Interview: Neil P. Sheth, MD

AHF Podcast Interview: Neil P. Sheth, MD

In this episode of the AHF podcast, host Joseph M. Schwab interviews Dr. Neil P. Sheth, who is taking over the scientific program for AHF 2025. Dr. Sheth discusses his journey with the anterior approach to hip replacements, his involvement with Medacta, and his efforts in building a hospital in Tanzania to provide education and care in underserved communities. The conversation covers the challenges and successes of these initiatives and the future direction of global health efforts.

Transcript

Joseph M. Schwab: 0:05

I'm Joe Schwab and welcome to the AHF podcast. My guest today is Dr. Neil Sheth Neil You're taking over the scientific program for AHF 2025. Is that right?

Neil P. Sheth: 0:18

That's correct, Joe. Thanks for having me on this podcast and very excited to be a part of the AHF board, which this is again, the first year that I've actually been to an AHF meeting and tremendously overwhelming for me in the sense that I have not been to a meeting where I've sat through every lecture for a two and a half day meeting.

Joseph M. Schwab: 0:36

Tell me a little bit about your journey with the anterior approach because you're not coming out of fellowship having done, 500 anterior approach hip replacements in residency and fellowship, tell me how you got to where you are

Neil P. Sheth: 0:49

Yeah. So this is back in 2017. So at that point I had already been in practice for about seven years. And, I decided I wanted to really delve into the anterior approach at that point for three reasons. Number one, as a hip surgeon and 40 percent of my practice is revision surgery. So that should be comfortable getting into the hip from the front side and back. Number two, Residents and fellows were asking for this in their education. So I was like as a fellowship director, I should be able to offer this to our residents and fellows. And number three, there was a lot of research and data coming out on the anterior approach. And I was like, I don't know if the socket's easy. I have no idea if the femur is hard unless I actually do something and try it. I spent a very long time, about a good three months of actually adjusting my brain to look at the hip differently. I know what all the muscles are around the hip, but now they're in the wrong spot. They're normally over here. Now they're going to be 180 degrees away from, or 90 degrees away from where I'm actually used to seeing them. This was not a small task for me because I was not interested in actually harming patients while I'm trying to learn and I was not unhappy with my posterior approaches. It wasn't an instability issue. Wasn't a recovery issue. It was nothing like that. It was just more of a, an academic issue for me with regards to our trainees, as well as my ability to get into the hip from any approach that I wanted to.

Joseph M. Schwab: 2:14

During your process, you ended up gravitating towards Medacta, right? As a primary system and everything that surrounds that. Tell me a little bit about how you ended up, taking that approach.

Neil P. Sheth: 2:26

Medacta's educational approach is very different. They wanted me to go see somebody to watch them do a total hip replacement. They wanted me to go to a lab with that individual. And then that person was going to come to Penn, and actually scrub in on my first two anterior hips, which, and Tyler Goldberg was my mentor, who taught me how to do an anterior hip. It was amazing having him there, scrubbed in, not touching the patient, but looking and saying, Yep, your incision is in the wrong spot, your retractor is in the wrong spot, you need one more click of rotation. But my anxiety was one third of what it normally would have been. So I thought Medacta's educational platform was by far the best out there. And at that point Medacta was not interested in giving implants to someone that they didn't think could do the actual procedure properly and reproducibly. But I thought their education was by far the best and they were so dedicated on making sure that I learned what I needed to learn and to make sure that I was, comfortable doing what I was doing. And I, again, I think the key thing is being reproducible. You can't do this and you got a fluke and you did it well once. It's got to be every single time.

