AHF Podcast
AHF Podcast
Legend Series: Prof. Frederic Laude, MD
Revolutionizing Hip Surgery: Anterior Approach with Prof. Frederic Laude - AHF Podcast
Join host Joe Schwab in an in-depth conversation with Professor Frederic Laude, a leading figure in anterior approach hip surgery. In this episode, they discuss the historical roots and key developments of the anterior approach, Laude's innovative educational methodologies, and his growing presence on LinkedIn. They delve into Laude's collaboration with Medacta to build a robust training system for surgeons and his role in organizing the European anterior hip meeting. This episode is a must-watch for anyone interested in the advancements of hip surgery and the importance of comprehensive surgical education.
Hello, and welcome back to another episode of the AHF podcast. I'm your host, Joe Schwab. There are few surgeons as close to the epicenter of anterior approach hip surgery as professor Frederic Laude practicing in Paris, France. Frederic trained under Emile Letournel, the protege of Robert Judet. Together, Judet and Letournel revolutionized surgery of the hip and pelvis, transforming acetabular fracture care from mostly non-surgical treatment to a full blown discipline within the world of orthopedic surgical trauma. And while Frederic saw many of these advances in fracture surgery firsthand. He also recognized the benefit of some of Judet and Letournel's, at the time, less well-known developments like anterior approach, hip replacement. I caught up with Frederic a recent weekend morning before he headed off to ski, and our wide ranging conversation bounced back and forth from how he was exposed to anterior approach at first, how he helped develop an educational system around it, his newfound interest in LinkedIn and how he's working with a group of like-minded surgeons across Europe to help foster its growth. Let's join in on the conversation. I. So Professor Frederic Laude, welcome to the AHF Podcast.
Frederic Laude:Thank you.
Joseph M Schwab:You're located in Paris, France, uh, and, think a lot of anterior approach hip surgeons, uh, would agree that France and Paris specifically, um, is a special place in the history of the development of the anterior approach. So from your perspective, um, what are some of the key developments out of Paris that have helped make the anterior approach what it is today?
Frederic Laude:ThEre is two things that change a little bit, uh, the, the, the world of anterior approach. First, Joel Matta came a long time ago in Paris and start to do the anterior approach. I think I wrote 97 or 96 or 98. I, I don't know exactly the time, but he start to do that because he had seen, uh, Emil to doing this kind of case. I think also something really pe the entire approach was the fact that, uh, Zimmer promotes the dual dual incision at the early 2000. People rediscovered the anterior approach and especially when we tell them that it was possible to do everything through the single anterior approach, but people start to get interest again in the anterior approach. And maybe I would say maybe the last, I'm not so sure. I think the fact the Austrians start also to do anterior approach without table was probably something which was quite important for the anterior approach, but it was without the table. So it's another story.
Joseph M Schwab:Um, and you, you have worked quite a bit, um, a as in terms of um, educating for anterior approach specifically with Medacta. Um, and tell me a little bit about how you developed an educational platform with them, uh, regarding anterior approach.
Frederic Laude:Okay. It, it, it's quite funny to see that in the nineties, the entire approach it was, had nearly disappeared. When I tried to promote this approach, it was like, we are not interested e even especially American company at this time, they start to get. Interest when Joel start to show that it was possible in America. And then I think I start to work with Medacta 2004. I had a few surgeons that visit me to, to see how it works because early 2000, so three, four years before I was working with Medacta, a few surgeon visit me, but it was very unusual. But, uh, so we start 2004 and you know, it's quite a different job to know to do it and to teach it. So at the beginning we, people were just coming to see me, they go back home and that was a disaster, uh, because, um, you cannot, um, understand everything in one sim single shot. Maybe you can see me doing one or two cases, but that's not sufficient. So we decide. Very fast. That was not solution. Solution was to do some cadaver course, which is still, um, I think the gold standard today and also what they call, uh, mentoring people. At the beginning I was going to the surgeon who want to start and uh, I was helping them. So how to do, uh, so usually I were doing one case, he was doing two or three other cases and I was just behind them. So I, it start really in Switzerland and after all over. At the beginning I was very busy to travel everywhere, but after I was able to, to teach some guy who become really good, they also teach. So it was, uh, like, um, something very positive because many surgeon, now, I'm not the only one to teach, I would say. Uh, I don't teach anymore. The basic, uh, if I do some course, it's more revision course or advanced course, the guy. But it's, I think it was really a very good and interesting way to do that. And I, I think education is really the basis of our, our job. We can put a lot of technology behind whatever you want, but education, uh, side by side is the, the basic for us.
