Latest / AHF Podcast / The Part Nobody Can Teach You (2026 Traveling Fellows - Ep 2)

Transcript

The Part Nobody Can Teach You (2026 Traveling Fellows - Ep 2) · 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.
0:26
Joseph M. Schwab: Today we're talking all about the AHF Traveling Fellowship, two weeks spent in the operating rooms of some of the most experienced and innovative anterior hip surgeons in the US.
0:39
Joseph M. Schwab: But it's much more than just watching surgery.
0:43
Joseph M. Schwab: Here to talk about their experience are three of our 2026 AHF Traveling Fellows: Dr.
0:49
Joseph M. Schwab: Jadye Kee, a joint replacement surgeon in community practice in Bryan-College Station, Texas; Dr.
0:56
Joseph M. Schwab: Pat Maher, hip and knee surgeon at EvergreenHealth in Kirkland, Washington; and Dr.
1:01
Joseph M. Schwab: Leo Zalikha, a Stanford-trained reconstruction surgeon now practicing in Long Beach, California.
1:08
Joseph M. Schwab: Three very different practices, but one shared experience.
1:13
Joseph M. Schwab: So let's get into it.
1:14
Joseph M. Schwab: Gentlemen, welcome to the AHF Podcast
1:18
Jadye Kee: Thank you.
1:19
Leo Zalikha: Thanks for
1:19
Pat Maher: Thank you for having us
1:21
Joseph M. Schwab: Before we talk about the fellowship itself, I wanna understand a little bit about where each of you has been coming from or was coming from as you were going into the fellowship.
1:31
Joseph M. Schwab: So what did your practice look like when you started?
1:34
Joseph M. Schwab: And Leo, I think you were earliest in your practice.
1:37
Joseph M. Schwab: Let's start with you
1:40
Leo Zalikha: That's right.
1:40
Leo Zalikha: Yeah, I was in my first year of practice, so maybe the experience looked a little bit different for me than everybody else.
1:46
Leo Zalikha: Um, in terms of what I was doing, so for primaries, I was pretty much all direct anterior, and for revisions, I was still largely posterior.
1:54
Leo Zalikha: So I was still pretty early on in developing my own way of doing things, which was nice.
1:58
Leo Zalikha: I wasn't too attached to one way.
2:01
Leo Zalikha: And I got to pick the brains of both, um, the staff on the fellowship and some of my co-fellows quite a bit, and still do
2:11
Joseph M. Schwab: And, um, Pat, let's talk about your practice
2:16
Pat Maher: I was about three and a half years in, uh, doing probably 95% of my primaries anterior.
2:23
Pat Maher: So I'd done probably between 700 and 1,000.
2:26
Pat Maher: So I had some experience, but was certainly looking to kind of get next level, um, and kind of refine things, get a little slicker and a little faster, and maybe expand my indications for anterior patients or revision anterior patients
2:40
Joseph M. Schwab: And Jadye, tell me about your experience
2:43
Jadye Kee: Yeah, kinda similar to Patrick.
2:45
Jadye Kee: Two years in, mostly anterior hips, uh, even doing some anterior revisions, but just needed to know some secret sauce to make those big males and difficult primaries just go much quicker than I was taking.
3:00
Jadye Kee: And, um, listening to the podcast, listening to a lot of these guys, see'em at the courses, and they just made everything look easy.
3:08
Jadye Kee: So figured why not go to their shop and see how it, how it's really done
3:13
Joseph M. Schwab: So you, you both, you, you all kind of touched on, you know, things that you were interested in looking for from the fellowship, and we're gonna get more into that experience specifically.
3:22
Joseph M. Schwab: But looking back, did you actually get what you thought you were going to get?
3:27
Joseph M. Schwab: And Leo, let's start with you
3:31
Leo Zalikha: Yeah, absolutely.
3:32
Leo Zalikha: In fact, I'd say a lot more than expected.
3:34
Leo Zalikha: Beyond the technical tricks and tips in the OR, it was really about developing a way of thinking about things, problems that you run into, and what makes, what makes a good surgery and different ways to think about how to do a good surgery.
3:49
Leo Zalikha: So yes, I would say a lot more than I expected
3:52
Joseph M. Schwab: How about you, Pat?
3:55
Pat Maher: Yeah, I got, I got similar to what Leo said, I got I think most of what I was expecting and looking for, and then probably some of the biggest takeaways were things that I wasn't really expecting or looking for.
4:07
Pat Maher: For example, seeing at these bigger practices how consistent things are between surgeons and how they've kind of minimized variation to make their overall, like, team and operative flow much smoother and faster and more predictable.
4:22
Pat Maher: And that's something I've kind of brought back and talked with my partners about how can we-- what changes can we make to make it as, as similar for the staff and, you know, the hospital without sacrificing any quality
4:36
Joseph M. Schwab: Jadye, how about you?
4:39
Jadye Kee: Yeah.
4:39
Jadye Kee: Um, you know, it's kinda like a finishing school.
4:42
Jadye Kee: Most of the, the staff that, uh, when I came back was like,"What did you, what did you learn?
4:47
Jadye Kee: What did you do?" And it was really like,"Well, my, my hand was right here, but it should be, like, right here is better." Um, and then all these little things where they're like, maybe they didn't pick up too much outside of like, you know, little things.
5:01
Jadye Kee: Um, it was like, well, you're doing it basically the same.
5:03
Jadye Kee: We're just doing it much more smoother.
5:06
Jadye Kee: We're getting to more cases, and, like, they don't-- they see how quicker we're going, but they didn't see the little nuance stuff that we picked up at the fellowship.
5:15
Jadye Kee: That I think was a big, big change in my practice, just, like, put me on the, another level.
5:19
Jadye Kee: And then the stuff that I didn't really think I was gonna really get was, um, I do shoulder arthroplasty, and there was some shoulder arthroplasty surgeons that I was able to go into and, and that significantly changed how I do shoulder arthroplasty.
5:34
Jadye Kee: And then even the knee, like you could go see some knee surgeons there'cause we were at these big centers, and now doing subvastus and some other things there.
5:43
Jadye Kee: So it's-- it didn't only change my anterior hip practice, it, like, pretty much changed my entire practice
5:48
Joseph M. Schwab: Wow.
5:49
Joseph M. Schwab: Um, well, and walk me through, so, um, walk me through sort of the schedule that you guys had.
5:56
Joseph M. Schwab: Um, what were the centers that you went to?
5:59
Joseph M. Schwab: What were the specific events, you know, maybe that were part of this fellowship?
6:03
Joseph M. Schwab: And, and Jadye, why, why don't you start off with site number one?
6:07
Joseph M. Schwab: Where did you guys start off?
6:09
Jadye Kee: Yeah, we started out at Irvine, uh, with the Hoag Institute.
6:13
Jadye Kee: And so we, we got off the flight, went straight to a rooftop bar, met Dr.
6:20
Jadye Kee: Patel and, and staff, and really just kinda looked over California, which I haven't really been to California, on sunset on a rooftop bar, having some drinks and, like, and just having fellowship, which is really what we had.
6:34
Jadye Kee: And then, uh, just what we were looking into, what we were wanting this fellowship to be.
6:39
Jadye Kee: Really asking questions about, like, what we wanted and then, um, yeah, just the day and day activities of what we're gonna do after the fact.