Joseph M. Schwab: 3:32

And so seven years in to this process, anything you would have done differently

Neil P. Sheth: 3:37

I don't think so. I'm now about 80 percent on anterior, my primary hips the, only patients that I don't do an anterior hip on. Patients who are, I think really, obese that have a huge pannus that's sitting over the incision. And in Philadelphia, we have a fairly large sickle cell population where the whole femur is completely sclerotic. So I feel like it's better for me to be able to look at the actual femur as opposed to working in this position where I'm not looking at it head on. That's about it. Other than that everyone's getting an anterior approach. So I don't think I would have done anything differently. I was Very fortunate that I got to slowly and gradually increase my practice in this direction. And it wasn't an all or none thing in 2017. It was a, Hey, let's do one a week to let's do two a week. And slowly growing to now I might do four or five in a day, depending on what day it is.

Joseph M. Schwab: 4:33

and you have a fellowship, right? You're, you have an adult reconstruction fellowship at your institution, and obviously

Neil P. Sheth: 4:40

Yeah, we have three fellows here.

Joseph M. Schwab: 4:42

Three fellows, and you're now teaching this to your fellows as well. Correct?

Neil P. Sheth: 4:47

Yes, correct.

Joseph M. Schwab: 4:48

My understanding is joint replacement is not your only passion and not even your only academic passion. You have some interest in development in underserved communities around the world. You want to tell me about that?

Neil P. Sheth: 5:02

I was really fortunate to have some great mentors when I was a resident in the global health arena. And so over the last decade, I've spent a lot of time, most of my time outside of the hospital either nights and weekends working on building a hospital in Tanzania in east Africa. And again, right? Like you said, Joe, there's a lot of people in the world that have very little access to care, simple, like basic care, nothing complex. So I've been really fortunate to have some great mentors that taught me to believe in what was important, at least to me. And I've, I'm really fortunate that my chairman up until now has been extremely supportive of the work that we were doing over there. And so just this past year, we actually finally got our hospital built in Tanzania. And so now we're looking at getting 32 different teams or different universities involved to actually come. And spend time there. So you're signing out of service every week. And so the hospitals covered year round,

Joseph M. Schwab: 5:57

Wow. And are those people from around the United States who are going to service that hospital or is it all around the world

Neil P. Sheth: 6:05

it's all around the world. Most of the, institutions are us based institutions, but it's also schools and universities in South America, Central America Europe and Asia.

Joseph M. Schwab: 6:16

and how did you end up, targeting Tanzania for this effort?

Neil P. Sheth: 6:19

So I got to go to operation walk in 2012, which was the first time I went on operation walk in first time. I went to Tanzania and that was the first time OpWalk went to Africa. And I fell in love with the people, fell in love with the country. And I realized in that short trip we did 53 joint replacements in four days with six surgeons and 50 other ancillary staff members and everyone was high fiving and I was like, something's off, I don't feel so great about this. So eight months later, I went back to Tanzania with one of our chief residents and what the orthopedic surgeon who was there during our trip, who lives in Tanzania. What he said to me changed my entire outlook on everything. He said he's we're not so happy when you guys come here. He goes, I don't mean to be disrespectful. You guys are very good. And you're very fast. You can take care of a lot of people in a short period of time, but you have left me with problems that I cannot fix, right? Four knee replacements got infected. One hip was chronically dislocating. He goes, I don't know how to do a revision hip replacement. I don't know how to take care of an infected knee. The second thing he said to me was even more jarring. And he said after you left, he goes, I had no business for three months, patients came to this hospital to get free surgery from us surgeons. No, one's paying an African surgeon until they realize that you're not coming back anytime soon. So I realized in that instant. Everyone has the best intention, but maybe what we're doing today is not the right model. We got to do something different, right? I didn't teach anybody on the ground in 2012 cause I was nervous. I was barely a year out of fellowship and I had six boxes to make someone's hip work. I can't be two millimeters off, right? If you're down in Philadelphia, Pennsylvania hospital, I've got 800 boxes on the shelf to be able to make your hip work. Within a millimeter of what it needs to be. So this guy's statement made me realize that it is not acceptable for us to come into a country, no matter what the intention is, but disrupt this guy's life. And disrupt the ability for him to take care of patients for even if it's one day, let alone three months, maybe we should do something different where we can help this guy become better. Change his standard of what he wants to provide for his patients in his own country.

