AHF Podcast
AHF Podcast
Advancing Anterior Hip Excellence in Latin America with Francisco J. Gómez Torres, MD
Join us on the AHF Podcast Live as we welcome Dr. Francisco J. Gómez Torres, an orthopedic surgeon and innovator from Mexico. Despite a recent earthquake, Dr. Torres shares his journey from founding Osteofit in Mexico City to advancing the field of orthopedics through mentorship and global collaboration. Learn about his inspiration to pursue orthopedics, his experiences with anterior hip surgery, and his thoughts on bringing advanced medical practices to Latin America. Engage with our host Joe Schwab and hear insightful questions from our live audience. Don't miss this enlightening discussion!
Hello and welcome again to the A HF Podcast Live. Today on the Anterior Hip Foundation podcast, we're gonna be joined by Francisco Gomez Torres, an orthopedic surgeon and innovator, and a passionate voice for Latin American orthopedics. And interestingly enough, there was an earthquake today, not too long ago in Mexico, and that caused a little bit of our delay to the broadcast. So we're happy to know that, uh, Dr. Gomez Torres is safe. That he's gonna be joining us here momentarily. Dr. Torres from founding Osteo FITT in Mexico City to shaping the next generation through mentorship and global collaboration, he's redefining what it means to lead with both skill and heart. Whether in the or behind a podcast, Mike or climbing a mountain, he's on a mission to restore movement, inspire others, and elevate equity in surgery worldwide. Dr. Torres, welcome. I hope you're okay. Is everything okay in Mexico where you're at?
Francisco Gomez Torres:Hello. Yo, it is really nice to hear from you I'm so sorry to be this late, but guess what? Welcome to Mexico City. There was just, an earthquake and the whole hospital was um, downstairs. We are up here right now. It's so good to, uh, greet you, again. Thank you, again for invitation. How are you?
Joseph M. Schwab:I, I'm, well, I'm just happy to hear that you, are safe and, and well, and, uh, hopefully your, your patients and your staff and, and your family are safe as well. So, thank you for joining me
Francisco Gomez Torres:I, thanks to you Joe. I would like to start just, um, telling you, do you, don't you miss these kind of experiences back in Switzerland?
Joseph M. Schwab:It's been a while since we felt an earthquake here. Yeah, no. Um, but I really wanna
Francisco Gomez Torres:you, you are missing it.
Joseph M. Schwab:yeah, yeah. I'm sure. I, I'm really interested in hearing, we had a chance to talk briefly at the a HF meeting in Nashville in June. And, um, but I'm interested for you to, to, kind of tell me about and share with our audience a little bit about what inspired you, um, to pursue orthopedics and specifically how did you end up, uh, getting involved in hip surgery and in anterior hip surgery? We, we learned it's quite uncommon in Mexico.
Francisco Gomez Torres:Yeah. Yeah, you're totally right. Well, I would like to start, um, telling you that since I was a kid, well, I was really exposed to medicine because both of my parents are doctors. So my, my mother is a family doctor and my father was a surgeon. Uh, since there, I do remember to be the whole time with them, I was raised with another two brothers who are not at all doctors. They see blood and they get dizzy. So I was the one, they were just smuggles. So after, after I, uh, was exposed to this, I kind of like it. Um, I studied medicine back in Mexico State. I even, um, got, um, this, I was like the president of my, um, class. So I, I was always. Pursuing, um, this kind of living. Um, and from there, when I was on the, on my internship, I had the chance to have these rotations, uh, through general surgery, orthopedics, internal medicine, pediatrics and stuff. And I saw that orthopedics was like the most, um, how you say it decisive. You, you, you perform, somebody got broken, you perform a surgery and it's healed a month later, which is something like, for example, internal medicine doesn't have to, you know, you know how to treat, uh, diabetic. Maybe you can control their issues, but it'll take years. Well, I mean, it's not even, uh, there's not even a treatment right now. No, maybe soon. But that, that was the way I choose orthopedics. And then I got a doctor who, on a vacation, he told me, you should come to me, uh, to the, to the surgery room. We can see if you like it. And damn, I saw, uh, uh, hip surgery that day. I say, yes, this is the thing. So I studied for my, um, specialty exam. I was the number 16th of the whole country. So I
Joseph M. Schwab:Oh wow.
