Latest / AHF Podcast / INOV8-ing Orthopedics: Dr. Stefan Kreuzer

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INOV8-ing Orthopedics: Dr. Stefan Kreuzer · AHF Podcast

• 0:22
  Joseph M. Schwab: Hello, and welcome again to the AHF Podcast.
• 0:26
  Joseph M. Schwab: I'm your host, Joe Schwab.
• 0:29
  Joseph M. Schwab: My guest today is Dr.
• 0:30
  Joseph M. Schwab: Stefan Kreuzer an orthopedic, hip and knee surgeon in Houston, and founder of INOV8 Orthopedics, a Houston based orthopedics and sports medicine facility.
• 0:42
  Joseph M. Schwab: He was born and raised in Switzerland, but living in the United States for the past 40 years.
• 0:48
  Joseph M. Schwab: He's well known and well respected for with minimally invasive approaches incorporating robotics navigation technologies, and being a champion for outpatient total joint arthroplasty.
• 1:02
  Joseph M. Schwab: Stefan, welcome to the AHF Podcast.
• 1:06
  Stefan Kreuzer: Thanks so much for including me.
• 1:08
  Joseph M. Schwab: So I gave a little bit of background to our listeners, but I think they'd like to hear from you directly a little bit about how you ended up where you are.
• 1:16
  Joseph M. Schwab: Tell us your story.
• 1:19
  Stefan Kreuzer: Yeah, so it's an interesting journey.
• 1:20
  Stefan Kreuzer: Um, as you mentioned, I grew up in Switzerland.
• 1:22
  Stefan Kreuzer: I was actually born in Austria, and when I was 15, my, uh, dad decided to, uh, explore other options in his career, and we moved to Vancouver, Canada.
• 1:33
  Stefan Kreuzer: I did, uh, high school there, finished my, uh, 12th grade in high school and then was fortunate enough to be recruited as a, uh.
• 1:41
  Stefan Kreuzer: A tennis player to play college tennis into Texas, then did four years of college tennis.
• 1:49
  Stefan Kreuzer: Had a little bit of a hard time getting into medical school at the time because as you know, I'm a dyslexic and I didn't do very well in the mcat, so I took a little left-hand turn and ended up going to graduate school and then, uh uh, did four years of molecular biology and biochemistry.
• 2:04
  Stefan Kreuzer: And then improved my MCAT score also improved my, you know, being a, uh, having a, a Master's of Science and biochemistry, and then got into medical school in San Antonio.
• 2:16
  Stefan Kreuzer: Then, uh, got into residency to do orthopedics in Galveston.
• 2:20
  Stefan Kreuzer: Did for five years of, uh, orthopedics.
• 2:22
  Stefan Kreuzer: Then did my fellowship at Baylor College of Medicine, and then started hanging a shingle and started swinging.
• 2:29
  Joseph M. Schwab: And you've been in practice, basically in private practice ever since, is that right?
• 2:34
  Stefan Kreuzer: No, actually I, I'm not, I was in private practice for a long time, then became employed.
• 2:40
  Stefan Kreuzer: About 15 years ago and did that for five or six years, and that was clearly not for me.
• 2:48
  Stefan Kreuzer: And then made the very difficult transition out of employment, back into private practice, not joining a group, just starting from scratch.
• 2:57
  Stefan Kreuzer: So that was an interesting journey.
• 2:59
  Stefan Kreuzer: I went from a, the fourth highest paid employee in the UT System, university of Texas system.
• 3:07
  Stefan Kreuzer: To being leveraged to the health, borrow money from the bank to, uh, build an outpatient total joint center, starting a practice, you know, buying computers, negotiating contracts with payers, and, uh, you know, rolled up my sleeve, started working very hard, and then it was probably the hardest things I, I ever did.
• 3:26
  Stefan Kreuzer: But now we're doing great.
• 3:27
  Stefan Kreuzer: Uh, we're doing great from a culture standpoint, from a workflow standpoint, from a patient satisfaction standpoint, and also financially, we've definitely caught up in, in doing quite well.
• 3:37
  Joseph M. Schwab: I want to get into your practice a little bit more in a little bit, but you mentioned something in the introduction about dyslexia and my understanding is how you came about your understanding of being dyslexic.
• 3:49
  Joseph M. Schwab: It wasn't something you knew at the time, is that right?
• 3:53
  Stefan Kreuzer: That's correct.
• 3:54
  Stefan Kreuzer: It was sort of interesting.
• 3:54
  Stefan Kreuzer: We, we were actually at ASChool function, uh, of my daughter and she went to a Montessori school and there was, um, a handout there that was written by Nobel Prize Laureate about dyslexia, and my wife picked it up.
• 4:06
  Stefan Kreuzer: And, uh, she read it and it sort of described me to a T.
• 4:10
  Stefan Kreuzer: So she actually came up with the idea, well, maybe, maybe the reason why you can't read is because you're dyslexic.
• 4:17
  Stefan Kreuzer: And so she read it to me since I can't read.
• 4:20
  Stefan Kreuzer: And um, it sort of really described sort of my.
• 4:24
  Stefan Kreuzer: My gifts and my challenges, and at the time I was already successful, so I, I really didn't, didn't think more of it.
• 4:32
  Stefan Kreuzer: Um, a few years later I had a patient that had, I did both for hip replacements and she's a psychologist who has, uh, uh.
• 4:40
  Stefan Kreuzer: A testing center for children with learning disability.
• 4:44
  Stefan Kreuzer: And so we got into a conversation and asked her if you can be tested as a, as an adult, because I didn't wanna say that I'm a dyslexic, never really officially having been tested.
• 4:53
  Stefan Kreuzer: And she says, oh, absolutely.