Joseph M Schwab:Uh, it's interesting, I, I watched an online q and a, um, that you were a part of. This was maybe about five, six years ago. And this question came up about how do you approach, um, learning curve for surgeons who wanna learn anterior approach? And you made a really interesting point that seemed to focus on what I would call, you didn't use these words exactly, but. You, you said, uh, really the focus should be less on the learning curve and more on the teaching curve, um, which is how do you become better instructors? How do you become better teachers as opposed to, um, you know, h how many surgeries does it take for a surgeon to be proficient at it? can we to make them better surgeons?
Frederic Laude:One thing was very important for me and very efficient. With Medacta, I was teaching the guy, and the guy start, and after I, I had the news, I had the information. What was the problem? The problem was by example, to cut the femoral neck. Do. So I, I insist, I try to find the best, best way to explain how to cut femoral neck, how to place the retractors, and each small step, sometimes it's some very small step, and if you miss one of those steps, that's a problem. So really by having a feedback from what was the problem the surgeon encounter. I was able to change the way I was teaching and that was really interesting for me because I told you I knew to do it. But teaching is another story and just by, because I have the feedback of all those case, uh, the poly during, I would modify the way I was teaching and that was really important.
Joseph M Schwab:how I find this really fascinating, how do you approach those modifications in your own way of teaching? I mean, obviously you, you see the, the areas that your, your learners are struggling. Um, but then what do you do in your process to make sure that you can teach it differently, better, more effectively the next time?
Frederic Laude:The, I think when I do my surgery, the id, I have no parit movement. I try to do everything step by step, the more logical and simple and as simple as as possible. And I think this is a very good way. I just want to come back to very, in the nineties I was a resident with, uh, the anterior approach I learned from Letournel was. He, he was not teaching anything. It was show me. And if you can do it, you can do it that. But there is another school in Paris, which was K Kha, Marcel Kabul. They were doing the transtrochanteric approach and they were doing exactly like that step by step. How to do a transtrochanteric approach. Charnley style. And I must say that was super efficient. So I decide to try to do. This way of teaching to the anterior approach. And that was so efficient.'cause the way Letournel and everything else teach me was just, just watch me. Don't ask any question. If you can do it, you can do it. If you don't do it, do something else.
Joseph M Schwab:It's a real sink or swim educational philosophy.
Frederic Laude:Yeah.
Joseph M Schwab:Um, so that's interesting. I, I see you're, you're reasonably active online as well, making comments on sites like LinkedIn, on other people's posts, for example. Is that something you enjoy doing or is that something you sort of feel a sense of, of obligation? Like is that an extension of your teaching or is there something else?
Frederic Laude:No, you know, I'm on LinkedIn for only maybe two months before I didn't even knew what it was, but I honestly, I think it's quite fascinating because. What I receive, like news from LinkedIn, it's only on orthopedics, so I see a lot of other guy makes great contact. So, um, and also it's a very good way to promote simple things and I will try to place one small. Um, video or explanation or teaching every week. I, I, I don't know how long I can do that, but I will try every week to do one stuff like that. So I show some critical step of the, of the teaching and everything, but I will try. It's, it's brand new for me. No, no, I'm not social guy, social media guy.
Joseph M Schwab:Are you enjoying it at least?
Frederic Laude:I, yes, I, I was a bit afraid at the beginning, but I quite enjoy it. The problem, many guy want to visit me now, so I, I don't know how can I can manage that, but I enjoy to do. Yeah, yeah, yeah. It's quite nice. You, you really just realized that I, I all the fascination about this approach. So it's, uh, it's interesting. I have, I don't know, many followers I have in one or two months. It's crazy. Or maybe it's not crazy at all. It's just regular. But, uh, my feeling, it's crazy.