6:47
Jadye Kee: So we stayed at Irvine, um, I think it was what?
6:50
Jadye Kee: Four or five days'cause we came in at the Memorial Day holiday basically, um, right before, and then we stayed till Memorial Day.
6:59
Jadye Kee: So it was a little bit extended trip at Irvine, which was great'cause there was a little bit more nuance in terms of surgeons and their schedules
7:07
Joseph M. Schwab: And then Pat from Irvine, where did you go?
7:11
Pat Maher: Our second stop was Anderson in Northern Virginia.
7:15
Pat Maher: Uh, we were with, uh, Bill Hamilton and Bob Sershon primarily.
7:19
Pat Maher: Um, they had-- we had a dinner with, uh, Zynrelef.
7:24
Pat Maher: Am I pronouncing that correctly?
7:26
Pat Maher: Zynrelef, uh, about the kind of a, an injection, like a periarticular injection, um, with some better pain relief.
7:35
Pat Maher: Um, we spent, uh, a day with Dr.
7:39
Pat Maher: Hamilton.
7:40
Pat Maher: He did a revision, like a complete revision anterior hip, which was quite slick and impressive.
7:45
Pat Maher: And then a couple days with Bob Sershon, who's very high volume, very quick, very efficient anterior hip surgeon.
7:53
Joseph M. Schwab: Le- Leo, where did you go after Anderson Clinic?
7:56
Leo Zalikha: So then we went to the Southern Joint Institute in Nashville, and we spent time with Doctors Morrison and Hodrick, and got some really good experience, um, with primarily anteriors, but we also got to join in for some, uh, primary knees.
8:15
Leo Zalikha: They do things in some interesting ways, so got to take that out of it as well.
8:19
Leo Zalikha: And we had dinner the first night and then went to a Nashville Sounds game, one of the minor leagues over there, so had a good time.
8:26
Leo Zalikha: They showed us a good time around Nashville
8:28
Joseph M. Schwab: But this wasn't Nashville, this wasn't at the same time as the conference, is that right?
8:33
Joseph M. Schwab: This was still before the conference happened?
8:35
Leo Zalikha: Correct.
8:36
Leo Zalikha: We had one stop before returning back to Nashville for the conference.
8:40
Leo Zalikha: We went to Louisville, Kentucky to spend some really good days with Dr.
8:45
Leo Zalikha: Yerasimides
8:47
Joseph M. Schwab: Hmm.
8:48
Joseph M. Schwab: So from Louisville, you ended up back in Nashville for the conference itself.
8:54
Joseph M. Schwab: Were there cadaver labs along the way?
8:59
Leo Zalikha: Yes.
9:00
Jadye Kee: in Irvine...
9:01
Joseph M. Schwab: Irvine
9:02
Jadye Kee: I, I guess I, I wasn't really specific in the Irvine part.
9:06
Jadye Kee: We did a, we did a, do a lab there with Dr.
9:09
Jadye Kee: Matta before we left and went to, uh, Anderson Clinic.
9:13
Jadye Kee: And so I left out a lot of details, I guess, in the, our Irvine colleagues,'cause we did the Duffy Boat, and we did a lot of other dinners.
9:20
Jadye Kee: But we also...
9:22
Jadye Kee: Dr.
9:22
Jadye Kee: Patel set up, um, like a mannequin with just certain retractors and how they use...
9:28
Jadye Kee: They use a certain retractor there that's a little bit hard to understand'cause it's underneath the drapes, so allowing us to play with that.
9:34
Jadye Kee: And then at the end of the Irvine, we had, um, an actual lab with Dr.
9:40
Jadye Kee: Matta and some of the other guys from Irvine.
9:43
Jadye Kee: Um, but it was, uh, yeah, it was great.
9:46
Jadye Kee: It was fantastic to get a lecture from Dr.
9:48
Jadye Kee: Matta and, and the rest of them.
9:50
Jadye Kee: But, um, yeah, that was the two there
9:54
Joseph M. Schwab: So you spent essentially two weeks watching these surgeons who are all very experienced with anterior approach.
10:01
Joseph M. Schwab: When you see that level of expertise up close, do you start noticing different things maybe even later in the fellowship that you didn't notice in the beginning of the fellowship?
10:14
Joseph M. Schwab: How did your ability to observe change throughout the experience?
10:23
Joseph M. Schwab: And Pat, why don't I throw this one to you?
10:26
Pat Maher: Yeah, I'd s- I'd say absolutely.
10:28
Pat Maher: So I, um, I do my anterior hips.
10:32
Pat Maher: I, I tag and keep the capsule.
10:35
Pat Maher: I use that, um, intentionally during surgery.
10:38
Pat Maher: I find it helps me to position my retractors, and I do repair it at the end.
10:43
Pat Maher: Uh, and I was doing, uh, what I thought was the way that, uh, Dr.
10:49
Pat Maher: Y- Yerasimides does it, and seeing him do it, I appreciated many little things about how he does it that are just, just a little bit different.
11:00
Pat Maher: The-- Similar to what Jadye said earlier, like, you just-- Hand is a little bit here, just these tiny little adjustments that make it so much smoother, and you can see so much better.
11:09
Pat Maher: And I've-- Every single case since I've been back, I'm working on it, and I still can't quite do it the way he does it, but it's gotten much, much better.
11:16
Pat Maher: So it was, it was awesome to watch him do 20 of these in two days and just see this over and over and pick up what I could
11:25
Joseph M. Schwab: Jadye, was there a moment when you watched someone do something and thought,"That's completely different than how I do it," or was m- most of what you saw similar to the way you had been practicing before?
11:40
Jadye Kee: I feel like a lot I, I was familiar with just because coming from, like, residency, we, we had a little bit of anterior, um, approach surgeons, but it was predominantly posterior and even into fellowship, um, one or two guys that were private, but you weren't really doing a ton of it on your, on your own.
12:00
Jadye Kee: I think that's important to do it on your own.
12:01
Jadye Kee: So a lot of these videos, when I came into my practice, I knew I liked the anterior approach.
12:06
Jadye Kee: I knew the, the benefits,'cause I've seen it with some of these private, uh, patients.
12:11
Jadye Kee: Um, so I wanted to bring that to the community'cause there was an anterior hip surgeon in College Station at the time.
12:17
Jadye Kee: Um, so I had to really learn from these videos of Dr.
12:21
Jadye Kee: Yerasimides', your, y'all's podcast, AHF, going to previous AHF meeting videos, and just really looking at the techniques and mimicking a lot of that stuff and going back and forth.
12:35
Jadye Kee: And so some of these techniques I'd seen how many times before, cause I was looking at it right before I do the surgery just to make sure, just to refresh my brain.
12:43
Jadye Kee: But just like Pat said, I mean, it was, you think you know how to do it, but until you're there with them and able to ask, like,"Why did you do it that way?
12:52
Jadye Kee: I noticed, like, in the video you did this, but just there you did this.
12:56
Jadye Kee: Like, why did you do that?" And they were able to like-- They had an answer for everything.
13:00
Jadye Kee: And it was almost like, you know, we're sitting there playing checkers, and they're playing chess, 3D chess, that they're having to like,"Well, I do this at this point so at the end of the case it makes this easier." Like, well, I should've been doing that all along, too.