Francisco Gomez Torres:the chance to choose. And after that, well, the rest is history. I studied in a, in, um, ims, which is like the biggest public service in Mexico. I'm from there. After COVID, I started, um, to create these kind of congresses for, uh, students and to join some leading voices about orthopedics. And a doctor, Dr. Victoria Manuel, I was one of my guests. He was delighted because of the effort, and I think that's, that was the way he invite me to join his team as a fellow surgeon at the national, uh, rehabilitation Institute here in Mexico, where I learned hip and knee reconstruction surgery with him. He's like a mentor to me, and I, I do appreciate the way he taught, uh, teach taught us, uh, on that time. But, um, as. Here is where the story starts. Uh, uh, some, some months ago I was reading, um, this, this book Dr. Ma signed for us at Nashville, and I saw that he, yeah, yeah, I saw, I saw he have a mentor of him, of his, who was performing surgeries, uh, in a posterior way or maybe a lateral approach. And when he decided that this wasn't the most natural way, uh, it was because he have the chance to hear fromelles, you know,
Joseph M. Schwab:Mm-hmm.
Francisco Gomez Torres:he, he. Writes on his book that the first time he saw him, it was because Dr. Letell was doing, uh, a tabular fracture through a anterior approach. But then he decided to join him in Paris, where Dr. Letell was performing, um, anterior approaches to, for hip prosthetics, and that he even had, uh, a table for it. So it was like for me, maybe 30 years later, but it's the, the same history here in Mexico. I don't know if it's a cultural matter, but the anterior approach is, might be, it might be not the most, um, acceptable, um, approach for the leading surgeons today. I
Joseph M. Schwab:In Mexico specifically. yeah, And we'll get into a little bit about, uh, I'm gonna wanna learn a little bit about why you think that is and how you think that might change, but we'll get to that.
Francisco Gomez Torres:Sure, sure. I, I'm your guest today, so I'm so happy to answer your questions as well. I do have some questions for you
Joseph M. Schwab:Yeah, of course.
Francisco Gomez Torres:I, I can, I can see you as, as a mentor also. I, I think I do have a lot of, um, to learn from you and the whole a HF uh, uh, crew.
Joseph M. Schwab:Yeah. Well, I think the a HF itself is a community of learning, so we all learn from each other and there's, there's a lot that we can learn by having these sorts of conversations, both locally, nationally, and, and internationally. Yeah.
Francisco Gomez Torres:Yeah. For, for example, I would like to know if the anterior approach was all, uh, the beginning for you or if you have to. Make this switch between approaches when you first started.
Joseph M. Schwab:Well, most of my, uh, residency training was in posterior approach and direct lateral approach. And, um, I first saw anterior approach at a course when I was, uh, later in my residency years. And I thought it was very interesting. I got to meet Dr. Matta, he taught the course. And, um, uh, when I came back into practice after doing my fellowship in Switzerland, where I saw some anterior approach towards the end, um, I decided that I wanted to start my practice doing all anterior approach. So when I began my practice, I just started doing anterior approach right away from the get go. So my training was, uh, a little haphazard. It's different than it was, than it is nowadays, uh, for sure. Um, but uh, but we, we made it there. So that's, that's how I ended up with anterior approach. But that leads me to a question. Was there, you talked about how you, uh, kind of found a mentor in, in hip and knee reconstruction surgery. was, there A particular case or patient or conversation that you had during that training that made you feel, this is exactly where I'm supposed to be, this is what I'm supposed to be doing, and that confirmed the decision you had made?
Francisco Gomez Torres:For sure. I must say that, for example, in this, in this practice I had as a fellow surgeon, it's always in the very same. Now you, you can't change the approach because you want to, you have to follow strict rules because this is the school we teach in, in this institute. Or for example, as I told you before, I was, um. A couple of months ago, I was trying to, uh, I was working in a, in IMS where they do have their own school. They do, uh, hips laterally, mainly, mainly, and I heard from this colleague, a doctor who have learned the interior way, um, in the us He was performing his cases, uh, under the water, as we say here, because he wasn't allowed to, well, this doctor even got punished. He, they took his consultation and he was changed, uh, to another service. So I think this, uh, the, the way I have been in touch with the anterior approach is mostly with colleagues of mine, friends who, which I do perform hip surgeries, but in. Our own. We have our own patients, our private, private patients, and we gather, you know, we gather a doctor from Central Mexico City, a doctor for, from Bolivia, who now works here in Mex, Mexico City. And I myself, and we do perform the entire hip surgery in on, on in our own way. You know, as the way we learned. One of my friends learned at the Hip Institute with Dr. Uh Dom, for example, and this other friend of mine learned in Magdalena De La Salinas, which is a hospital here in Mexico City, and I did my own thing learning through them. And through you, for example, and you know, like this, like drop water drops. I have been learning on my own, as you said before, I'm kind of an entrepreneur, but I'm looking for my practice everywhere. I even went to Switzerland, uh, at Pass Basil where I had the chance to perform with Dr. Carl Stoffel, which I do, I admire a lot. He taught me some tips. I went to the AO courses, uh, at tables at Luer. So it's all kind of a mix. You have to look for your own way and more than look for it. Create it in some, some way. Yeah.