Joseph M Schwab:it's, uh, not what you expected maybe, huh?
Frederic Laude:No, not really. I was just, uh, I was just curious at the beginning. Some guy said, you should go on LinkedIn. So I went there. I was, I was positively surprised.
Joseph M Schwab:Um, well, that's good. I mean, it's, it's interesting. Not everybody has a such a positive reaction to, you know, using social media, but I think that speaks to the community of surgeons who are interested in the anterior approach and their desire for high quality education and high quality materials. So, uh.
Frederic Laude:I think I, I was especially fascinating by people from, I will say third country world because there is no more sales world, but from India, Turkey, Egypt, those guys really want to learn. That's fascinating. They just want to improve and learn and become Chinese. I have some chi be from China. They are really? Yeah. They, they want to grapple you all. Oliver, in your nose. That's interesting.
Joseph M Schwab:And, and oftentimes those are folks who are tackling some of the most difficult cases, uh, and we, know, that I would say in, in, in France, certainly in the US and Switzerland are, we're much less likely to see. Uh, the education of that quite interesting, doesn't it?
Frederic Laude:yeah. Absolutely. Yeah. They have some crazy cases also.
Joseph M Schwab:Um, so apart from your, your activity online, you're on this organizing committee for the European anterior hip meeting, um, which takes place, uh, June 26th and 27th, I London.
Frederic Laude:Hmm.
Joseph M Schwab:and this is the. The first meeting of this organization, and
Frederic Laude:Yeah.
Joseph M Schwab:is that this organizing committee is kind of a powerhouse of European anterior approach surgeons, including you, uh, Richard Field, Michael Leunig, Kristoff Corten in Belgium and Jonathan Hutt. Tell me a little bit, how did this meeting come to be and what are you trying to accomplish with it?
Frederic Laude:I, I, honestly, honestly, I, I would be totally unable to organize this kind of meeting. I'm really, uh. Uh, the worst organizer of everything. If you watch my, my, my, my desk where it is, I here, it look like nearly okay. But if you go, it's a nightmare. So Richard Field is not like that. Richard Field is a guy who like to organize everything. So this is really his idea. And as you know, we are very good friend and I really admire him and he's, I say, whatever you ask me, I will do it. So I have no choice. So, um, and we also try to invite Christoph Corten. Michael Leunig, the other guy, will really promote this approach and are really very serious guy, very enthusiastic guy. So I think it's, uh, he should be a good, and we also want to, to have something, uh. Uh, dependent of what's happens in America, where it's very active and Joel Matta is very active, also a very good organizer. So we have the, Richard Field does the job very well, so I want to thank him for, for doing that.
Joseph M Schwab:And what do you think is the opportunity in Europe, uh, in terms of anterior approach? There's a decent amount of anterior approach being done. Of course, it's different country by country, but what's the, what are the opportunities in improving anterior approach in Europe that you see?
Frederic Laude:Yeah. Uh, there is some country by example, like Belgium. Nearly eight 70 to 80% of the case are done. anterior approach in France, I would say it's around maybe 40, 30 plus approach is still very strong in France, especially because of dual mobility implant, which is uh, maybe 50% of the market share. But by in England. It's maybe one or two persons. So in England there is a lot of probably the Scandinavian country also and all those countries that really ping like Poland, uh, or uh, Czechoslovakia. And it's really, people are interesting and also, um, um, Turkey, Egypt, all those country also, which is not really Europe, but very close to Europe. They really want to learn. So I think there is a lot of opportunity.
Joseph M Schwab:Um, and do you see this, uh, committee organizing meetings on an annual basis, on a regular basis, or is this kind of a we're gonna see what happens?
Frederic Laude:That we're gonna see what happens. Usually it's in June, the last week of June. So England is nice at this time, and especially, uh, field organize something after, which would be very nice. I love. So, uh, I maybe we're gonna see, we're gonna see and, uh, if it's a success or not, um, solu see.
Joseph M Schwab:Um, I, I'm interested too, shifting gears just a little bit, um, in addition to anterior approach, um, you're, you're known in the field of hip preservation, young adult hip surgery as well. I. I, I wanna know how, from your perspective, how is having an understanding of young adult hip disease, how has that shaped your, uh, the way you approach total hip replacement, or the way you approach patients about total hip replacement or the way you do anterior approach?