• 4:54
  Stefan Kreuzer: So I, I went to her testing center and it was.
• 4:57
  Stefan Kreuzer: Two tests and then sure enough it came back.
• 4:59
  Stefan Kreuzer: Severe dyslexia, you know, most people read around two 50 to three 50 words a minute.
• 5:05
  Stefan Kreuzer: I clock that at 89 words a minute with a reading comprehension of 51%, which pretty much means you, you can't read very well.
• 5:14
  Joseph M. Schwab: So tell me a little bit about how that was a challenge for you.
• 5:17
  Joseph M. Schwab: it, it, it, obviously I can perceive how there might have been challenges growing up, but how did you deal with it before you understood you were, you know, trying to make your way through this world with this condition of dyslexia?
• 5:33
  Stefan Kreuzer: Yeah, I mean, many ways the main challenge, the main effort was, was just.
• 5:39
  Stefan Kreuzer: Working harder, right?
• 5:40
  Stefan Kreuzer: So I just had to work twice as hard to get things accomplished.
• 5:44
  Stefan Kreuzer: And I tried all kinds of techniques.
• 5:46
  Stefan Kreuzer: I don't know if you remember all in the old days, the bubble diagrams, um, on, on how to learn stuff, right?
• 5:52
  Stefan Kreuzer: And so, because I'm more visual than a linear thinker, I don't know how many bubble diagrams I had put together in order to study.
• 6:00
  Stefan Kreuzer: And I just put in more effort.
• 6:02
  Stefan Kreuzer: You know, on the one hand, when it came to reading, I struggled.
• 6:04
  Stefan Kreuzer: But then on the other area where.
• 6:06
  Stefan Kreuzer: Where, like for example in math, that was extremely easy for me.
• 6:09
  Stefan Kreuzer: Calculus was easy.
• 6:10
  Stefan Kreuzer: Algebra was easy.
• 6:11
  Stefan Kreuzer: So I, I had to spend very little effort to understand those concepts, which gave me the time to spend more effort when I had to read a book or write an essay.
• 6:21
  Stefan Kreuzer: And then I got a lot of help from people around me.
• 6:23
  Stefan Kreuzer: 'cause, um, I just, I just couldn't write very well.
• 6:27
  Joseph M. Schwab: And when you came away with this diagnosis.
• 6:30
  Joseph M. Schwab: Um, how has your approach to learning changed since then?
• 6:35
  Joseph M. Schwab: I mean, you're an adult learner at this point, right?
• 6:38
  Joseph M. Schwab: Um, but how has your approach to learning new information, learning new skills, assimilating new medical information, how has that changed?
• 6:48
  Stefan Kreuzer: Great question, and now that I think about it, you asking that question, there are probably two technologies that have really been incredibly instrumental to me as a person.
• 7:00
  Stefan Kreuzer: One was audible books.
• 7:02
  Stefan Kreuzer: Um, you know that that started probably about 15 years ago and I'm extremely interested in things, but I just couldn't read very well.
• 7:10
  Stefan Kreuzer: So it was very difficult for me to read a book.
• 7:12
  Stefan Kreuzer: And once Audible came out, I got an account and I was just inhaling books.
• 7:17
  Stefan Kreuzer: I mean, there wasn't a week that didn't go by where I didn't read a listen to a book.
• 7:21
  Stefan Kreuzer: And it just opened up a new era of, of knowledge to me that that did not exist before.
• 7:28
  Stefan Kreuzer: Came to business, whether it came to personal health.
• 7:32
  Stefan Kreuzer: Uh, so that was one instrumental, um, technology that really helped me as a dyslexic a great deal.
• 7:39
  Stefan Kreuzer: And now, uh, ai, AI is just for me, is amazing.
• 7:44
  Stefan Kreuzer: I mean, I'm on chat GBT constantly, uh, writing documents and, and, and collecting thoughts and using to, to brainstorm to really put my ideas.
• 7:55
  Stefan Kreuzer: Down the words because that was the biggest challenge.
• 7:58
  Stefan Kreuzer: Um, you know, I'm not a texter.
• 7:59
  Stefan Kreuzer: I'm not an emailer.
• 8:00
  Stefan Kreuzer: Uh, I like to talk on the phone, but nowadays everybody texts, you know, you call somebody they don't pick up, but they'll send you a text back.
• 8:07
  Stefan Kreuzer: Um, you know, I like having conversations like, hence the podcast today, which I really, uh, I know I enjoy.
• 8:15
  Stefan Kreuzer: But using chat GPT to kind of take my thoughts and putting them down the paper has been really amazing for me.
• 8:23
  Joseph M. Schwab: So you seem really comfortable with technology and, and looking at, you know, your history, looking at how you have grown as an orthopedic surgeon.
• 8:33
  Joseph M. Schwab: Clearly your cv.
• 8:34
  Joseph M. Schwab: You don't shy away from technology in the operating room either.
• 8:38
  Joseph M. Schwab: Um, I, I would like to talk to you a little bit about how you got involved in anterior approach, which I think was around 20 years ago at this point, right?
• 8:47
  Joseph M. Schwab: Mm-hmm.
• 8:48
  Stefan Kreuzer: It was 2003.
• 8:49
  Stefan Kreuzer: So it's been, uh, 20, 21 years.
• 8:52
  Stefan Kreuzer: 2 22 years.
• 8:53
  Stefan Kreuzer: Yeah.
• 8:53
  Stefan Kreuzer: Um, I think that's another one of those things that I think dyslexia helped me is, you know, when I learned about the anterior approach from a visual standpoint, from a a 3D standpoint, it.