Joseph M. Schwab: 8:38

Wow. That's incredible. So does this hospital also provide education for local providers?

Neil P. Sheth: 8:45

Yeah. So we just recently, this is fresh off the press. Literally a week and a half ago, we just hired an orthopedic surgeon. Who's going to be living there. Who lives in Tanzania, but who's going to be working there full time. So now having 30 schools come in, each school come in for about a week. Sign out of service to another school. You're just basically bringing in 30 fellowships. You stay there. But the best part is that if I'm there for a week and I do a total hip replacement on someone and they slip and fall out of bed and they break their femur, but the next team's coming in, they'll say, no problem. We can fix this, but we will teach this guy who lives here all the entire time and works here on how to fix this problem. So in essence, I think we're just basically building his local brand, right? Over time. I want to do that fellowship myself. I'd like to be there for a year and hang out with 30 different like experts who come in and do what they do. But in six months, in a year, two years, like this guy would be a different surgeon, right? And if he goes to somewhere else in Tanzania, we'll provide a different level of care based on what he has learned.

Joseph M. Schwab: 9:48

So are your fellows involved in this project too? Do they get to go and experience this or.

Neil P. Sheth: 9:54

Yeah. So we're going to probably start going next year. You can imagine the logistics with the government and in the private setting of life, but the hospital takes some time to get everything in order. The plan is next year to start. Initially we will have one team go per month for six months for us to figure out the system, our fellows. So we, it will be available for senior level residents, senior level and fellows who who can go for this one week, right? Take a week of vacation. When each team will fundraise on their own to take their team over. This is the best way to sustainably teach somebody and to build a system that actually works. As opposed to let's go in, do cases for a week and leave. I can tell you now, Joe, if I do a surgery on a random day, whatever it is, And I leave town, I'm nervous. If something happens to my patient and I am not there physically present. Now I have eight other partners that can take care of anything that happens to one of these patients, but I still don't feel like a very good doctor that I'm not there. I can't imagine if you're in a foreign country and forget not being there, like you're 10, 000 miles away. And you have no intention of going back because that's not home, right? You got to get back to your life and take care of patients locally. So I think the best thing that we can do is to help build somebody's brand, but also help build someone's education and experience on how to take care of these patients so that we're not inadvertently adding burden to their healthcare system.

Joseph M. Schwab: 11:23

What an incredible undertaking. Not just the infrastructure within the country that you're creating, but the opportunity that you're creating for your learners as well to learn how to function within an entirely different system and within an entirely different level of resource. That's incredible.

Neil P. Sheth: 11:41

Thanks. Yeah. This has been, I've been, again, I've been really fortunate to have some amazing mentors, and this is the part of my job that doesn't feel like work. I spent a lot of time on it. But it's never felt like work, right? This just has always felt like this is the right thing to do. So I'm very happy that over a decade, it's taken a long time, and the pandemic definitely did not help. But I'm happy we got to a point where now we actually have a structure. We have a 3 OR 60 bed hospital built. And we're just working through the logistics over the next six months to make sure that we can do this safely. Reproducibly with the, with all the teams in place. And we've got 32 teams that have already signed on and given me a non a non committal sort of letter to say that we'll be one of your teams. The nice thing is that we've also got a implant company that's actually based out of India, but they have a distributorship in Tanzania. So they can give us implants for one ninth the cost.

Joseph M. Schwab: 12:33

Wow.