Frederic Laude:Yeah, I think it, it goes in the same way. My idea to have only one incision from. Child, child to the end of your life. So by example, when you do A-A-P-A-O, it's nearly an anterior incision when you do fal, I do femoral sto troian anterior incision. And when I do my, my first case, I do troian incision because this is a, you can go three, four time. I know that without damaging in the muscle and the patient do well. And also when you see very young patient doing preservation surgery, sometime it doesn't work so well. So you have to find a solution. But those very young patient. Don't want to be like an old guy. They want to do sports, they want to do skis, they want to do everything. So it's really nearly the same approach. You don't, you have an implant of course, but at the end the philosophy is the same. You want to give them back their normal life, not a life that, uh, would be a guy who is 75 years old who have arthritis at the end of, uh, his life. So that is, for me, it's, it's a complete, uh, continuum and I like to do that. I have some patient, I have done some 25 years ago. Uh. Preservation surgery and they come back to have the total hip replacement. It's, it's logical. I think it, yeah, it works.
Joseph M Schwab:And if they come back to you, it means they must have been satisfied with what you did.
Frederic Laude:Yeah, yeah, yeah. Say when do you retire? I say
Joseph M Schwab:I.
Frederic Laude:few more years.
Joseph M Schwab:Well, so the, the, so this raises a question. I know there's lots of people who want to come visit you. Um, you have been very thoughtful about the way you approach education. Um, what is, I mean, what's the plan for, in terms of what would you want your legacy to be? Um, what would you want to be known for? What would you want to be remembered for as you, uh, now have transitioned to sort of the senior statesman of, of hip, uh, surgery?
Frederic Laude:I am a little bit afraid that nobody will remember you in 20 or me in 20 years. So I don't know. Usually people forget, uh, but maybe, I don't know. Uh, to do it in a very nice way. I. Uh, and uh, also probably I'm, I'm very proud to do revision through the approach because if, you know to do it, it's really fascinating for the patient. And, uh, what else? Um, okay, we'll see.
Joseph M Schwab:see, um, well, I actually think, Frederic, this has been just a fantastic conversation. I, I, your time is precious and I want to make sure that I'm of it. But, um, from my perspective, uh, one of the most fascinating. Uh, perspectives that I've heard on education, and I really appreciate what you've been doing, uh, for all the surgeons around the world. I know there's many in the US who have come to visit you, uh, and bring your level of enthusiasm for anterior approach. Uh, back to the us there's many, uh, where I'm located here in Switzerland that have also come to visit you. So, uh, on behalf of them, uh, you know, thank you for the work you're doing, educating everybody.
Frederic Laude:Now it's so you are in Switzerland You know this guy?
Joseph M Schwab:I can't see it. My screen's a Who, who looking at?
Frederic Laude:Yeah. It's, uh, this guy really, and Gester, he, he, he was from Basel. He really helped me to, to promote, because at the beginning, when you are alone to promote something, it's a little bit not very efficient. So this guy really helped me to promote. He is from Switzerland, Basel. He died a few years ago. He was a very nice surgeon and he really, uh, when you, you have a few guys that follow you and help you to, that's really interesting because. When you're alone, it's not very efficient. For a long time, I was alone to try to promote anterior airport didn't work very well. Medacta really helped me. And, uh, this kind of guy really also, uh, helped me. And so I, I all, I was to science a Swiss surgeon to, uh, follow me at the beginning. Uh, that's interesting. And after all the world, now we have to convince the, the English, English guy because it's, that's another story.
Joseph M Schwab:Many thanks to Frederic Laude for joining me on the AHF podcast, and thank you for listening to this episode. I hope you enjoyed this conversation as much as I did. If you can remember to take a moment to like and subscribe, you'd be helping us find more people just like you. To share our thoughts with. You can always drop an idea for a topic or any feedback you like in the comments below. 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, all one word. New episodes of the AHF podcast come out on Fridays. I'm your host, Joe Schwab, asking you to keep those hips happy and healthy.