13:15
Jadye Kee: And so that's where I really took it from.
13:17
Jadye Kee: So we could really ask them, like,"Why are you doing that?" And especially Dr.
13:21
Jadye Kee: Yerasimides, he's-- he, he had a reason for every single question we threw at him, and he, he really pers- told us, like, we should have-- you should have a reason.
13:29
Jadye Kee: It might not be a great reason, but you should have a reason why you do every single step, so
13:34
Joseph M. Schwab: and, and Jadye, I'm gonna stay with you because I'm curious, were there things that you saw that maybe initially just seemed like personal preference, but after either thinking about them more or having a conversation with the surgeon, you really realized that it wasn't just a no reason, there was actually a deeper reason behind what they were doing?
13:58
Jadye Kee: Yeah.
13:58
Jadye Kee: Um, I mean, it's just so many little things.
14:01
Jadye Kee: I guess big ones would be, um, certain retractor timing and, and where you're doing the releases.
14:11
Jadye Kee: Uh, with Dr.
14:12
Jadye Kee: Yerasimides, I didn't realize that he does episiotomy kind of, um, along that calcar up to where the, the acetabulum is, and how he does it is kind of specific to how the, the femur drops, and so that was something I never picked up on with m- many of any of the other ones.
14:30
Jadye Kee: But, like, looking back, I think a lot of the surgeons were already doing that, but maybe they just don't voice it.
14:36
Jadye Kee: It's like they just run it up, and they do a episiotomy.
14:39
Jadye Kee: Um, I mean, I could, I could nitpick little details,'cause if you looked at my notes, they're extremely detailed, and every time I'd go in there and I'd just have to look and find little things that I wasn't doing and review them later.
14:52
Jadye Kee: So it's, it's hard to pick out just one game-changing,'cause I think they all do it pretty much the same.
14:59
Jadye Kee: It's just how, you know, they have their own little nuance, and I think we gravitated towards Yerasimides'cause maybe we saw more surgeries done by one surgeon at one time in two days.
15:12
Jadye Kee: So that's...
15:12
Jadye Kee: And that was the last one we, we had.
15:14
Jadye Kee: So I think most of the guys together, when we think of, like, little, the small things that we, we implemented, was probably from Dr.
15:23
Jadye Kee: Y
15:24
Joseph M. Schwab: Um, Leo, I wanna ask you,'cause one of the interesting things I think about when watching multiple experts, um, do the same surgery is that they can-- maybe they're doing the same surgery, but maybe they're doing it differently, but clearly they all still get excellent results, right?
15:42
Joseph M. Schwab: That's one of the reasons why, um, they, they ended up where they are.
15:47
Joseph M. Schwab: Um, did that-- Does seeing that across multiple experts, um, help make you more confident in maybe finding your own way of doing things, or does it make you sit back and think,"Oh my gosh, I still just have so much to learn"?
16:07
Leo Zalikha: You know, I think it does make you more confident because you realize that the goals of the surgery are actually pretty simple.
16:14
Leo Zalikha: You know, you, you want a stable cup, you want a stable femur, and you want to do as little damage to the soft tissues as possible.
16:22
Leo Zalikha: And that's the whole surgery, really.
16:25
Leo Zalikha: And seeing everybody have slightly different paths to get there makes you realize that as long as you can accomplish what are really those three simple goals, you-- and you can do them re-reliably and repeatedly without running into complications, then you're, you'll be a great surgeon.
16:43
Leo Zalikha: And I think I picked that up along the way, seeing that everybody has a slightly different way to get there to those goals
16:51
Joseph M. Schwab: Pat, I wanna ask you, you know, we've talked a little bit about some of the technique.
16:56
Joseph M. Schwab: You can teach someone where to put a retractor or how to position a leg, but you can't necessarily teach someone when to make a decision.
17:04
Joseph M. Schwab: And in, in your opinion, with your experience, how much of becoming sort of an excellent anterior hip surgeon is more about judgment than just technique?
17:19
Pat Maher: Great question.
17:20
Pat Maher: I mean, I think definitely both.
17:22
Pat Maher: So, um, as Leo said, you-- there are different ways to get to the end.
17:28
Pat Maher: Um, and I think the techniques, um, a-as taught by all of these guys, there are reproducible things, but then there are certainly judgments, for example, is my femur sufficiently released?
17:42
Pat Maher: Do I have a good enough exposure and elevation to broach and prepare this safely?
17:47
Pat Maher: And this took, you know, my first hundred cases probably weren't, uh, you know, uh, as slick, or my femoral, uh, exposure wasn't as good.
17:59
Pat Maher: You get judgment from your experience, but then also seeing the little tricks or the kinda internal rules that some of these surgeons had.
18:08
Pat Maher: Like, is this released enough?
18:10
Pat Maher: If I can do it with, you know, by hand and with my over the top retractor and come up and out easily, like it almost dislocates, then I'm released enough.
18:19
Pat Maher: Um, so adding their judgment into mine, I think helped make that portion of the case, just for example, go better for me.
18:27
Joseph M. Schwab: Mm-hmm.
18:28
Joseph M. Schwab: L- Leo, when, when you were watching some of these guys, you know, maybe you saw them get to deal with something a bit unexpected, um, during a case, hopefully not too much, but it, it happens, um, just about every operative day, you run into something a little unexpected.
18:45
Leo Zalikha: Mm-hmm.
18:45
Joseph M. Schwab: When you're observing somebody like that, what-- are you looking for the maneuver they use to get out of it, or are you looking at how they are thinking through the problem?
18:59
Leo Zalikha: Yeah, I would say a little bit of both, but I probably lean towards more how they think about the problem, because when you run into something unexpected, and as you said, that happens all the time with surgery, you really need to get down to the bottom line of why that problem is happening and how to fix it.
19:19
Leo Zalikha: So I think I tend-- and in the same way you can get to the end goals of a surgery in multiple ways, you can fix an issue that you run into a couple of different ways.
19:28
Leo Zalikha: So I tend to lean more towards how they think about the problem, what the root cause is, and then probably secondarily, how they're specifically managing it in that case, I'd say.
19:40
Joseph M. Schwab: Jadye, w- when you're looking at these sort of high-volume experts, right, in a, in various settings, um, and you're coming from your community practice, how do you think about bringing something you learned from them back into a practice where maybe your patient population may look different or the environment that you're doing the surgery in might look different?
20:04
Joseph M. Schwab: How do you think about that?
20:08
Jadye Kee: A few things like, um, at least in the revision setting,'cause we did see at Anderson Clinic, they, I mean, they had everything available to them, and things I'd never seen before.
20:19
Jadye Kee: They were just sitting, taking pictures.
20:21
Jadye Kee: So bringing that to my community hospital with my rep was, uh, uh, appreciated I, I feel.
20:28
Jadye Kee: But, uh, yeah, we, we may be able to get to that eventually, buddy, maybe if you do another 200 or 300.
20:34
Jadye Kee: Um, so just knowing what was out there when things are in the revision setting was, uh, helpful to know what to bring to the hospital.
20:43
Jadye Kee: Yeah, a few things here and there that would be not cost-prohibitive, um, was nice.
