AHF Podcast
AHF Podcast
The Future of Anterior Approach in the UK (Interview with Mr. Jonathan Hutt)
Join host Joe Schwab on the AHF Podcast as he discusses the nuances of hip disease and surgery with Mr. Jonathan Hutt, a consultant orthopedic surgeon specializing in hip reconstruction and preservation at the London Hip Unit. Jonathan shares his journey from a surgical trainee considering plastic reconstructive surgery to becoming a dedicated hip specialist. They dive into the details of hip preservation, the significance of the anterior approach in hip replacements, and the upcoming European anterior hip meeting. Discover how technological advancements are shaping their practice and Jonathan's vision for the future of hip surgery. Tune in for an engaging and insightful conversation about hip care and innovations in the field.
Hello everyone and welcome to the AHF Podcast. I'm your host, Joe Schwab. My guest today is Mr. Jonathan Hutt, a consultant orthopedic surgeon, specializing in hip disease at the London Hip Unit. He specializes in hip reconstruction as well as preservation, having trained in places like Montreal, as well as in the uk. He is one of the few surgeons in the UK who openly admits to performing anterior approach total hip replacement, and his passion for comprehensive hip care has landed him on the organizing committee of the very first European anterior hip meeting. Jonathan, welcome to the AHF podcast.
Jonathan Hutt:So.
Joseph M. Schwab:So let's start by having you take us back a little bit to what first sparked your interest in orthopedics and maybe even more specifically hip surgery.
Jonathan Hutt:That's taken me back a little while actually. Um, well actually, when I, when I was a surgical trainee, um, as you know, in the uk we don't specialize first up straight outta med school, so we do sort of a lot of surgical specialties. So at that point, I was actually considering plastic reconstructive surgery as an option. Um, and as part of my rotation, I, I did a six month. Post, and it was actually during that post, I realized I, I've been heading down the wrong track and so I made a, a hand brake turn, changed all my plans, ditched everything I've got, and, uh, headed straight to, I haven't really looked back since. Actually, it's definitely the best decision I. Um, I then, as a result of that, did another hip, uh, surgery job, uh, shortly after that. And, uh, it was with a, um, a consultant, uh, called Mark Banks, who's a hip preservation surgeon in London. Uh, and that really kind of got me, uh, going down the hip track quite early on in my orthopedic training. And I, and I sort of never really deviated from that. I've always found, uh, the hip both from a sort of preservation and a reconstruction one. In the body and I've always kind of, you know, focused my sort of ladder training and fellowship, uh, all around that. Uh, which has sort of landed me, um, in the place I'm at now, which is great. I have a sort of half and half practice of preservation and, uh, and replacement essentially.
Joseph M. Schwab:And is it, is it roughly about 50 50 or do you do, uh, more preservation than, uh, reconstruction or the other way around?
Jonathan Hutt:Oh, it varies a bit, but I would say probably hits about 50 50 these days.
Joseph M. Schwab:And who were your preservation, mentors
Jonathan Hutt:yeah, so. The, the guy who trained me, um, I, he did get a lot, a lot of exposure to preservation actually, at that point. He was, um, you know, we were sort of talking late 2010s, sorry, mid 2010s I guess. And, you know, there wasn't that many people in and around, uh, London or even UK doing, uh, high volume hit preservation work. So, um, I would certainly say that he was the one who. George's hospital in South London, and, and I moved after a few years to where I'm from my main NHS post now, which is, uh, university College London, uh, hospital, which is, uh, you know, in central North London. Um, and there I've worked with another, uh, sort of very well known, uh, colleague of mine, Johan Witt, who, um, is a very well known hip preservation specialist, as well as another, uh, fan of anterior hip surgery.
Joseph M. Schwab:Uh, and what keeps you, uh, you're focused on hip preservation, you're heavily focused on hip preservation. What keeps you passionate about that? Or what, what do you find interesting about that area?
Jonathan Hutt:Well, it's, um, I mean it's, it's very different, um, in terms of the sort of patients you might see. So, I mean, I'll treat anyone probably from about age 12. I don't really do pediatric surgery, but I'll do surgery on adolescence. Um, and I think it's just. To, to, to the job. Um, you know, there's something a bit different and technically challenging about hip preservation surgery. You know, I do a lot of osteotomy as well as, uh, arthroscopy and I find that variation, uh, in my sort of, you know, surgical life, sort of very interesting and very, sort of keeps me enthusiastic.