Joseph M. Schwab:It. Give me a little bit of an idea of what the, what's the, medical care system like in, in, at least in Mexico City, and is it the same all throughout Mexico? Is there nationalized healthcare? Is it private? Is it a mixture of public and private? Tell, tell our listeners a little bit about how healthcare is delivered in Mexico so we can understand the environment you're working in.
Francisco Gomez Torres:Sure. in Mexico we have, uh, two different ways of doing things. The, the first one is the, um, the public one, which is divided mostly into three institutions, which, which are IMS is there, and, uh, which is, um, health in general. These three services are the public ones. Yeah. so we are, um, how do you say, uh. We do have, uh, um, we're stuck to the, to the money the government gave us to perform surgeries. So, for example, to do an anterior approach, you know, better than me, that maybe we do, we need special, um, instrumentation to place this, this, um, uh, how do you say prosthetics? So it's kind of hard for the, the government to, to pay No. And through the public to the private one. Well, we do have the, the insurances, which do mostly in the biggest hospitals like this, like hospital Al. But there is also a way where people can pay on their own without having, uh, an insurance. So. There are three kinds. No public, private, or a hybrid one. Yeah.
Joseph M. Schwab:Self play. Self pay are there. So when we had, um, a Richard Field from the UK came and gave a talk at the Anterior Hip Foundation about, uh, anterior hip replacement in the uk, which is only about 1% of, uh, of hip replacements between one and 2%. Um, Mexico is similar in its percentage, but he also described there's the public system, there's the private system, there's the self pay, and then there's also the public system that, for lack of a better term, contracts out certain types of, uh, cases to that they are, are not able to handle within the public hospitals, to private institutions who will take public patients. Does that also exist in Mexico, or is that aspect not a, is that not similar?
Francisco Gomez Torres:yeah, yeah. It does exist, but it's not like the biggest, uh, way of doing things. It's mostly because the hospitals are very crowded, so they choose to deliver the, this kind of patients to, uh, specific, um, center. You know? But I have only hear of that maybe here in Mexico City and maybe in Monterey and Guadalajara. So it's not like the most common thing. But I think things are going to that way because the public service, it's full, it's overcrowded, uh, awfully. Yeah, we do have that problem here. Yeah.
Joseph M. Schwab:Yeah, the o the overcrowding problem. Um, how much do patients in the public system in Mexico, how much do they have input into how they want their care to be delivered? So could somebody in the public system say, I, I want an anterior approach, hip replacement, all as uncommon as that might be in Mexico? Could somebody say that and expect that that's what they would get?
Francisco Gomez Torres:I must say the patient doesn't have, uh, an option when they are through the public service. It's mostly, uh, the decision of the service, maybe the decision of their surgeons. Uh, but no, as far as I know, the patient doesn't have their right to choose, but they can talk with their doctor, and if he does now the entire approach maybe. It's a possibility. Like in that hospital, I told you before, the doctor that was doing his own, uh, anterior approaches, but he got, I mean he got, uh, he got punished. It's crazy.
Joseph M. Schwab:Yeah. Well, and and that leads me to my next question. If you could change one thing about how anterior approach hip surgery is either perceived or practiced or it sounds like it's not taught much in Latin America, in Mexico, um, what would that be? What would be the first thing you would change?
Francisco Gomez Torres:Yeah. Well, I think there is a cultural problem because of doctors that are not willing to change their approach. I think that's the biggest thing. The big names, the names that have been with us a lot of time, they are accept or they does not, do not want to change this kind of, uh, technique. Mostly because, well, they don't want to lose their. Power position. you know, as we saw in Nashville, as I have been watching through the days, during my, uh, surgeries, the surgeries of my friends or co or colleagues, and we see this kind of better results. I, I don't remember a doctor who told me in, in Nashville, the worst, uh, plant is the one that doesn't want to see, and that was Dr. Mar. So it's crazy how we are so, so ret to say, no, no, keep it lateral. Keep it posteriorly because it's the bear. I even had a discussion with a friend of mine, I mean, a friend of mine told me the posterior way is the way. I was saying like, dude, you are like a shoulder surgeon. Why are you talking about hip surgery? That that's the way it's like discussing about the football. You know, football is something big here in Mexico and people gets, it breaks relationships. It was the same with this guy. He was saying, why are, yeah. Yeah. Go lambster.