20:49
Jadye Kee: But really, I mean, the-- Our-- We have a interesting mix of patients here in terms of, um, we're close enough to Houston and Austin and, uh, and San Antonio, so big centers around us, but there's still a lot of surgeons in between that, um, that do joint replacements that sometimes fail.
21:12
Jadye Kee: Uh, unfortunately, we- we're the ones really taking care of that, me and my partner, so we do a, quite a bit of revisions, and it's a unique practice, so it was nice seeing both.
21:22
Jadye Kee: Coming from like California and seeing that everybody's skinny over there to my population in Texas, like, how can I carry this back over?
21:30
Jadye Kee: Bikini approach is, uh, really, really good for, in my hands here, just at least with the soft tissue stuff.
21:36
Jadye Kee: But I don't know.
21:37
Jadye Kee: I mean, I think it was a lot, a lot of, a lot of similar things.
21:40
Jadye Kee: A lot of things I wanted, a lot of wish list and Christmas list were made, but, um, you know, something that I could see happening here in our community hospital, and I think I push a little bit too much at our hospital than they like to be like these centers.
21:56
Jadye Kee: Like, why can't we do this?
21:57
Jadye Kee: Like, why can't we do, you know, 6-by, you know, 12?
22:01
Jadye Kee: Not 12-by-12, but w-what about 6-by-12?
22:04
Jadye Kee: That would be pretty cool, you know?
22:06
Jadye Kee: And just, uh, those are the types of conversations I came back with
22:12
Joseph M. Schwab: So Leo, I'm, I'm gonna go to you for a minute, um, because after you spend a couple of weeks watching surgeons who are essentially at the top of their field, um What actually separates a good anterior hip surgeon from a, a great one?
22:33
Joseph M. Schwab: Did you see something during the fellowship that made you think differently about what surgical excellence really looks like?
22:45
Leo Zalikha: Yeah.
22:45
Leo Zalikha: Um, you know, and I wish there was some little trick that I could have, uh, picked up that just, you know, changes everything.
22:54
Leo Zalikha: But I think it, it's really about time, volume, and as Pat was saying earlier, pattern recognition and knowing what is normal, what's not normal, when you need to improve your release, when you don't.
23:11
Leo Zalikha: And thing that's a consistent theme is that all of these guys have a ton of experience and volume and top-tier levels of that pattern recognition.
23:24
Leo Zalikha: So I would s- you know, when you watch a great surgeon, they make it look easy.
23:30
Leo Zalikha: So when you're d- when you go back to do something or when you're in training, you think this surgery looks really easy.
23:39
Leo Zalikha: I can do it, no problem.
23:40
Leo Zalikha: Then you do it for the first time in training or whenever it is, and you realize it's not so easy.
23:45
Leo Zalikha: So these guys are, I realized, making it look easy because they know what is normal and what they should expect, and I think that's just mostly a function, honestly, of, of time and judgment that comes from doing so many of these
24:03
Joseph M. Schwab: Hmm.
24:04
Joseph M. Schwab: Jadye, at, at some point, every surgeon has to stop trying to operate exactly like their mentors, for instance, and develop their own system and style.
24:17
Joseph M. Schwab: So how do you know when you're starting to do that, what to adopt and what to maybe leave behind?
24:27
Jadye Kee: I think trial and error.
24:29
Jadye Kee: Uh, I mean, that's exactly what I've done on my own, um, learning the anterior hip from somebody, coming back, going to a course, seeing that, coming back, you know, safely.
24:41
Jadye Kee: You, you know, you wanna do it safely.
24:42
Jadye Kee: So I think definitely working in a lab when you're first coming to the anterior approach and learning from these high-volume surgeons and think that it's something you can take back.
24:54
Jadye Kee: You should take it back, and you should practice, but you wanna practice it safely.
24:57
Jadye Kee: And so a lab's an, an easy middle window, especially if it's close to you, and you have access to it.
25:03
Jadye Kee: But if you don't, you know, just set aside longer time and know that, you know, try these things.
25:08
Jadye Kee: And then if they don't work out, or you may modify them.
25:12
Jadye Kee: Like I have-- and the way I do a hip replacement is, like, it's not just like Dr.
25:17
Jadye Kee: Y's, it's not just like Hodrick or Morrison or Sershon.
25:20
Jadye Kee: It's, it's a little bit of everybody, and I've gotten into areas where I'm like, that trick that they do every time gets me out of this problem, and I'll go back to that.
25:30
Jadye Kee: And I'm-- that's where the judgment and things come in.
25:33
Jadye Kee: I think really learning from these masters and having the opportunity for this fellowship just puts you way above anyone else that hadn't done it because you have all these items in your tool belt that you can pull out at any point.
25:47
Joseph M. Schwab: Hmm.
25:48
Jadye Kee: so being able to do that and practice and coming back and forth and when to use it and when to not use it, and then you'll notice that the flow, you get a, you get a flow state that is your state now.
26:01
Jadye Kee: 'Cause it-- only you can remember the, your steps.
26:04
Jadye Kee: It's not just like someone else's.
26:07
Jadye Kee: And it's, uh, the team, and it's everything.
26:09
Jadye Kee: It's not just you.
26:10
Jadye Kee: It's your team knowing what to do, a good team, what you've done, and now that's been more consistent.
26:17
Jadye Kee: I think that's really what really sets your practice apart from the rest and going on your own technique.
26:25
Jadye Kee: But I don't know.
26:26
Jadye Kee: Hopefully that makes sense.
26:27
Jadye Kee: I just-- in my, in my hands, it's been I'm a hodgepodge of everybody from residency up to this fellowship.
26:34
Jadye Kee: Mostly certain things from certain surgeons that I've picked up, and some things I've thrown in there that I've liked along the way that in my hands makes it much easier
26:43
Joseph M. Schwab: Hmm.
26:44
Joseph M. Schwab: So Pat, we often talk about anterior approach in terms of things like we're talking about, technique, you know, table, instrumentation, things like that.
26:53
Joseph M. Schwab: But ultimately, we're operating on a person.
26:57
Joseph M. Schwab: Um, did anything you saw during the fellowship change how you think about patient selection or individualized care?
27:08
Pat Maher: I, I would say yes.
27:11
Pat Maher: I trained in a place that was very, very selective about who was a candidate for an anterior approach with BMI, for example, even 30, certainly 35 being a strict cutoff for no.
27:25
Pat Maher: Um, in our community, many surgeons don't practice that way.
27:29
Pat Maher: Um, anterior approach, um, indications are wider, and I think seeing just even some positioning tricks like the, the way they retract a pannus for a patient who maybe has, uh, like a reasonable thigh for the surgery, but the abdomen would be potentially, uh-- would impede you.
27:49
Pat Maher: I think there are ways to get around that where you can do this operation safely and have the benefits of the rapid recovery and less pain for a wider selection of patients.
27:59
Joseph M. Schwab: Um, Jadye, I, I wanna ask you, we've read that your fellowship program offered you a, a training not just in adult reconstruction but also in value-based orthopedic care.
28:13
Joseph M. Schwab: Did anything during the AHF fellowship, traveling fellowship, make you think, um, differently about the balance between adopting, um, uh, the latest technique versus doing something, um, maybe that you think is more correct for a patient?
28:36
Jadye Kee: Yeah.
28:37
Jadye Kee: So I mean, the value-based, uh, at least at UT in Austin with, uh, Kevin Bozic is, um, it was great.