Joseph M. Schwab:And, uh, do you find, um, sort of the difference in age range, you know, the d the different aged patients that you see? Does that make it. Difficult. Does that make it more interesting? Does that make it, um, uh, do you have to be on your toes with different areas of the, uh, literature in order to feel like you're doing that well? How, how does that affect your practice?
Jonathan Hutt:Yeah, I, I think that's true. I mean, I think it, it, it feels in some ways, like it's two slightly separate things, but actually in many ways it's continuation. Um, whatever's coming through the door from the perspective of what you can achieve for that patient. And it's, if you've got that range of tools, uh, at your disposal, then it helps you kind of, um, you know, you don't feel like you're trying to shoehorn one technique in when another one would be perhaps more appropriate. And that, I find is quite helpful. And, you know, the age thing is interesting. I think it, I. You know, different cohorts of society in different ways. Um, you know, my patients range quite wildly. Even my hip replacement patients range from.
Joseph M. Schwab:Yeah. And so speaking of hip replacements, so this June, um, you are helping lead the European anterior hip meeting, uh, which takes place in London and seems to be. A rather significant milestone for the European community in terms of embracing anterior approach. Um, how did you become part of that platform? What drove you to be interested in, in that platform?
Jonathan Hutt:Yeah, I think it's, you know, so I've been doing the anterior approach for a while now. Um, in the UK there really isn't an awful lot of it going on. Uh, and there hasn't been, there's been, you know, a few people who've been very positive about it, but it's never really gained an awful lot of. Traction. Um, certainly when I started it was still, you know, relatively infrequent to come across other people doing it. I would say I think we're at a bit of a zeitgeist moment now in the uk. Um, and there's a lot of reasons for that. You know, if you go around, if I talk to my trainees and particularly the people who are coming up for fellowship, if I go around the country at conferences and courses and I chat to the junior consultants, enthusiasm. You know, as UK surgeons, we often travel to the us, to Canada, to Australia, uh, for our fellowship training, um, you know, even to Europe as well. Um, and therefore people are picking up these techniques and wanting to come back and, uh, and use them. So, um, you know, it's an interesting thing because of course in Europe it's, it's not a new thing at all. I mean, it's been well established for forever, really and quite interesting when. Novel technique in many respects. And, uh, you know, I think the surgical community in the UK has not really come round to it in, in a hugely enthusiastic manner as a, as a large body. But I think there is now a significant portion of people who have seen it done well and are really interested in kind of, you know, continuing it in their practice. Um, so actually when I was thinking about. The sort of meeting I wanted to run, I, I was thinking, well, what I would love to do is kind of, um, you know, get, get the sort of UK on side and show them, you know, what the anterior approach is all about. Try and infuse everyone about it. You know, try and get some, some further traction really in, in, in the community here. But then, you know, I was chatting with Richard about it. And his idea was a, a much broader and, and better one, as it often is. And he said, well, you know, let's run it as a European meeting. And then of course you, you can bring on all the, you know, the great European guys and, and, and the rest of the crew that we've got organizing it. And I think that's gonna, you know, really hopefully cement, uh, a really good meeting this summer.
Joseph M. Schwab:Uh, coming from the perspective of the Anterior Hip Foundation, it, it looks to me looking at the outline of the program, that there are some aspects that are very, um, similar to what we've done through the AHF. Do you feel that was, um, was that a deliberate approach to the meeting? Was that accidental? Does it just turn out that great minds think alike and so do ours? H how did that, uh, what do, what's your perspective on that? I.
Jonathan Hutt:Um, well, I mean, there's. You know, the model of the meeting that the AHF has set up is a really good one. And I think it was almost inevitable that we were gonna, you know, look at that and see how, uh, we could do something along similar lines. I mean, in many respects, I suppose you're gonna think very similarly, but I think there's, there, there's little things about how you run the meeting out there that are quite appealing. So obviously there's the, you would expect most meetings to bit. Bringing along the sort of DAA surgery along with the technology and the innovation and, and the disruption and all the rest of it, that, that I think gives it that little bit extra. And I think that's part of what the has done so well that we would like to introduce into our meeting as well, because I think it creates a very different and more enthusiastic environment.