• 9:04
  Stefan Kreuzer: Made so much sense to me and in general when it comes to technology, I think I can assimilate fairly quickly whether something makes sense and it's gonna work or if something is not gonna make sense.
• 9:15
  Stefan Kreuzer: And so I think that has kind of given me an edge on, in orthopedics of.
• 9:19
  Stefan Kreuzer: Sort of figuring out what is the technology, what are the approaches that makes sense.
• 9:23
  Stefan Kreuzer: And that's how I got into energy approach, hip replacement.
• 9:25
  Stefan Kreuzer: Uh, I remember I watched Joel Matta give a talk on it, and when he mentioned when he, when he gave the talk, I says, oh, I need to learn how to do this.
• 9:33
  Stefan Kreuzer: And then, you know, a month later I was in his operating room observing and then came back home and, and started swinging.
• 9:41
  Stefan Kreuzer: Uh, that was back before we had any courses or anything.
• 9:44
  Stefan Kreuzer: In fact, I had the, I think I had the fourth OSI table that came off the assembly line, uh, to, uh, to perform anterior approach, hip replacement, um, and then other things like robotics.
• 9:55
  Stefan Kreuzer: You know, I remember I was meeting with Martin Roche who mentioned about the Mako robot, and I think I had the third Mako robot in my operating room that came off the assembly line.
• 10:06
  Stefan Kreuzer: That made a lot of sense to me.
• 10:07
  Stefan Kreuzer: And so in that area, I think, um, I've excelled because of my dyslexia more than anything.
• 10:14
  Joseph M. Schwab: And it sounds like you have gravitated towards this technology early.
• 10:18
  Joseph M. Schwab: You don't ever seem to be fully satisfied with one technology.
• 10:21
  Joseph M. Schwab: What I observe is that you continue to strive for bigger, better, faster, stronger.
• 10:27
  Joseph M. Schwab: Uh, tell me a little bit about your sort of central philosophy around how you pick and choose and grow with technology.
• 10:37
  Stefan Kreuzer: Yeah, I think when, when you adopt technology.
• 10:41
  Stefan Kreuzer: You.
• 10:42
  Stefan Kreuzer: You quickly learn of what is a value add and what is a challenge.
• 10:47
  Stefan Kreuzer: And I think by continuously rethinking on how you're doing things, when you then get exposed to a new technology, you immediately realize, oh, this is gonna fix the problem that I'm currently facing.
• 11:02
  Stefan Kreuzer: And I think that's how I've progressed from one navigation system to the next, from one robotic system to the next.
• 11:09
  Stefan Kreuzer: Um, and I just continuously try to push on how we can do a little bit better, uh, for our patients.
• 11:17
  Joseph M. Schwab: You had a, a publication about, value of, of introspection specifically in, in adopting new techniques, early parts learning curve.
• 11:30
  Joseph M. Schwab: Was that something that you learned from surgery and you, uh, applied it to, uh, your technology, robotics, things like was it something that you had inherent to yourself maybe the way you, uh, grew up in your education?
• 11:45
  Joseph M. Schwab: That you brought to medicine, how, how did you develop that philosophy?
• 11:50
  Stefan Kreuzer: It's a good question.
• 11:51
  Stefan Kreuzer: I'm not sure that I could pinpoint to, to exactly one event other than early on in my life.
• 11:58
  Stefan Kreuzer: My father once told me an open mind is the highest form of intelligence.
• 12:03
  Stefan Kreuzer: Hmm.
• 12:04
  Stefan Kreuzer: And so I've always tried to use that and it's been part of my email on the bottom for a long, long time.
• 12:10
  Stefan Kreuzer: Um, because you.
• 12:14
  Stefan Kreuzer: You think you know it all, but you really don't.
• 12:16
  Stefan Kreuzer: And as you learn more, you've actually realized how little you know.
• 12:22
  Stefan Kreuzer: So I always feel like knowledge is not.
• 12:25
  Stefan Kreuzer: It's not a, a pyramid, it's an upside down pyramid.
• 12:29
  Stefan Kreuzer: And so as, and, and to me that was very real when I started reading a lot or listening to audio books because that really expanded my knowledge base.
• 12:40
  Stefan Kreuzer: And that sort of created, created this hunger for more and more knowledge.
• 12:45
  Stefan Kreuzer: And so I think that may be part of the, the, the, uh, growth that I went through in, in my.
• 12:54
  Stefan Kreuzer: Early forties, uh, by having been exposed to that knowledge base where I just got so hungry of learning more because I was deprived of this for 40 years of my life because I couldn't read.
• 13:05
  Stefan Kreuzer: And, and maybe that's what sort of pushed me to always try to do better and always try to learn more.
• 13:11
  Stefan Kreuzer: Um, even now it's, I mean.
• 13:13
  Stefan Kreuzer: Today I've had three calls with startup companies about new stuff that could be incorporated into the workflow in our clinic.
• 13:21
  Stefan Kreuzer: So it's, it's just a really exciting time.
• 13:24
  Joseph M. Schwab: In a recent conversation you had.
• 13:27
  Joseph M. Schwab: Um, you had a quote, um, that, that I just thought I would, I would ask you about.
• 13:32
  Joseph M. Schwab: You said a better tool will make a better person.
• 13:35
  Joseph M. Schwab: So you had three companies today contract, uh, contacting you in theory, offering you a better tool.
• 13:41
  Joseph M. Schwab: Um.
• 13:42
  Joseph M. Schwab: What tools may, uh, I'll ask this in sort of two parts.
• 13:46
  Joseph M. Schwab: What tools do you wish you had, um, back when you were in your training that would make you a better surgeon?
• 13:53
  Joseph M. Schwab: And what tools do you wish you have now going forward to deliver better for your patients?
