'm doing also a lot of robotics now, and I talk to some people that say, oh, doing robotics, like.
• 18:12
  Leandro Ejnisman: Gives you an extra time in surgery and it's, I don't wanna do that because if I add like five or 10 minutes to my case, in the end of the day, I'm doing one less case.
• 18:21
  Leandro Ejnisman: And actually it's not my reality, you know, if I'm doing like two cases and even I, I feel like the, the more in the advanced learning curve you are, the less.
• 18:29
  Leandro Ejnisman: It, it take, it adds time to the surgeon actually starts, lessen the time.
• 18:34
  Leandro Ejnisman: But even if it does, for me doing two cases that in 10, 10 minutes not be like a great difference, I think the biggest difference, inefficient that's happening in my or now that people are getting more used to interior approach, you know, because at the beginning I would get to the OR and every time people would say, okay, so let's turn the patient to the side.
• 18:50
  Leandro Ejnisman: And I'm like, no, I don't, I'm not turning the patient to the side.
• 18:53
  Leandro Ejnisman: I'll be asking for Flora and like, why do you need flora for, for a, for a hip replacement?
• 18:57
  Leandro Ejnisman: You know, so.
• 18:58
  Leandro Ejnisman: That's something that has changed and I think that's a bigger, efficiency that I added.
• 19:03
  Leandro Ejnisman: You know, like having a team and also the people that scrubbing with me.
• 19:07
  Leandro Ejnisman: It's not every time the same people, but most of the time, most of the people you know.
• 19:11
  Leandro Ejnisman: So now I feel like you're getting like a proper protocol that you're doing like the things basically the same, same way every time.
• 19:18
  Leandro Ejnisman: You know?
• 19:19
  Leandro Ejnisman: So having the numbered retractor is something that, it's so simple, but it adds, you know, like giving the refactor number one, number two, number three, and people start getting used to it.
• 19:27
  Leandro Ejnisman: Definitely add adds efficiency to the surgery.
• 19:29
  Joseph M Schwab: are there other surgeons in your practice who are doing anterior approach, or is it just you?
• 19:37
  Leandro Ejnisman: no, there's not, there's there, there are more people there.
• 19:39
  Leandro Ejnisman: One, more senior guy that actually he's doing interior approach, but it's a Watson Jones, not a direct interior.
• 19:47
  Leandro Ejnisman: and as I said, like in in, in, in Sao Paulo people we are not like, I think it's different like from Europe and US or patients, but people, surgeons mainly go like to one hospital.
• 19:57
  Leandro Ejnisman: So like people go around in different hospitals.
• 19:59
  Leandro Ejnisman: So I say that, that the doctors that like operate mainly at my hospital, I would say this, me and this other guy that does Watson Jones are the only two.
• 20:08
  Leandro Ejnisman: But like people that will come from time to time there, there are more people that do anterior approach as well.
• 20:13
  Joseph M Schwab: So I, I mean, you have this perspective of the, you know, the possibility of growth of anterior approach specifically in Brazil.
• 20:21
  Joseph M Schwab: If you were to give advice, to some surgeons who are considering switching to anterior approach, but are hesitant, what advice would you give them?
• 20:34
  Leandro Ejnisman: look for proper education.
• 20:35
  Leandro Ejnisman: Definitely.
• 20:36
  Leandro Ejnisman: So that's something that's growing in Brazil.
• 20:37
  Leandro Ejnisman: So one thing that I think really changed in the past year is that we're starting to get more, more, more support from the industry.
• 20:45
  Leandro Ejnisman: You know, so like our, our Brazilian hip meeting from our society happens every two years.
• 20:50
  Leandro Ejnisman: So the last one was in 2023, and it was amazing'cause I saw like most of the symposiums of the, the companies were.
• 20:58
  Leandro Ejnisman: About interior approach.
• 20:59
  Leandro Ejnisman: So they brought a lot of, foreigners that do interior approach.
• 21:02
  Leandro Ejnisman: I participated in one.
• 21:03
  Leandro Ejnisman: I work a lot of the, I work a lot with the Pew Johnson, so I, we had a symposium about interior approach.
• 21:10
  Leandro Ejnisman: So I always tell, don't be like, I think I was probably a little bit too brave.
• 21:14
  Leandro Ejnisman: I tell patients, like, I tell another surgeons, like, go to a lab, you're gonna, I know you're gonna have a great lab in, in Nashville this year.
• 21:22
  Leandro Ejnisman: visit a surgeon if possible.
• 21:24
  Leandro Ejnisman: Ask to have like a reverse.
• 21:26
  Leandro Ejnisman: Visitation when you can, you know, really pick your cases in the beginning.
• 21:30
  Leandro Ejnisman: You know, like something that happened with me that I don't hear very often from people, as I told you that I, I had like a, I was very picky in the beginning of my patients.
• 21:39
  Leandro Ejnisman: I almost feel like I have a doubled curved learning curve.
• 21:42
  Leandro Ejnisman: What I mean is that like, I was like, I think I did like a hundred cases, like really picking the, the easy ones.
• 21:48
  Leandro Ejnisman: Then I decided, okay, let's move to the harder ones.
• 21:51
  Leandro Ejnisman: And then almost felt like I was learning again, you know?
• 21:53
  Leandro Ejnisman: So I started to have like a little bit more complications.
• 21:55
  Leandro Ejnisman: The cases were difficult again.
• 21:57
  Leandro Ejnisman: So I really understood the difference between doing an easy case and a tough case.
• 22:01
  Leandro Ejnisman: So I usually tell tell people like start easy cases and don't be in a rush to turn your practice to a hundred percent interior approach.