Joseph M. Schwab:Yeah. And as a matter of fact, you just posted this morning on, uh, on LinkedIn about your excitement, about the debate about technology, what technologies really needed to do this sort of, well. Is the focus on innovation and technology within the space of anterior hip surgery something that was attractive to you? Or, um, was that something that was a driving focus for this?
Jonathan Hutt:I mean, I think it's, I, I'm, you know, a surgeon. I'm very enthusiastic about technology and I, I, the future of our, our specialty. I, I don't see technology being, I see it. Refined and, um, you know, obviously working in tandem with technology, certainly for my career and going forward. I think there's a lot of really interesting things happening in that, in that space. And, you know, my practice, I, I use a fair amount of technology. Um, I don't expect that to change, you know. I'm quite enthusiastic about the benefits, not only for, you know, my operations, but also for when I'm talking to people at the start of practice and they're looking to kind of, you know, get into their groove without having any problems, without having any difficulties. And it's, and I think it's really good for training. I think it's really good for narrowing your bandwidth. While you are really getting to grips with something, you know, when you are experienced and.
Joseph M. Schwab:So I think it's exciting. It, you know, from my perspective, to see anterior approach taking a bit center stage, especially in, in London, right in the heart of the uk. Um, but as you pointed out, adoption in in the UK has not always been easy. Um, do you. Uh, what are some of the biggest myths that you encounter or hesitations that you hear from fellow surgeons in the uk and how do you address it?
Jonathan Hutt:So yeah, stories when I Canada one destinations. Um, and I, I in fact, um, turned down the opportunity to go and do Paul Vallas fellowship, and I did that on the basis that I decided I didn't want to learn anterior hip surgery. Uh, because at the time that was my perception being trained in the uk that it was, I, I can't, probably can't even really remember exact thoughts about it, but there's certainly an element to where it was seen as a sort of passing trend. Um, perhaps quite a bit of something, a little bit niche. The environment in which you're trained. If there is a very consistent environment in which you're trained, and the UK is a very consistent place in many respects, particularly when it comes to approach, then that's often where you come to by the end. And if you're not exposed to these things in training, it's a very different experience trying to get into the mid practice and you know, because we've now. Awareness of the anterior approach and what it can do. So I think, going back to your question, you know, the sort of things that I, I think people don't often necessarily say outright, but are rethinking when they're talking to you about it, is they say, you know, it, it's a marketing trend. Um, it's, you know, it's just a fad. It doesn't really add anything. Um, you know, the, what's the benefits and also look. Um, you know, and the truth is that the data is now there to support the fact that those statements really aren't true. You know, we know that there are, you know, benefits to the approach. Um, we know what they are. Um, we also know that there's no detriment. And I, I often say my argument to them is not, I'm not trying to tell everybody that you should go anterior'cause it's way better if you're a good posterior surgeon. I don't think that's a really terribly valid argument, but I'm saying that if I can do something and I can see the benefits from my patients. I'm doing any downsides in either the.
Joseph M. Schwab:So it's one thing to talk to your fellow surgeons who are in practice, or maybe even your senior surgeons who have questions or uh, concerns. Um, it's another thing to be a mentor and a teacher to the younger surgeons who are in training. How do you approach the next generation of surgeons who wanna explore, we'll say anterior approach? Uh, total hip replacements or hip preservation?
Jonathan Hutt:Um, yeah, so I think it's, um, in some ways it's probably easier, uh, now than it was when I was training. I mean, I'm not, I'm not that old, but, you know, I think that it is possible now to map out for someone how they might approach their final years in practice if they're wanting to specialize in a particular technique. Um, and you know, if we, if we take the anterior approaches as a good example, you know, I've got colleagues, uh, sorry, colleagues of fellows really and senior residents as we now call'em as well, who are interested in the technique and they'll come and spend time with, you know, me or another surgeon in the UK who does the technique. That's the sort of starting point. They can get a feel for it and see if that's what they wanna do. And now there's lots build on. Fellowship training in it. I, you know, having not had that myself, I can definitely attest to the fact that that will make your transition and your adoption of the new surgical technique so much easier than if you try and just pick it up in practice. Um, and they'll see there's loads of great courses, there's loads of great conferences. You know, there's a whole world you can immerse yourself in now where people are really happy and willing to share their expertise, uh, and their experience with you. And I think that practice. That's particularly unusual, uh, or that they don't have enough experience to take on independently. Um, I do try and say to them, you know, if they can find people to work with who are doing it already. I found that immensely helpful when I, when I was really, I mean, um, Richard was one of the first people who introduced me to the approach, but I was in the process of moving hospitals at the time. So we did a handful of cases, uh, together. Um, but when I moved to UCH and I had Johan there pretty much in the next theater team, me doing the approach as well, that's very reassuring. It means I've got a little bit of cover and I've given a similar amount to my junior colleagues as well who come and work in at once to start the approach as well. So I think that sort of ongoing mentorship and practice is extremely helpful, whatever your specialty. Uh, but certainly in the world of, um, you know, anterior hips and, and particularly in hip preservation is something we.