• 14:01
  Stefan Kreuzer: It worked better to back then, um, I wish I had audible books textbooks in schools because that was torture.
• 14:10
  Stefan Kreuzer: Trying to read textbooks.
• 14:11
  Stefan Kreuzer: Uh, you know, I spent, I basically got my mail at the library'cause I spent so much time at the library.
• 14:17
  Stefan Kreuzer: So back then, I think.
• 14:20
  Stefan Kreuzer: The educational process was not very conducive to people with dyslexia.
• 14:25
  Stefan Kreuzer: It just, we just sort of had to bear it and, and, and go through it moving forwards.
• 14:30
  Stefan Kreuzer: Uh.
• 14:31
  Stefan Kreuzer: Just like Charlie DeCook who started the Anterior Hip Foundation, I very much focus on efficiency and improving workflow, and so I'm hoping that AI tools, which is one of the companies we have had a conversation with and virtual reality tools from an educational standpoint, which is another company we had a conversation with, that this can improve my efficiency in, in delivering.
• 14:56
  Stefan Kreuzer: Care to my patients because as I'm sure you know, he, healthcare delivery system is not optimal, especially in the United States.
• 15:03
  Stefan Kreuzer: It's very scatterbrained.
• 15:04
  Stefan Kreuzer: It's very cumbersome.
• 15:06
  Stefan Kreuzer: It's, it's, it's, it's not a, there's so many different technologies that don't talk to each other.
• 15:12
  Stefan Kreuzer: You don't have, the EMRs, don't have APIs.
• 15:14
  Stefan Kreuzer: It's very frustrating'cause you're always putting bandaids on trying to improve your workflow.
• 15:20
  Stefan Kreuzer: So I think moving forward with AI and with some of these newer technologies of delivering.
• 15:25
  Stefan Kreuzer: Educational, uh, content will be very instrumental in improving patient care.
• 15:32
  Joseph M. Schwab: Focusing the technology conversation a little bit more on anterior approach, hip replacement.
• 15:37
  Joseph M. Schwab: In your experience, because you've been at this 20 years, if you were to identify of the single biggest contribution or greatest contribution of technology to the way we do anterior hip replacement today, what would that be and why?
• 15:56
  Stefan Kreuzer: Yeah, so two technology that I think have really made, uh, the anterior approach hip replacement more predictable.
• 16:04
  Stefan Kreuzer: And, you know, just as a matter of disclosure, I obviously have a biased view.
• 16:08
  Stefan Kreuzer: I think that.
• 16:09
  Stefan Kreuzer: A table, um, you know, I'm part of INOV8 Orthopedic Technology and we make a table attachment.
• 16:15
  Stefan Kreuzer: OSI makes the HANA table.
• 16:17
  Stefan Kreuzer: So I think a, a positioning device that allows the, the leg to be positioned in a certain way that it makes it easy to access the femur has been very instrumental in reducing the learning curve and probably also reducing the risk of, of complications.
• 16:34
  Stefan Kreuzer: Now there are many surgeons to do without a table extremely well.
• 16:37
  Stefan Kreuzer: I happened to be in the camp that I think at table was one of the technologies that has improved that approach.
• 16:43
  Stefan Kreuzer: And to me.
• 16:45
  Stefan Kreuzer: Currently, uh, I use a navigation system that is CT based.
• 16:48
  Stefan Kreuzer: Uh, and, uh, that to me, uh, called NaviSwiss and that to me has been extremely, uh, instrumental in making the surgery very predictable because we do the vast majority of the surgeons in an ASC and ambulatory surgery center, uh, from an inventory management and from a predictability.
• 17:07
  Stefan Kreuzer: For us, that's extremely important because we don't have the resources a hospital does, and so.
• 17:12
  Stefan Kreuzer: Before I go to the operating room, I'm, I know what cup size, what femur size.
• 17:16
  Stefan Kreuzer: I know what the leg length and offset needs to be, what the cup position needs to be.
• 17:20
  Stefan Kreuzer: Uh, and that has made it, uh, much less stressful of shifting volume from inpatient to outpatient.
• 17:27
  Joseph M. Schwab: Hmm.
• 17:27
  Joseph M. Schwab: And so speaking of technology like navigation, like robotics, uh, obviously you, you have had extensive experience with different, uh, robotics platforms, uh, several different navigation platforms, you have your current set that you prefer to use when you're talking or thinking about the distinct benefits of each of these platforms.
• 17:50
  Joseph M. Schwab: For a surgeon who is maybe starting to look into those sorts of things, what's your advice about how they should decide which technology suits them, their practice and their patients?
• 18:03
  Joseph M. Schwab: Are there distinct benefits that you see, uh, of certain types of platforms?
• 18:09
  Stefan Kreuzer: That's a good question.
• 18:10
  Stefan Kreuzer: And every surgeon has to sort of decide that for themselves.
• 18:12
  Stefan Kreuzer: Right?
• 18:13
  Stefan Kreuzer: where are my challenges?
• 18:14
  Stefan Kreuzer: And so if a surgeon has a higher dislocation rate, yeah, he may want to use a technology that improves cup position.
• 18:23
  Stefan Kreuzer: Or if a surgeon had some patients who are, the leg length wasn't correct, um, and which is can be quite.
• 18:30
  Stefan Kreuzer: Disturbing for certain patients, especially if they're younger, if they're female, if they wanna wear flip flops, you know, you can't really adjust it with an insert.
• 18:39
  Stefan Kreuzer: Um, that's another area where probably a a, an additional technology can help make it a more predictable.
• 18:47
  Stefan Kreuzer: Uh, but every surgeon really hasn't decided for themselves, you know, is good, good enough, or do they wanna do better?