• 22:08
  Leandro Ejnisman: You know, take your time.
• 22:10
  Leandro Ejnisman: That's something that I did and I'm really thinking, I'm glad I did that.
• 22:12
  Joseph M Schwab: I almost feel like publishing about the double learning curve is something worthwhile.
• 22:17
  Joseph M Schwab: That that's such a,
• 22:19
  Leandro Ejnisman: That'd be interesting.
• 22:20
  Joseph M Schwab: That is such an interesting observation that I've never heard anyone say before.
• 22:24
  Joseph M Schwab: But you're absolutely right.
• 22:25
  Joseph M Schwab: If you start out with that sort of, narrowed set of patients, you get really comfortable with it, and then you expand your indications.
• 22:32
  Joseph M Schwab: Yeah, absolutely.
• 22:33
  Joseph M Schwab: You can hit a whole nother learning curve.
• 22:35
  Joseph M Schwab: Right.
• 22:38
  Joseph M Schwab: I mean, you, you have this tremendous perspective.
• 22:40
  Joseph M Schwab: you've seen the growth where you're at.
• 22:42
  Joseph M Schwab: You're, you're clearly you're interested in innovation and technology.
• 22:46
  Joseph M Schwab: What do you see for the future of, of hip surgery, hip replacement surgery?
• 22:51
  Joseph M Schwab: You mentioned robotics.
• 22:52
  Joseph M Schwab: Where do you see this going?
• 22:56
  Leandro Ejnisman: I feel like if it, I don't know the number, it's gonna be 10 years, 20 years, or 50 years, but I feel like we're gonna move to a hundred percent robotics and technology.
• 23:04
  Leandro Ejnisman: That's something that I'm really, really be believing.
• 23:06
  Joseph M Schwab: Mo
• 23:07
  Leandro Ejnisman: not sure it's gonna be some.
• 23:08
  Joseph M Schwab: out of the operating room and everything's or what?
• 23:11
  Leandro Ejnisman: If you go like farther far, yeah, I think if you go further away, probably at some point I think like it's gonna be like in a Star Wars where the robots like the rain plant, like the looks hand.
• 23:22
  Leandro Ejnisman: But I think that's definitely farther away.
• 23:25
  Leandro Ejnisman: But I would say like in.
• 23:26
  Leandro Ejnisman: Not so long, not in so long time, like 10 to 20 years we're gonna move.
• 23:31
  Leandro Ejnisman: Like every case is gonna have technology with it, you know, which the thing that I'm not sure is which technology will quote unquote win.
• 23:38
  Leandro Ejnisman: You know, if it's gonna be 3D printed guides, if it's gonna be help with, augmented reality, if it's gonna be a robot itself.
• 23:46
  Leandro Ejnisman: Navigation, that's something I think it's open for, for discussion.
• 23:49
  Leandro Ejnisman: You know, at this point I've been using mainly the valve system from the pew, which I really like.
• 23:54
  Leandro Ejnisman: And the Mako from, from Stryker.
• 23:56
  Leandro Ejnisman: I've been using both and I feel like both has have their adv advantages and disadvantages.
• 24:02
  Leandro Ejnisman: But like as I told you, like I'm, I'm, I'm not able every time to pick the implant that I'm using.
• 24:06
  Leandro Ejnisman: So I still do a lot of surgeries with other implants without the help of technology.
• 24:12
  Leandro Ejnisman: And definitely like when I'm doing without technology now I'm kind of, I'm not sure if I'm doing like the best treatment that I can do to this patient.
• 24:19
  Leandro Ejnisman: You know, that's something that, that's a feeling that I have at this point.
• 24:22
  Joseph M Schwab: I mean, I, I feel, I, I, I absolutely hear what you're saying and I feel like, I mean, that's almost the goal of every surgeon, right?
• 24:28
  Joseph M Schwab: Is to feel like what do we need to be doing better?
• 24:31
  Joseph M Schwab: it's that, that, desire to be content with what you've done, but also to be, even more content with what you can do in the future.
• 24:41
  Joseph M Schwab: boy, I, I Leandro, I, I really appreciate the opportunity of talking with you.
• 24:46
  Joseph M Schwab: I, I really love hearing your perspective on this, and I, and I love that you are, bringing this approach and this enthusiasm for innovation, to Brazil and, you know, bringing it all around the world At this point, you know, we've been to, to Belgium, you're coming to, to Nashville, and, you're gonna be, giving us some of your perspective there.
• 25:08
  Joseph M Schwab: So.
• 25:08
  Joseph M Schwab: I really appreciate you being with me today on the podcast.
• 25:13
  Leandro Ejnisman: Thank you very much and, thank you for the opportunity to be here and I look forward to seeing you in Nashville and every other surgeon that, really, eager to talk to everyone and learn from people from all over the world.
• 25:24
  Joseph M Schwab: Thank you for listening to this episode of the AHF podcast.
• 25:28
  Joseph M Schwab: Remember to like and subscribe so we can reach a wider audience.
• 25:33
  Joseph M Schwab: If you have an idea for a topic, leave it in the comments.
• 25:36
  Joseph M Schwab: Remember.
• 25:37
  Joseph M Schwab: You can find us in audio podcast form in your favorite podcast app, as well as in video form on YouTube slash at anterior hip foundation, all one word.
• 25:48
  Joseph M Schwab: New episodes of the AHF podcast come out on Fridays.
• 25:53
  Joseph M Schwab: I'm your host, Joe Schwab, asking you to keep those hips happy and healthy.