Joseph M. Schwab:You mentioned with learners in the UK it's quite common for them to go do fellowships abroad, whether it's in the us, whether it's in Canada, whether it's in Europe. Um, certainly not to, um, a address this politically, but looking at how Brexit may or may not have changed the educational opportunities for the uk, has there been any effect that you've seen? I.
Jonathan Hutt:Um, I don't think from that perspective, no. Um, you know, the, the fellowship kind of model was, is quite well established. Um, and I, I don't think it seems to have affected many people's choices. I think that there are a portion of people who will be, you know, do want to and do go to Europe for their fellowships there. I have to say, you know, as, as British people, the language bar. Well enough to really communicate properly in two different languages and make ourselves useful, uh, as a ve and I think that's part of the reason why we gravitate to places like Australia and, and, and Canada and US if you have the time and inclination to do, of course. But that's often a bit of a big burden as you the end of orthopedic training if you haven't done it.
Joseph M. Schwab:Yeah. Yeah, for sure. Um, I'm, I'm curious, is there a case that you can think of, whether it's anterior approach or whether it's hip preservation? Um, can you share a case that has really stayed with you, that made a particular impression on you, or something that reminds you of the importance of what it is that you do?
Jonathan Hutt:Oh, that's quite a deep question. Um, um, yeah, I guess, um. I think, I think the ones that I find quite affecting are, are, are sort of the adolescent patients that I get that, I mean, I would give you two sides to that. I have adolescent patients who have preservation surgery, so if you do preservation surgery in Peros osteotomy in particular on young patients, 15, 16, that is an amazing operation. You know, they heal so, so quickly and they just get back to stuff and. It's super rewarding to see. Um, and you know, a similar, in a similar manner, some of the patients I get who are sent to me for possible preservation surgery and they're in the adolescence and they've got, you know, variety of different sort of problems going on. But really there's no salvage operation that's possible and short of joint replacement, it's really, um, rewarding to take replacement in. Whereas actually, you know, our experience of it is, is reasonable and, and you know, provided you choose well and wisely and do the operation well, they do extremely well. And you know, you can reach the point where, you know, I had a very young girl came to me probably about 18 months, two years ago now. Um, and she was at the point where she was basically going to school in a wheelchair. They'd been setting up orthopedic beds at home. You know, she loads of care, loads of time off school and all the rest of it. And you know, we took them through the, the kind of the problem that she had, which was a complex kind of, uh, congenital sort of deformity issue. She had a hip replacement six weeks later she was walking normally. And, you know, that was really something to see, you know, just, you know, from our own personal outcomes, but also from the family and, and how different their life is now. You know, that that's been super rewarding and.
Joseph M. Schwab:Let's, let's talk a just a little bit about your, your setup for how you do an anterior approach.'cause obviously there's table, there's orthopedic table, there's standard table, there's navigation, there's fluoroscopy, there's all sorts of technology that can be used. Can you give us a sense of what you're using? Um, and for instance, in this case that you just mentioned, would you be doing anything different in an adolescent who's gonna be undergoing that?