• 18:52
  Stefan Kreuzer: Um.
• 18:54
  Stefan Kreuzer: You know, I'm in the camp.
• 18:55
  Stefan Kreuzer: I always try to do a little bit better and, and I look at technology that makes me a better surgeon.
• 19:01
  Stefan Kreuzer: I'm not arrogant enough to say that I know it all and I know how to do it perfect.
• 19:05
  Stefan Kreuzer: Uh, so I always look for technology that may give me a little bit additional information, whether that's intraoperative or preoperative, that then, uh, results in a better outcomes.
• 19:17
  Joseph M. Schwab: Have any of those insights that technology, uh, has given you changed not only your sort of intraoperative mindset or decision making during the surgery?
• 19:28
  Joseph M. Schwab: But has any of it changed the way you approach surgery?
• 19:31
  Joseph M. Schwab: Completely sort of shifted your mindset, uh, in the way you think about hip replacement.
• 19:37
  Stefan Kreuzer: Uh, on the hip replacement, probably less because, you know, hip is a very simple joint and you get the cup at the right place, you get the fem at the right place.
• 19:45
  Stefan Kreuzer: Uh, a hip will do well.
• 19:46
  Stefan Kreuzer: Well, um, a lot of my focus now is on knee replacement.
• 19:51
  Stefan Kreuzer: Um, where there's an area, I think there's more room for improvement.
• 19:56
  Stefan Kreuzer: Because, you know, hips can run marathons, but knees cannot.
• 19:59
  Stefan Kreuzer: Um, and I'm hoping that one of these days, knees can run marathons as well.
• 20:03
  Stefan Kreuzer: Um, and, but that's, I think, an area where some of the soft tissue measuring devices, uh, can improve outcome.
• 20:11
  Stefan Kreuzer: Uh, and so I, I, I do spend quite a bit of focus on the development side and also on the thinking side in that area.
• 20:18
  Stefan Kreuzer: I think hips, hips do great.
• 20:20
  Stefan Kreuzer: I mean, you, you're a hip surgeon, you, you know this as well as I do.
• 20:23
  Stefan Kreuzer: Um, most of the time if you get the stuff in the right place, they're gonna do phenomenal.
• 20:28
  Joseph M. Schwab: Does the use of this technology affect your confidence in the OR at all, or is that not really a is, is there not really that sort of mindset effect for you?
• 20:38
  Stefan Kreuzer: Oh, I think you hit the nail on the head.
• 20:40
  Stefan Kreuzer: It does impact my confidence.
• 20:42
  Stefan Kreuzer: I mean, I walk into a room, look at the plan, and, and I know where I'm going.
• 20:47
  Stefan Kreuzer: So it definitely improves my, reduces my stress level and, and improves my confidence that I'm gonna do a great job with this patient.
• 20:57
  Joseph M. Schwab: Are there additional sort of downstream effects of these technologies that aren't necessarily the exact thing that you're looking for?
• 21:04
  Joseph M. Schwab: So for instance, you know, you may have a lower dislocation rate because you're very confident in the position of your cup and the position of your stem.
• 21:12
  Joseph M. Schwab: Um, but does your increased confidence translate to.
• 21:16
  Joseph M. Schwab: Maybe greater efficiency within your ASC setting or more cost-effective use of technology, other technologies, um, especially in somebody who's trying to maximize their efficiency.
• 21:29
  Stefan Kreuzer: Yeah, great question.
• 21:31
  Stefan Kreuzer: And in, in the one area that.
• 21:34
  Stefan Kreuzer: A recent upgrade of the navigation.
• 21:37
  Stefan Kreuzer: Just to be specific on, on one particular point, or to answer your question, I wanna give an example.
• 21:41
  Stefan Kreuzer: Uh, there's an upgrade on the navigation system that allows for navigated reaming.
• 21:46
  Stefan Kreuzer: And because it's a CT based navigation system, so we collect 32 points in the acetabulum, and then so you know exactly where the acetabulum is.
• 21:56
  Stefan Kreuzer: And so that has allowed me to go.
• 21:59
  Stefan Kreuzer: To a single reamer.
• 22:01
  Stefan Kreuzer: So if it's a 52 cup, I put in a 52 reamer and I ream the acetabulum to the exact depth of what the plan is, and then I put in a 52 cup.
• 22:12
  Stefan Kreuzer: So my cup efficiency has improved significantly.
• 22:17
  Stefan Kreuzer: Um, you know, we put in a cup in less than three minutes.
• 22:22
  Joseph M. Schwab: How do you communicate these values, these philosophies and, and how you use technology to your patients?
• 22:31
  Joseph M. Schwab: Do your, do your patients seek you out because they know you use this, or is this something that you have to convince them is the right thing for them?
• 22:39
  Stefan Kreuzer: I think patients are very, have a very poor understanding of the different.
• 22:47
  Stefan Kreuzer: In surgeon quality and, and surgeons utilization of technology.
• 22:53
  Stefan Kreuzer: And I've never been a big marketing guy.
• 22:55
  Stefan Kreuzer: I don't have billboards, I don't have, you know, ads in the paper.
• 23:00
  Stefan Kreuzer: I don't help what, what I do.
• 23:03
  Stefan Kreuzer: Um, I don't even mention to the patient.
• 23:06
  Stefan Kreuzer: I use navigation unless they ask, uh, I could probably do a better job in doing that.
• 23:11
  Stefan Kreuzer: Um, you know, it's, there's also the question, there's an increased cost, right?
• 23:17
  Stefan Kreuzer: So should I charge patients more for navigation?
• 23:21
  Stefan Kreuzer: Which you can, I mean, you can legally tell the patient that this is not a covered service and, and you pay extra for it.