28:44
Jadye Kee: It was more of, uh, understanding the payer side of it, understanding where we're at as surgeons can kinda make that, and really how do we make the population health better.
28:57
Jadye Kee: And so going into that, the value-based, like it's not necessarily-- A lot of it's cost.
29:02
Jadye Kee: You know, yeah, they're, they're looking at cost for sure, but it's value.
29:06
Jadye Kee: What brings value?
29:07
Jadye Kee: That's the most of what I took from the, the fellowship is, um, you know, getting outcome scores, getting some kind of measurable value that you know that you're doing the right thing.
29:17
Jadye Kee: And like just me going through training and knowing even with knees and stuff like that, certain surgeons, you know their patients just did better.
29:26
Jadye Kee: They got up quicker.
29:28
Jadye Kee: They left the hospital faster.
29:30
Jadye Kee: In clinic, we, we were the ones seeing them, and so-- and we knew which ones and which techniques really did well.
29:37
Jadye Kee: And so in my, in my-- at least in my training, it was a lot of the anterior approaches, some of these gap balance knees and things like that.
29:46
Jadye Kee: And so that adds value.
29:47
Jadye Kee: That patient had a better surgical result.
29:51
Jadye Kee: Maybe, maybe at a year they're all the same.
29:54
Jadye Kee: Maybe, you know, if they didn't have a major issue.
29:57
Jadye Kee: And then the revision stuff in 30 years, can't really talk about that value-based care.
30:01
Jadye Kee: But I think just understanding that, what adds value in terms of like how you approach a patient, uh, is this approach better?
30:10
Jadye Kee: Should you invest the resources into learning this approach and bringing it to a community?
30:14
Jadye Kee: If it adds value, then yes.
30:17
Jadye Kee: Um, how you investigate that value is, I think, is gonna be a little bit more individual.
30:21
Jadye Kee: Um, on the other set is just understanding cost of things, understanding some of these bundled payments, uh, models, which we had great conversations with Dr.
30:31
Jadye Kee: Patel at the Hoag Institute, Sershon, and those types that were, um, really in the middle of those things.
30:38
Jadye Kee: And so we were able to talk business-related stuff that really went back to value-based care too.
30:44
Jadye Kee: Um, but yeah, I think it, it doesn't go against the grain.
30:47
Jadye Kee: I think it-- if anything, it's with it, um,'cause in my-- it just adds value to the patient's care
30:54
Joseph M. Schwab: Leo, with your background, um, in not just complex joint reconstruction, but also research, how do you think about the relationship between maybe what the evidence says at any given time, point in time, and what an experienced surgeon might know from years of doing an operation in the, uh, in the actual operating room?
31:17
Leo Zalikha: I see.
31:17
Leo Zalikha: Y-yeah, I would say experience in the OR always wins out.
31:22
Leo Zalikha: Uh, research in my mind is useful because it tells you what tends to work, but it's strongest on a population level, and the problem is the OR is always an N of one.
31:32
Leo Zalikha: And so, you know, all-- the best surgeons use evidence, and they consider it very car-carefully.
31:40
Leo Zalikha: They just know that it's not granular enough to tell you exactly what to do in a specific case.
31:47
Leo Zalikha: So yeah, I would, I would say OR experience always wins out
31:54
Joseph M. Schwab: Pat, is there a danger to becoming maybe too attached to a particular approach or technique simply because you got really good at it?
32:05
Pat Maher: I think there can be, yeah.
32:06
Pat Maher: So I think for, for me, for probably for many surgeons, doing a long femoral revision really is probably easier posterior.
32:16
Pat Maher: Um, when you get really good at anterior and your staff is really good and you already have that table and fluoro in the room, there may be a little nudge towards thinking, oh, I could probably, uh, I could probably get away with this one anterior.
32:30
Pat Maher: Um, it's-- I've had some conversations with my fellowship mentors after about, is this the case you think?
32:36
Pat Maher: And I, I find myself still falling back probably for long posterior or for long femoral revisions for, I think they're just easier to do and safer posterior for me.
32:46
Joseph M. Schwab: Um, uh, let's, you, so you brought up table.
32:48
Joseph M. Schwab: Um, it's interesting.
32:50
Joseph M. Schwab: Can you give me, uh, just a breakdown of the mentors that you saw, the experts that you saw on the fellowship?
32:57
Joseph M. Schwab: How many of them were on table?
32:59
Joseph M. Schwab: How many of them were not on table?
33:01
Joseph M. Schwab: And what are you guys doing in your own practice?
33:03
Joseph M. Schwab: And, and Pat, why don't we start with you?
33:07
Pat Maher: I think all but one were on table, or was it 100% on table?
33:11
Pat Maher: It was nearly 100% on table.
33:14
Pat Maher: Um, th- that's my practice as well for anterior, it's on table.
33:18
Joseph M. Schwab: And Jadye, how about you?
33:21
Jadye Kee: Yeah, same.
33:22
Jadye Kee: 100% on table
33:23
Joseph M. Schwab: And w- for, for both you guys, that was the same before the fellowship as well?
33:27
Joseph M. Schwab: Nothing changed from that perspective?
33:30
Jadye Kee: Yeah.
33:30
Jadye Kee: About the only change was the, my table needed to be serviced and I needed-- I still had patients to take care of, and so I flirted with learning how to do it off-table, and I've done a little bit of it in the lab, but, um, I just haven't.
33:47
Jadye Kee: It's just, I, I feel like you have that there and it, it helps out with the surgery and it's less, uh, I mean, it's less, um, issues with the patient and having an extra set of hands.
33:59
Jadye Kee: I think I just, I gravitate to the table
34:02
Joseph M. Schwab: Leo, how about you?
34:03
Joseph M. Schwab: What's your practice look like?
34:05
Leo Zalikha: Yeah, I'm also all on table.
34:08
Leo Zalikha: I was actually previously using a Guardian table, which is a similar fracture-type table where you can manipulate the legs, add traction.
34:15
Leo Zalikha: But I, I actually switched over to the Hana table primarily for the hook, to be able to use the hook for elevation
34:24
Joseph M. Schwab: So something I've heard kind of repeatedly from talking to surgeons who've participated in fellowships like this one, not necessarily the AHF Traveling Fellowship, but some of the biggest lessons that they learn aren't necessarily technical.
34:38
Joseph M. Schwab: So did you notice things about how these surgeons maybe communicated with patients or taught younger surgeons or handled uncertainty or ran their operating rooms that stayed with you?
34:52
Joseph M. Schwab: And maybe Jadye, why don't, why don't we start with you on that one?
34:57
Jadye Kee: Yeah, it's mostly how big, at least from the anterior side of things, really anything in the OR is just a team sport.
35:05
Jadye Kee: It really depends on how well you commu- communicate with the team, how well your team is put together.
35:12
Jadye Kee: Everybody has, uh, their own job and duty, and they know when to call out things that are not going right.
35:20
Jadye Kee: And then we s- I, I think we still saw that there.
35:23
Jadye Kee: There are certain times that, you know, we, we probably didn't notice it as much, but s- there was a stop, something happened, and they were able to quickly change things.
35:34
Jadye Kee: Um, I think that's the biggest thing is it's a team sport, and having a, a, a great team around you only makes you better.