Jonathan Hutt:Yeah. So, um, where I am now is product of going through a lot of the things you've mentioned. So, you know, I. My first few cases doing a table based, uh, extension of based approach, um, I didn't really get on with it very well. I found that the jump from being essentially freehand posterior, which is what I was before, to being very sort of tied up in the, in the mechanics of the table, that felt like too big a jump for me. So, um, and that was the technique that I'd done a bit with Richard, but I then to visit Christoph in Belgium. Um, release. I decided that was, that was the way for me. So I, I pretty much modeled my technique on, on the things that I learned from him that day. Um, I now do it sort of on standard operating table, uh, without any extra bits and pieces. Probably two and a half, maybe in three years of, of, of my D approach. I had inoperative fluoroscopy. Um, I used that initially because I had no other sort of, uh, check and I really wanted to make sure I didn't make any mistakes. You know, one of the things about doing the approach in the UK is people are waiting for you to make some mistakes, so I wanted to give them no opportunities that weren't, you know, unavoidable, wean myself off Fluor. You know, it's, it's, it's a bit of an inconvenience. Um, there's a lot of faffing around involved in it. Um, and also there, I really, I wear lead for lots of operations. I really wanted to get outta the lead. So I, I've now transitioned to, um, a simple navigation system. So, uh, it's a sort of combination for me of anatomical stuff and, uh, a fairly simplistic optical navigation system. And. Radiology free for about a year now. Um, there are probably some cases where I might consider bringing it in, um, if I've got, you know, maybe complex femoral deformity or, you know, very strange acetabular deformity. And, you know, as I was transitioning over in my practice, I would, I didn't go all in from the start with the cases that I would take on for anterior surgery and it before I. So reserve right fact, have to be as precise as you possibly can in a way that doesn't disrupt. Workflow too much in a way that doesn't bring in too much cost in a way that that works for you, then that's, that's always been my aim. So that's kind of why I've stuck with the, with having something in the form of the navigation. And I still will sort of probably keep the image intensifier on the, on the back shelf for occasional, but I haven't yet done that in my rebirth as a II based surgeon.
Joseph M. Schwab:So you, you described some change to your technique over the past few years. If you were to look ahead and project forward maybe five or 10 years. Years. Are there innovations that you see or technologies that you would want to see that you believe may transform what you do in hip surgery, whether it's reconstruction or preservation?
Jonathan Hutt:I mean, certainly in the preservation world, there's a, there's a huge opportunity te. Know, we take a complex three dimensional problem and then we try and solve it. Having planned it in 3D in our heads and on, you knows, and dimensional imaging in operating, I've always. So, uh, and that is coming and, you know, there are a few things that on the market or coming to market or certainly in people's minds, that, that I think we're gonna see some very interesting technology, particularly from an osteotomy perspective, you know, in the coming years. Um, the problem I suppose is that there isn't quite the industry funding and interest behind it because unlike hip replacements, you're not selling an awful lot, you know, three screw for an industry partner. So, you know. It is more difficult, I think, to infuse the industry to join us on that particular journey. Uh, but I would say that as a space, that that is the space that probably has more coming to it of interest soon than maybe joint replacement, where there's quite a lot happening all the time and, you know, a lot of interesting things on and off the market. Um, and we're probably making quicker strides towards, you know, interesting technology in that space. Uh.
Joseph M. Schwab:What do you hope people walk away from the European anterior hip meeting, having experienced, having learned after attending it? What do you want them to walk away with?
Jonathan Hutt:So I think I, what I want from the meeting is I, I want people to come, I want to, you know, they can be already doing the approach. They could be thinking about starting. I want come by it to recognize that it's pretty established. There's lots of really good techniques out there. I want. Make some changes to their practice, want to go away and take on more complex cases, or build their practice or, or make the swap or make the change. That's what I would like to happen because, you know, and, and feel that they've got this community of surgeons which they can then rely on and, and, and continue to network with us as time goes forward. Um, and then we can take a little bit more of a piece of what's going on in, in UK arthroplasty and, you know, have a bigger voice in the, in the international community when it.
Joseph M. Schwab:Are there plans for a second EAHM or possibly a a UK a HM?
Jonathan Hutt:So I, I would love for this to continue. Um, I think that's all of our plans. You know, we were provisionally saying, we'll do it, we'll do it in London this year. We'll go to Europe, uh, for the next one. So, you know, I see this as the first of many and hopefully maybe a collaboration with the AHF.
Joseph M. Schwab:Well, we're, we're looking forward, uh, on behalf of the AHF leadership to be part of the EAHM this year and, and seeing what you put together, we know partnership across the world makes everything grow stronger and faster. So, um, Jonathan, it's been really a pleasure to talk with you today and to hear your perspective and, um, I look forward to seeing what you're able to put together in London this summer.
Jonathan Hutt:Yeah, thanks.
Joseph M. Schwab:Yes. Sounds good. Thank you. Thank you for joining me for this episode of the AHF podcast, and thank you to our guest, Mr. Jonathan Hut. Please take a moment to like and subscribe. You'd be helping us find more people just like you to share this content with, and as a subscriber, 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 help keep those hips happy and healthy.