• 23:28
  Stefan Kreuzer: And I've always been asked the question, well, if the patient is not willing to pay for it, would I, would I not use it?
• 23:35
  Stefan Kreuzer: The answer is no, I'm gonna use it regardless.
• 23:38
  Stefan Kreuzer: And so it's really hard to charge for something that you're gonna use regardless.
• 23:42
  Stefan Kreuzer: And so that's probably an area where I could probably benefit a little bit more if I spend a little bit more time talking to the patients.
• 23:49
  Stefan Kreuzer: Um, but in the scheme of things, I think at the end of the day, the happy patients, probably the most satisfying part of my jobs.
• 23:56
  Joseph M. Schwab: So how do you approach the doctor-patient conversation?
• 23:59
  Joseph M. Schwab: Is that, uh, you're, you're really just giving them the facts of.
• 24:03
  Joseph M. Schwab: What you plan to do in the procedure, or are there other aspects to it that you find to be important, especially in a highly efficient ASC setting?
• 24:12
  Stefan Kreuzer: Yeah, so we, we definitely talk about the imp importance of going to an ASC, what the benefits are, the lower risk of infection, you know, the, the focus factory type approach where the nurses, uh, know exactly what they're supposed to do because that's all we do in that surgery center.
• 24:29
  Stefan Kreuzer: Uh, the efficiency that it creates and that it translates into, uh, a better outcome.
• 24:35
  Stefan Kreuzer: So we definitely focus on that.
• 24:36
  Stefan Kreuzer: And then we always focus on technology if, if the patient asks, and a lot of that content is out on the web and, you know, I've had several patients now that go into chat GPT and say, you know, who's the best surgeon in Houston?
• 24:48
  Stefan Kreuzer: And, and for some reason my name popped up.
• 24:51
  Stefan Kreuzer: Uh, so which is, which is kind of, you know, interesting, right.
• 24:54
  Stefan Kreuzer: Since I use chat, chat GPT much.
• 24:56
  Joseph M. Schwab: So one of the things that I saw, um, on one of the recent posts you were involved in was this idea of the surgeon as an elite athlete, and I know you, you have.
• 25:09
  Joseph M. Schwab: Uh, I mean, you have your athletic abilities, obviously you, you, you know, you were recruited for tennis, but you continue to be an athlete now.
• 25:17
  Joseph M. Schwab: I'm interested in hearing your thoughts and treating this surgeon like an elite athlete
• 25:27
  Stefan Kreuzer: In fact, that's my next call at 10 o'clock.
• 25:29
  Stefan Kreuzer: So, um, there's an interesting connection.
• 25:32
  Stefan Kreuzer: The, in fact, the navigation company that I work with, the, um, the president, uh, one of his best friends is a physical therapist from Australia who at HI think 23 or 24 decided to.
• 25:48
  Stefan Kreuzer: Become an Olympic athlete.
• 25:50
  Stefan Kreuzer: So and so, she, she moved to a different town where biking was a lot, uh, easier to do and trained and actually made it to the Olympics in Brazil.
• 26:00
  Stefan Kreuzer: Uh, came in second at the World championship one year.
• 26:03
  Stefan Kreuzer: So obviously this lady has put an enormous amount of effort trying to optimize because, you know, most athletes they.
• 26:12
  Stefan Kreuzer: They retire at age 25.
• 26:13
  Stefan Kreuzer: They certainly don't start at age 25.
• 26:15
  Stefan Kreuzer: And so she came up with that concept.
• 26:17
  Stefan Kreuzer: Can, can you utilize the techniques she used in order to optimize her performance?
• 26:24
  Stefan Kreuzer: And in general, Olympic athletes or any athletes,'cause they have lots of coaches and they optimize their performance and translate that into, uh, trying to optimize the performance of a surgeon in the operating room.
• 26:37
  Stefan Kreuzer: 'cause there are really two benefits.
• 26:39
  Stefan Kreuzer: A, you know, you, you as a surgeon can go through a full day of, of surgeries healthier and, and with less stress and better performing and improve efficiency and hope for this will also translate into patient bit better patient care because we know we make better decisions if we are in, in a good state of mind.
• 27:03
  Stefan Kreuzer: And so.
• 27:04
  Stefan Kreuzer: I love that concept.
• 27:05
  Stefan Kreuzer: Um, it very much goes sort of hand in hand with Charlie, the cook's concept of 12 by 12, um, where you optimize the OR team.
• 27:13
  Stefan Kreuzer: But I realized after I sent my team to Charlie, the cook, that the limiting factor wasn't my team.
• 27:19
  Stefan Kreuzer: It was me I was the biggest variable.
• 27:22
  Stefan Kreuzer: You know, I would do a hip in 28 minutes and then I would do a hip in 45 minutes.
• 27:25
  Stefan Kreuzer: And why is that?
• 27:27
  Stefan Kreuzer: And so can we apply some of those techniques to the surgeons to try to improve their efficiency?
• 27:31
  Stefan Kreuzer: Which, uh, and then also from a mental health standpoint and longevity standpoint, you know, I'm, I'm a big exerciser.
• 27:39
  Stefan Kreuzer: I exercise an hour every morning before I start surgery, and so can we take that to the next level?
• 27:44
  Stefan Kreuzer: I find that an interesting concept.
• 27:47
  Joseph M. Schwab: Well, and it seems like you take, um, data, you know, feedback.
• 27:51
  Joseph M. Schwab: On your performance too, both as an athlete and surgically.
• 27:55
  Joseph M. Schwab: And in fact, I heard in one of your recent interviews that one of the first people you hired at your practice was a data a computer programmer, uh, to set up a database collecting clinical data on your patients.