35:43
Joseph M. Schwab: Pat was
35:43
Jadye Kee: these great surgeons, they have a great team
35:46
Joseph M. Schwab: Pat, was there a, a surgeon whose operating room culture particularly stood out to you?
35:51
Pat Maher: Uh, several, um, for different reasons.
35:55
Pat Maher: I think, um, I'll say more generally the, the flow things that I noticed differently that I took back immediately were everyone had fluoroscopy basically set up and ready to go prior to the start of the case, where I was more kind of calling them when it was time, and that built in some waiting around.
36:14
Pat Maher: Um, and everyone was preparing the acetabulum under fluoroscopy.
36:18
Pat Maher: Instead of just the cup, they were doing the reaming under fluoroscopy, which has been a, a big time saver and more accurate for me.
36:24
Pat Maher: And then I think, um, probably two specific examples.
36:29
Pat Maher: So at, at Anderson, Bob Sershon, the whole team had walkie-talkies.
36:33
Pat Maher: Like, everyone knew what was going on all the time.
36:36
Pat Maher: Um, and you know, they were communicating constantly to keep flow all day, and there was no, no miscommunication, no waiting, no downtime.
36:45
Pat Maher: And then at-- Dr.
36:46
Pat Maher: Yerasimides, at his surgery center, there were two rooms right next to each other, um, with the same staff in each room all day, and they would do a case at exactly the right time.
36:55
Pat Maher: His PA would show up to assist with the femoral part and close the X-ray machine to move over to the other room where they had the patient draped and ready to go.
37:04
Pat Maher: So he was probably operating, you know, as efficiently all day as possible
37:10
Joseph M. Schwab: L- Leo, did the fellowship change what you want your own OR to feel like?
37:18
Leo Zalikha: I, I would say so.
37:19
Leo Zalikha: I think the overarching principles are you want it to be calm and efficient.
37:25
Leo Zalikha: It was almost never a high-stress environment there, but it was very high expectation.
37:31
Leo Zalikha: And these guys empower people to want to take ownership of every step.
37:38
Leo Zalikha: Uh, the two examples that really stood out, uh, uh, agreed with Pat are Dr.
37:43
Leo Zalikha: Yerasimides and Dr.
37:44
Leo Zalikha: Sershon over at Anderson Clinic.
37:46
Leo Zalikha: And there was one, uh, lady on his team who functioned basically as an OR manager, and she really stood out, I think, to the three of us with the personal pride she took in the quick turnovers, um, anticipating what was needed next, and being able to get so many cases done in such a short amount of time.
38:06
Leo Zalikha: So all of the staff on the fellowship really drove that point home.
38:15
Leo Zalikha: You want, you want to empower people to take personal pride in what they're doing, and they're really good, especially learned this from Charles DeCook.
38:23
Leo Zalikha: If you listen closely to what he's saying, they really value human capital, so when they have a good person, they retain them and they surround themselves with high levels of human capital
38:37
Joseph M. Schwab: Um, a- I, I'm gonna pose this question to all three of you, and, uh, please feel free to just join in and answer.
38:46
Joseph M. Schwab: But I'm curious to know how the fellowship affected your perception of the type of mentor that you would wanna become
39:03
Leo Zalikha: Yeah, I, I would say orthopedics is a very relationship-driven field, both in terms of our colleagues and with our patients.
39:12
Leo Zalikha: And the doctors that patients always tend to like, and the friends and mentors in the field that you always tend to like are those that are generous with their time, just are deeply decent people, treat people well, and are available when, when you need them.
39:29
Leo Zalikha: So it really just drove the point home that these guys are the best, both for their technical skills, but because of that part of their character.
39:38
Leo Zalikha: So I definitely would like to be that kind of mentor as well.
39:43
Jadye Kee: I mean, I think just having patience, uh, that goes a long way.
39:48
Jadye Kee: I mean, all of these guys took their time to tell us, you know, their, their technique and everything else, but also really took us on as, like, family.
39:58
Jadye Kee: Like,"Here's my number.
39:59
Jadye Kee: I'm gonna come pick you up." You know, was always there on time.
40:02
Jadye Kee: No expa- e- expectations, you know, one or two of us late or whatever, they never got mad.
40:08
Jadye Kee: It was always patient with us.
40:09
Jadye Kee: And then even at the end, we're at the end of our, um, track and we're with Dr.
40:14
Jadye Kee: Y, and he has other things to do.
40:17
Jadye Kee: We don't realize, he just wants us to come over to the house and just hang out and have a beer, and we're just grilling him with nonstop questions for, like, two hours.
40:27
Jadye Kee: Like, we should have recorded it.
40:29
Jadye Kee: We got so mad at one of us.
40:31
Jadye Kee: But he didn't, like, he didn't, he never skipped a beat.
40:33
Jadye Kee: He just, like, his wife went and got us some more beer.
40:36
Jadye Kee: Um, and, and after that we, you know, had dinner, I think, and it was just...
40:41
Jadye Kee: I, I just took from that just he was, he was such...
40:44
Jadye Kee: He's already there.
40:45
Jadye Kee: Like, he's already at the top, right?
40:48
Jadye Kee: And just being able to, like, not get frustrated with these silly questions that these surgeons are asking for two to three hours when he had another meeting is just something I took as a mentor.
40:59
Jadye Kee: Like, I am, I'm definitely not that patient, and I probably should be'cause if he has that much patience, then I at least need to model half of that, so.
41:07
Joseph M. Schwab: Well, I, I'll just say, Pat, before you answer, it's always good to eat something when you're drinking with Jonathan Yerasimides.
41:13
Joseph M. Schwab: That's just, uh, that would be my piece of advice there.
41:18
Pat Maher: we learned
41:18
Jadye Kee: It was a Wednesday or a Tuesday.
41:23
Pat Maher: Um, so, uh, two things jump out.
41:26
Pat Maher: One is, as the other guys said, the generosity with their time.
41:30
Pat Maher: So I-- with, uh, both with Dr.
41:32
Pat Maher: Hamilton and Dr.
41:33
Pat Maher: Yerasimides, I had a couple of pending anterior revisions to do when I got back, and they both took at least a half an hour to actually go through and talk through and look at my X-rays and kind of give me their thoughts and their plan, um, which, uh, was extremely helpful, um, for going back and doing these cases.
41:54
Pat Maher: Um, and then the, the other thing is, um, just how, how good they were about explaining...
42:03
Pat Maher: You, you learn steps and why you do them, and you, you go out and you do five hundred or a thousand cases, and you do the steps.
42:10
Pat Maher: Um, and then there's a next level of, of why are we doing these steps straight-- going all the way back to Dr.
42:15
Pat Maher: Matta, and why were some of these decisions made, or why do people do them differently?
42:19
Pat Maher: And, uh, I found, for example, with Dr.
42:22
Pat Maher: Yerasimides, just asking particular, um, like there's one thing he did slightly different I've never seen anyone do, and I asked him.
42:29
Pat Maher: So when he's doing his, um, initial capsulotomy, he doesn't place an inferior cobra.
42:36
Pat Maher: He does the capsulotomy and then places it inside the capsule, and I've, I've never seen anyone do that.
42:40
Pat Maher: They always place it outside the capsule, cut the capsule, place it inside.