Neil P. Sheth: 12:34

And it's the same implants I use here in Philadelphia. I don't care what the like brand name is. And I've been to their facility in India and everything is. Properly made. Everything is sterilized. Everything is made by a laser etched with robots. It's very high tech, but they've figured out a way to do this very cheaply and luckily being at the university of Pennsylvania, I had the access to the Wharton school and the Wharton school has actually created our business model where we can actually have a cross subsidized model where paying patients will help pay for some of the patients that are really poor. Good things. I'm offering them the component, which is the most expensive, which is volunteers. We don't get paid. And I'm offering you the highest level of talent that can do what they do. I'm not fixing your ankle fracture. My trauma guy will. But if there's a hip and knee issue, like that's my concern. And so what better way than to teach the guy who's on the ground, how to fix an ankle fracture by the guys who are trauma surgeons who do this every single week. And right. They can show you some techniques that's less invasive. That's nicer to the soft tissues. And, Hey, I don't need any fancy variable angle locking plate. Give me a one third tubular plate and I can fix any bone in the body. At least that's how most of the trauma guys think. And what a better, what better way than to teach somebody on a daily basis to say, this is how you do it. Don't come to Philly to see how we do it. Let me work with you here. You stay at home. We'll bring the talent to you. And so I don't think I'd be able to do this without a Scott Levin as my chair, who has been so supportive over the last decade and a half.

Joseph M. Schwab: 14:11

So where do you see this project going in the next 10 years or in the next 20 years?

Neil P. Sheth: 14:16

So I think the, model that we have created should be franchised. Go build this in Nicaragua, go build this in Cambodia. The model shouldn't change. What should change is the cultural needs of that country compared to Tanzania. It's different. Think in the next 10 years, my goal is to get this up and running properly, make it self sufficient so we can leave Tanzania, but then go build this somewhere else.

Joseph M. Schwab: 14:43

Wow. again I just find this whole idea rather fascinating and, having sprung from this idea that you were doing some good initially and recognizing the problems with that model and being able to tackle that and take it head on very, impressive. I, I'm happy to have somebody of your vision and your leadership and your sense of purpose as a, as part of the AHF to help that organization as well.

Neil P. Sheth: 15:10

Thank you, Joe. And I think it was great that we had actually are one of our guys from Tanzania was here as a Burkle fellow for the AHF this year. I actually spent a lot of time with the international folks that were at the meeting and it's interesting I think that there are certain things that they see that we don't see at all, right? Patients have different needs in countries outside of the United States. And there was a lot of interest, I think, on the anterior hip side for these surgeons because they have patients that want to hyper squat after surgery, right? Whether to go to the bathroom or to eat or to pray or do their job and maybe this is, anterior approach is what I need to actually spend time learning. This is better for my patient population.

Joseph M. Schwab: 15:52

And not only a perspective on what they see, but a different perspective on additional benefits that we might not even think about from an anterior approach in the United States that cultures around the world are seeing because of their

Neil P. Sheth: 16:06

Yeah. There's no question, right? We are so focused on incision length and pain and length of stay and can I do this in a surgery center at all important.

Joseph M. Schwab: 16:17

Yeah.

Neil P. Sheth: 16:18

It's very different when you are from coming from a country that is a predominantly Islamic country where patients want to get on the ground and pray. if they can't pray five times a day, which they've done their entire life, now you got to sit in a chair to do this. You have disrupted that person's life. I'm, really excited to see where this grows in the next several years. I think the amount of buzz that's going on about the AHF, this is going to become the premier anterior hip meeting. And even as someone who's eight years deep and getting close to a thousand anterior hips, there's so much more for me to learn. And I love sitting there and listening to other people who are masters who have done this for years longer, have done it on every single patient. There's more to learn, right? And it's amazing to be involved at this level, where we can really impact, I think other surgeons who are interested in the anterior hip. then even personally, like how much I'm going to grow in the next five years and what I'm going to learn.

Joseph M. Schwab: 17:14

I couldn't have said it better myself, Neil. Thanks for meeting with me today.

Neil P. Sheth: 17:19

Thank you, Joe. Great. Great seeing you.

Joseph M. Schwab: 17:21

Good to see you. thank you for joining me for another episode of the AHF podcast. If you want more information, you can check us out on Facebook, LinkedIn, or X, or you can visit us at our website, anteriorhipfoundation. com.