• 28:10
  Joseph M. Schwab: Um, and so you should have an exceptional amount of data at your disposal about their outcomes.
• 28:17
  Joseph M. Schwab: Patient data.
• 28:18
  Joseph M. Schwab: Do you also collect surgeon and surgical data, and can you tell me a little bit about how you use data in your practice?
• 28:26
  Joseph M. Schwab: Mm-hmm.
• 28:27
  Stefan Kreuzer: Great question, and I think that's what makes this a perfect match for me and, and this this new consultant is because we do collect so much data.
• 28:36
  Stefan Kreuzer: You know, David, my data guy, I've had him for almost 20 years and so we've collect a lot of data.
• 28:40
  Stefan Kreuzer: So we have a lot of retrospective data, um, and I collect a lot of surgeon data.
• 28:45
  Stefan Kreuzer: I have a whoop on my right hand.
• 28:48
  Stefan Kreuzer: I have a Garmin watch now converted to a Kronos watch on the left side.
• 28:53
  Stefan Kreuzer: Um, I wore a glucose monitor for at least two years, a continuous glucose monitor.
• 28:58
  Stefan Kreuzer: Um, there is a device that actually can measure, um, the electrolytes in your sweat.
• 29:06
  Stefan Kreuzer: So we're gonna start using that to, uh, collect, uh, data.
• 29:11
  Stefan Kreuzer: So the, the approach that we're gonna use is we'll collect.
• 29:16
  Stefan Kreuzer: Two months worth of data on me in every form that we possibly can, and this next call will define that a little bit better.
• 29:24
  Stefan Kreuzer: And then see after that, what kind of intervention can we utilize?
• 29:29
  Stefan Kreuzer: Whether it's making sure you drink enough fluid, whether you, you know, take some electrolytes, whether.
• 29:34
  Stefan Kreuzer: Take glucose around noon because your glucose may be a little bit lower to try to micromanage the metabolic health of me to see whether that then translates into better performance.
• 29:47
  Joseph M. Schwab: So I, I don't know if you'll allow me to make the, the analogy, but, so I did a traveling fellowship in, in the UK and we, three and a half weeks around the uk, and part of which we spent at Wrightington Hospital where John Charnley practiced.
• 30:02
  Joseph M. Schwab: And one of the things that struck.
• 30:04
  Joseph M. Schwab: Me about him his ability to experiment on himself.
• 30:10
  Joseph M. Schwab: So when he was looking for materials that were biocompatible as he was developing his hip replacement, one of the things that he would do was implant different materials basically over his shin, uh, and see how, how well his body responded to him.
• 30:29
  Joseph M. Schwab: Would you accept the analogy?
• 30:31
  Joseph M. Schwab: The analogy of being the next John Charnley, if that were the basis for it.
• 30:36
  Stefan Kreuzer: Well, I mean, the next John, Charnley, that's, that's a, that's a high order.
• 30:41
  Stefan Kreuzer: I, I love the analogy, you know, I'm not gonna have a skin incision and implant something into my shin to accomplish this.
• 30:48
  Stefan Kreuzer: Maybe if it gives you enough data to make a difference.
• 30:51
  Stefan Kreuzer: Sure.
• 30:51
  Stefan Kreuzer: Um, I think with the current monitoring devices, you can collect an enormous amount of data, um, during surgery to, to see whether that will, can translate into, into different outcomes.
• 31:04
  Joseph M. Schwab: Is the surgeon the source of the data that we're gonna be looking at in the next round of innovative technology?
• 31:10
  Joseph M. Schwab: Um, sort of along that lines of them like the and are our biggest limitations in achieving our best outcomes.
• 31:20
  Joseph M. Schwab: Starting to be the surgeon.
• 31:25
  Stefan Kreuzer: I certainly think 100% that is a correct statement and if you want to expand a little bit on this, um, I'm afraid that we're gonna have a massive shortage of physician in the next five to 10 years because if you look at what has occurred.
• 31:43
  Stefan Kreuzer: Number one, during COVID, a lot of physicians retired.
• 31:48
  Stefan Kreuzer: Uh, there was a recent survey that showed that physicians that are 40 years old, I think like 40% plan on retiring.
• 31:58
  Stefan Kreuzer: And at age 55, were not training enough surgeon and the volume required to take care of patient is gone up.
• 32:08
  Stefan Kreuzer: And finally, with the employed model.
• 32:11
  Stefan Kreuzer: Physicians are not nearly as productive than in private practice.
• 32:15
  Stefan Kreuzer: Uh, my wife says this all the time, is the new physicians that are coming on board, you know, it's their work life balance is extremely important and they really believe in.
• 32:27
  Stefan Kreuzer: In work-life balance.
• 32:29
  Stefan Kreuzer: So they have as productive as we are.
• 32:32
  Stefan Kreuzer: So my prediction is in the next five to 10 years, we're gonna have a massive shortage of physicians.
• 32:37
  Stefan Kreuzer: And so if we can optimize physician output, uh, hopefully we can combat some of that, uh, that uh, uh, shortage of physician.
• 32:47
  Joseph M. Schwab: Hmm.
• 32:48
  Joseph M. Schwab: You had had also mentioned, I think in, in a recent interview, um, one of the, uh, one of the most, um, influential or I, I guess you mentioned it as a book.
• 32:59
  Joseph M. Schwab: I don't recall how influential you said it was, power of why, um, creating that sense of purpose.
• 33:07
  Joseph M. Schwab: Um, in what you do, and this sort of speaks to this idea of optimizing and, and, uh, uh, maximizing the output of the surgeon.
• 33:16
  Joseph M. Schwab: Um, can you just tell me a little bit about why, how that book has influenced you?