42:43
Pat Maher: And I said,"Why?
42:44
Pat Maher: Why would you do it that way?" And he said,"Why wouldn't you do it that way?
42:48
Pat Maher: You don't, you don't need it below the capsule.
42:50
Pat Maher: You need it inside." Like, well, yeah, that, that totally makes sense.
42:53
Pat Maher: I just never seen it or thought of it.
42:55
Joseph M. Schwab: Hmm.
42:56
Joseph M. Schwab: So y- you, you raise an interesting point, which is if the purpose of the traveling fellowship was, was just to learn a surgical technique, you could probably do that without spending two weeks sort of traveling from operating room to operating room, right?
43:11
Joseph M. Schwab: We have videos, we have all this, these resources.
43:15
Joseph M. Schwab: So, I-- and I'll stay with you, Pat, what do you think the fellowship is really offering a surgeon?
43:22
Joseph M. Schwab: Is it just technique?
43:24
Joseph M. Schwab: Is it exposure to a community?
43:26
Joseph M. Schwab: Is it mentorship?
43:27
Joseph M. Schwab: Is it perspective, confidence, something else?
43:32
Pat Maher: I, I think it's all those things.
43:33
Pat Maher: So it depends where you come in.
43:35
Pat Maher: So if, if I had come in with a half a year or a year experience, I probably would be looking at just getting technique.
43:42
Pat Maher: I had been three or three and a half years in, so I, you know, I have some technical skills.
43:46
Pat Maher: I've had- I've done a lot of cases, but there are still refinements, little things that I could do better, and still, I- still little things that I could do better.
43:54
Pat Maher: There's also the more global, like I trained at two very academic places, which were not high-volume centers and not focused on efficiency, and then you go to these places that can do 10 hip replacements in six hours.
44:06
Pat Maher: You're like,"This is-- Everything is different," right?
44:09
Pat Maher: Um, and yes, part of it is a very, very fast, reliable surgeon, but part of it is everyone else and the way you've engineered this team or this product to make these things move.
44:20
Pat Maher: Um, and that was pretty eye-opening, and I don't think you can...
44:23
Pat Maher: I couldn't see that without actually being there and experiencing it.
44:26
Joseph M. Schwab: So Leo, I'm gonna throw the same question to you, and, you know, Pat sort of stated with his level of experience, and you're a, a surgeon on the younger side of your practice.
44:35
Joseph M. Schwab: So do you see that the same way?
44:37
Joseph M. Schwab: Do you see something different?
44:41
Leo Zalikha: No, I, I would agree with, uh, Pat that at this stage I s- I very much appreciated the technique differences between the surgeons.
44:51
Leo Zalikha: Um, and that may be something that I picked up, um, through the fellowship.
44:57
Leo Zalikha: I realized that it's also not just about technique.
45:00
Leo Zalikha: The technique was great, but the culture of the room, how they set up the room, the efficiency of the day, how they give responsibilities to each staff member, each member of the team, was something that I realized perhaps the importance of a little bit more throughout the, throughout the experience.
45:21
Joseph M. Schwab: Jadye, how about from your perspective?
45:24
Jadye Kee: I feel like it's more mentorship.
45:25
Jadye Kee: I feel like these guys almost see, at, at least how I felt was how they were back when they were learning it, and they're really wanting to re-educate or re, you know, just pass the buck along to these younger surgeons that are really taking initiative to do things like this, and it was more of a mentorship.
45:46
Jadye Kee: Everybody gave me their number.
45:47
Jadye Kee: We reach out, we go over cases, just like Pat was talking about.
45:51
Jadye Kee: I mean, there's technique involved, but again, like, technique can be learned through videos and all that stuff.
45:58
Jadye Kee: But this is really a, like I say, a finishing school.
46:01
Jadye Kee: It's, it's getting all that technique, the mentorship, and knowing the reasons why this is important and why to keep it going and, you know, hopefully have some leadership in the field, at least on the anterior hip side of it maybe.
46:15
Jadye Kee: Um, I think that's how I took the fellowship
46:20
Joseph M. Schwab: So I, I'm gonna ask the same question to all three of you, and Leo, I'm, I'm gonna start with you.
46:26
Joseph M. Schwab: But, um, Pat Jadye, feel free to start thinking about this.
46:30
Joseph M. Schwab: If you could go back to the first day of the fellowship knowing everything you know now, is there something you would pay more attention to, or would you have, um, diverted your attention differently than you did?
46:46
Leo Zalikha: Hmm.
46:48
Leo Zalikha: Yeah, I think I would go back to the idea of perhaps focusing less on the-- each technical step of the surgery, which everybody may do slightly differently, um, and more about the decisions and setup and culture of the OR that everyone created.
47:10
Leo Zalikha: I would actually say that's probably the most consistent thing among these great surgeons with high efficiency, high volume practices.
47:20
Leo Zalikha: Um, so I was able to make that transition probably about halfway through the fellowship and start focusing on that more.
47:26
Leo Zalikha: But if I were to go back to day one, I probably would have driven home just how important that is, building these great teams and systems around you in order to maximize your potential.
47:38
Joseph M. Schwab: And Pat, how about you?
47:41
Pat Maher: I think if, if I could do one thing consistently at each place, so I, I took a lot of notes and a lot of photos.
47:48
Pat Maher: I probably would have paid more attention, maybe taken notes or photos about the room setup and, like, what happened prior to the case.
47:57
Pat Maher: I think I, I probably spent a lot of time really hyper paying attention to tiny surgical technical details, and maybe spending more time looking at the global flow would've been something that I-- would, uh, be useful and valuable to me, like, going years forward.
48:14
Joseph M. Schwab: Jadye, how about you?
48:17
Jadye Kee: Yeah, same there.
48:18
Jadye Kee: I wa- I, I kinda knew what I was looking to get at and really wanted to take the notes and be super vigilant on that, and my wife allowed this two weeks with all the kids at home, and so I was gonna be working hard and playing hard.
48:31
Jadye Kee: And the in between stuff that I didn't pay attention to really was, like, how that patient got there, what the clinic kinda looked like, how they ran their clinic.
48:44
Jadye Kee: Um, outside of a few little questions, um, perioperative things that, you know, I asked about spinals and things like that, but didn't really delve de- too deep into that part,'cause we were really, you know, we were kinda going into the OR and just staying in that part and then coming out and just asking questions and doing dinners after.
49:05
Jadye Kee: So probably the whole picture wasn't fully taken,'cause I didn't get that clinic picture and, like, what happens there, what is, what's happening before the case, uh, which is just hard to get to, I think, in two weeks
49:17
Joseph M. Schwab: So Jadye, I'm gonna stay with you, um, but I'm gonna come back around and ask, um, Pat and Leo the same question.
49:25
Joseph M. Schwab: Five years from now, what do you hope will still be maybe different about the way you practice because of this experience?
49:38
Jadye Kee: Yeah.
49:38
Jadye Kee: I think continuing to be hungry for knowledge.
49:42
Jadye Kee: Uh, I, I would hope that I'm still doing these things, still going to meetings.
49:48
Jadye Kee: Maybe not a two-week fellowship, but at least being involved in, in either the foundation or teaching or even things like locally with med students.