• 33:23
  Joseph M. Schwab: Um, what is your why for how you've gone about creating the tools that you've created, building innovate, orthopedics, for instance, um, and why patients will continue to benefit from your pursuit of progress?
• 33:37
  Stefan Kreuzer: Yeah, the book is called Start With Why, and it's by Simon Sinek.
• 33:42
  Stefan Kreuzer: Yeah, and and I highly recommend anybody to read it to me.
• 33:46
  Stefan Kreuzer: It, it was transformational because I was in a situation where revenue and productivity.
• 33:54
  Stefan Kreuzer: To generate revenue.
• 33:56
  Stefan Kreuzer: Was the main focus.
• 33:57
  Stefan Kreuzer: That's the system that I was in, and that's, I was not part, I didn't want to be part of that system anymore.
• 34:05
  Stefan Kreuzer: And so my why was it have, it wasn't well defined at the time.
• 34:10
  Stefan Kreuzer: It just needed to be something different.
• 34:11
  Stefan Kreuzer: Um, and.
• 34:13
  Stefan Kreuzer: I realized that in that system we didn't really provide a very healthy environment.
• 34:19
  Stefan Kreuzer: And so my why was I wanted to create a healthcare delivery system where the team worked better together.
• 34:28
  Stefan Kreuzer: It was a system with really good culture where nurses wanted to be there.
• 34:33
  Stefan Kreuzer: Uh, they wanted to to be part of a team approach.
• 34:37
  Stefan Kreuzer: And the financial aspect was a secondary gain or.
• 34:41
  Stefan Kreuzer: Tertiary gain, that was not the main focus.
• 34:44
  Stefan Kreuzer: Uh, and so I exited the employed model.
• 34:49
  Stefan Kreuzer: And started innovate.
• 34:50
  Stefan Kreuzer: And Innovate was really, there are four companies.
• 34:52
  Stefan Kreuzer: There's Innovate Orthopedics, which is the practice, innovate Surgical, which is the Surgery Center.
• 34:57
  Stefan Kreuzer: Then Innovate Research because of the research component, and then Innovate Healthcare, which is the value-based care contracting, uh, company.
• 35:06
  Stefan Kreuzer: Uh, and so the focus was to create a very happy environment for employees.
• 35:11
  Stefan Kreuzer: Which then translates into a happy patient.
• 35:15
  Stefan Kreuzer: And the destruction needs to be efficient in order to reduce healthcare cost.
• 35:21
  Stefan Kreuzer: Um, because.
• 35:23
  Stefan Kreuzer: We're, you know, healthcare costs in the United States is outta control.
• 35:26
  Stefan Kreuzer: And, and I think we've accomplished that.
• 35:28
  Stefan Kreuzer: I think we are not relevant yet because we're just one.
• 35:31
  Stefan Kreuzer: And if we can make, you know, 10 centers or 20 centers or 30 centers to create that, then, then we do become relevant for the healthcare cost, uh, challenge in the United States.
• 35:43
  Joseph M. Schwab: If you've reached those goals, has your why changed?
• 35:46
  Joseph M. Schwab: And if so, what's your new why?
• 35:50
  Stefan Kreuzer: It has changed.
• 35:51
  Stefan Kreuzer: It has evolved.
• 35:51
  Stefan Kreuzer: Um, you know, probably two or three years ago, or maybe a little bit more than five years ago, um, I also started having a much stronger focus on personal health, uh,'cause and I felt that I didn't wanna work.
• 36:05
  Stefan Kreuzer: Like a dog and then die, you know, of a heart attack.
• 36:08
  Stefan Kreuzer: So, um, I really sort of focused my why to also improve my personal health and started exercising more and eating better and sleeping better.
• 36:17
  Stefan Kreuzer: And, and, you know, one of the books there that really sort of impacted my, my Personal Health journey is by Peter Atia, the book called Outlive and his podcast, the Drive.
• 36:30
  Stefan Kreuzer: Yeah, both of which, uh, the book is an audible book and the podcast is obviously audible as well.
• 36:36
  Stefan Kreuzer: So very good for me.
• 36:37
  Stefan Kreuzer: Uh, but that has really sort of, um, evolved my, my why on a personal level, not just on a business level.
• 36:46
  Joseph M. Schwab: Well, Stefan, I really taking the time to be with us today.
• 36:50
  Joseph M. Schwab: I want to be mindful of your time, but, uh, my producer, Lila, uh, she described you after her initial conversations as it's like talking with chat GPT and I, I'm gonna take the kindest interpretation of that, uh, in that you are a wealth of knowledge.
• 37:09
  Joseph M. Schwab: You're exceptionally thoughtful.
• 37:11
  Joseph M. Schwab: You're very well spoken.
• 37:12
  Joseph M. Schwab: And, um, it's just really been a pleasure talking to you today.
• 37:15
  Joseph M. Schwab: Thank you for being on the podcast.
• 37:18
  Stefan Kreuzer: Yeah.
• 37:18
  Stefan Kreuzer: Thank you so much for including me.
• 37:20
  Stefan Kreuzer: It's been a, it's been, it's been a great conversation.
• 37:23
  Joseph M. Schwab: Thank you for joining me for this of AHF podcast.
• 37:27
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• 37:33
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• 37:36
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• 37:42
  Joseph M. Schwab: You can find the AHF podcast on Apple Podcasts, Spotify, or in any of your favorite podcast apps, as well as in video form on YouTube slash at anterior hip foundation.
• 37:56
  Joseph M. Schwab: All one word, episodes of the AHF Podcast come out on Fridays.
• 38:02
  Joseph M. Schwab: I'm your host, Joe Schwab, asking you to keep those hips happy, healthy, and intelligent.