50:00
Jadye Kee: That would be my hope, and then I, I obviously hope that I would be much, much more efficient surgeon, much more, um, you know, in, in my hands just quicker and better and involving more revisions and things, just growing that nature.
50:15
Jadye Kee: But really just giving back and, like, education I think is something I'd, I'd be switching to I think five to 10 years
50:23
Joseph M. Schwab: Hmm.
50:23
Joseph M. Schwab: Pat, how about you?
50:26
Pat Maher: I, think I, I want to continually be improving.
50:31
Pat Maher: I think this is re- you know, this is a practice and an art.
50:34
Pat Maher: I think, uh, this was a tremendous experience to see a bunch of incredible surgeons.
50:40
Pat Maher: Um, I think going forward, continuing to have experiences like this, either having people come to operate with me or me go to operate with people with some frequency just to continue to refine and improve is better, uh, or will be better.
50:57
Pat Maher: I think a big focus for me for this whole, uh, two weeks was on the acetabular part, kinda refining that, and I think, um, adding in some things I learned, maybe adding some technology.
51:09
Pat Maher: I hope that every cup that I put in will be a little bit better for every case going forward
51:17
Joseph M. Schwab: Leo, how about you?
51:20
Leo Zalikha: Yeah, I would, I would say, and perhaps you disagree with me, but I think one of the driving principles of the Anterior Hip Foundation, especially having had some long conversations with Dr.
51:31
Leo Zalikha: Matta about how he got here and how it all started, is that the foundation really teaches you to be forward-thinking and slightly contrarian and willing to question the dogma a little bit.
51:45
Leo Zalikha: So I hope in five years I'm still questioning the dogma.
51:49
Leo Zalikha: I mean, y- I think he-- Dr.
51:51
Leo Zalikha: Matta really shows that you need to do that in order to make huge leaps forward for the field.
51:57
Leo Zalikha: So I hope I'm still doing that both in five years and un- until I'm done practicing.
52:03
Joseph M. Schwab: So, um, I, I've got kinda one final question, um, that I, I wanna throw out to all of you.
52:10
Joseph M. Schwab: But before I do that, it's important to know we did a recording, um, with the other traveling fellowship group, and they made a very strong case that they were the better group.
52:22
Joseph M. Schwab: And I just wanna give you guys an opportunity to, to, um, maybe make the case that you guys were better, or I, I don't know how you wanna rebut those allegations, but, um, I, I just wanna give you a few minutes in order to do that.
52:39
Joseph M. Schwab: Jadye, you look like you wanna say something
52:42
Jadye Kee: Yeah.
52:43
Jadye Kee: Um, I know is they went home earlier than we did every time we were around them.
52:50
Jadye Kee: And I think we were a, a much funner bunch to be around from what I understand too.
52:56
Jadye Kee: But they're good guys.
52:58
Jadye Kee: They're super good, and they're part of the fellowship as well, so, you know, I don't really wanna hash it out that they're just bad.
53:04
Jadye Kee: They're just...
53:05
Jadye Kee: You know, sometimes they're just better, better people, and you just gotta deal with it.
53:09
Jadye Kee: I think we were just a better group
53:11
Joseph M. Schwab: They, so their theme song was You're Still the One by Shania Twain.
53:16
Joseph M. Schwab: I just wanna let you know how deep this, this went.
53:20
Joseph M. Schwab: Pat, what do you think?
53:22
Joseph M. Schwab: What's your case?
53:24
Pat Maher: I think they were a bunch of academic guys, and this sort of thing is really important to them, and we were there just to become better surgeons and take p- better care of our patients, which we achieved, so just wrong pr- wrong priorities.
53:35
Joseph M. Schwab: Wrong
53:36
Leo Zalikha: Hi I agree.
53:39
Leo Zalikha: I think, I think, um, ask Dr.
53:41
Leo Zalikha: Yerasimides what he thinks.
53:42
Leo Zalikha: I think he'll say, uh, I think he'll favor us, us three
53:47
Joseph M. Schwab: That's, uh, that's a bit unfair'cause he only got to spend time with you guys, right?
53:54
Jadye Kee: So, hey, they don't know that.
53:55
Jadye Kee: The listeners don't, don't listen to
53:57
Joseph M. Schwab: Oh, all right.
53:58
Joseph M. Schwab: All right.
53:58
Joseph M. Schwab: Okay.
53:59
Joseph M. Schwab: I- we'll cut that part out.
54:01
Joseph M. Schwab: All right.
54:01
Joseph M. Schwab: So, um, before we wrap up, I, I just have one, one sort of last question, but it's really, it's really phrased as a sentence, and I want each of you to kinda complete this sentence for me.
54:12
Joseph M. Schwab: Um, and I'll, I'll go one at a time.
54:14
Joseph M. Schwab: We'll start with you, Leo.
54:15
Joseph M. Schwab: But the biggest thing-- The sentence is, the biggest thing I took away from the AHF Traveling Fellowship wasn't a technique.
54:24
Joseph M. Schwab: It was blank.
54:26
Joseph M. Schwab: Leo?
54:29
Leo Zalikha: Um, I'd say it was what excellence as a surgeon and team looks like
54:37
Joseph M. Schwab: Hmm.
54:38
Joseph M. Schwab: Pat, the biggest thing I took away from the AHF Traveling Fellowship wasn't a technique.
54:44
Joseph M. Schwab: It was
54:47
Pat Maher: Continual improvement, education, mentoring, trying to get better with every case
54:56
Joseph M. Schwab: Jadye: The biggest thing I took away from the AHF Traveling Fellowship wasn't a technique, it was
55:04
Jadye Kee: Friendship and mentorship
55:08
Joseph M. Schwab: I will give you guys this.
55:09
Joseph M. Schwab: Your answers were shorter than the first group, that's for sure.
55:15
Joseph M. Schwab: More- I- and by shorter I mean more concise, more compact.
55:18
Joseph M. Schwab: You know, it was, uh, well-delivered.
55:20
Joseph M. Schwab: No, guys, um, I really appreciate this and I appreciate you sharing your experiences, not just with me and with our listeners, but with anybody who's thinking about applying for the AHF 2027 Traveling Fellowship,'cause we want to keep doing this.
55:34
Joseph M. Schwab: We found it to be very popular.
55:37
Joseph M. Schwab: Um, and through conversations with, uh, with surgeons like yourself, um, we're gonna continually try and keep what has worked well and improve what needs to be improved.
55:49
Joseph M. Schwab: So, um, thank you so much for taking the time today to join me on the AHF podcast
55:58
Leo Zalikha: Of course.
55:58
Leo Zalikha: Thank you for having us
56:00
Jadye Kee: Thank you for having us
56:02
Joseph M. Schwab: So that's all for today's episode of the AHF Podcast.
56:07
Joseph M. Schwab: If you found some value in this conversation, share it with a friend or a colleague, or just drop us a comment to let us know.
56:15
Joseph M. Schwab: And make sure to connect with us on LinkedIn to join the discussion between episodes.
56:20
Joseph M. Schwab: There's a link to our brand-new LinkedIn page in the description.
56:25
Joseph M. Schwab: Find us every Friday with new episodes on Apple Podcasts, Spotify, YouTube, and all the major podcast platforms.
56:34
Joseph M. Schwab: I'm your host, Joe Schwab, reminding you to keep those hips happy and healthy