Joseph M. Schwab:I, I, I, no, that's okay. I was gonna say maybe it'll take a famous, uh, footballer from Mexico to get an anterior approach, hip replacement someday to change the
Francisco Gomez Torres:you're talking. Yeah, yeah, yeah. I, I do remember having a football coach. Um, he was already retired, but he was a very famous, uh, football player back in the day. He have anterior approach and he's doing great. He's still playing football. You know, he, he tells me that when he's playing football nowadays he plays, but when the other, um, teammate comes to closer, he just drops the ball.
Joseph M. Schwab:yeah.
Francisco Gomez Torres:But he's playing football. It's crazy. He shoots and he scores from far away. He has it still, but, you know, it's crazy. And people, people doesn't, uh, maybe they don't know that yet. I think another
Joseph M. Schwab:know that. Yeah. That he's had a hip replacement. Yeah.
Francisco Gomez Torres:Yeah. Yeah. Maybe the thing I will try to change will be, um, making this info even more, um, available for people that wants to, to get better results. Not, I'm not talking about patients because patients do come and they ask for the AMI approach, but I mean, through another colleagues, you know, through doctors, through another hip surgeons That are stuck because they learn that way as the way I learned back for years ago when I was doing orthopedic surgery, but not a following hip replacement.
Joseph M. Schwab:So talk to me a little bit more about the group of orthopedic leaders within, um, the Mexican community who have, um, maybe some, uh, some oversight over what They, perceive to be quality and what they perceive to be the right way to do things. Is this a formal structure within the Mexican orthopedic community, or is it, is it a bit more informal and um, uh, you know, is this, is this the elder statesman, so to speak, or stateswomen of the, of the orthopedic community who are telling you, quote unquote, the right way to do things?
Francisco Gomez Torres:Yeah, well, I think mostly of them. It's not like a formal, um, group. It's this. Bunch of groups that have been through a lot of time. They, they, for example, they do work a lot with the insurance, uh, companies. They have been there forever and they keep growing because they do accept more fellows, more, more, uh, doctors to join their team as they are the voices that resonate between us. Um, they are the ones that have to change, I guess. I mean, not very easy for me to raise the voice and to make people hear me, but little by little as what a lady was telling me yesterday, uh, we have an, uh, an interview with, um, a social activist who told us, don't you ever give up. Just if you can change a person a day, it's okay. I think. We have to keep pushing with this kind of efforts. I don't know, uh, Joe, if you will have the metrics of this speak layer, but I would like to know if Latin America is listening because we did have a lot of, uh, talks with our friends back in Brazil, Chile. Uh, I don't, I even have a discussion with, uh, uh, research team in Egypt, uh, who is committed, was committed to hear this talk. I think we have to keep pushing to, to make people's mind change, especially these ones, these big guys, uh, that have been there forever and that are negative about the anterior hip. But just because they have, they don't know it. Maybe they are, they don't want to change. I mean, 20 years doing the same procedure the very same way. I do understand that. Um, they might be in a comfort zone, but for example, Dr. Sa also talks about, uh, his transition through the, from posterior to anterior, which is something crazy for me. I, I, I, I, it's kind of remarkable for me because it's, uh, 180 degrees, uh, change. It's totally different. But I can say Dr. S is having great results, and he even talks about it in his book also. So.
Joseph M. Schwab:Yeah. And, uh, just to, um, just to, uh, address one of your, uh, comments there. We've got live about 15 people watching us right now, which is for a first live podcast episode. I'll take it. And I wanna remind those users on YouTube and on LinkedIn that in the latter half of this discussion, if you have questions, uh, for Dr. Gomez Torres or for myself. Um, we've got our producer Lila, behind the scenes and she is feeding us the best comments and questions, um, that you leave. So please feel free to be a part of the conversation. We would love to have you. I wanted to uh, sort of follow up because one of the things that you seem to have done or seem to have put together in your quest to bring anterior approach to Mexico and to Latin America is you have really, uh, made a lot of international connections or made international global outreach something, um, that something that's part of how you learn, but also how you connect. Um, how do you stay engaged with the orthopedic community internationally? How do you cross borders like that?
Francisco Gomez Torres:Well, I, can, I would like to say that since I was a kid, I was like a really friendly guy. you know, I, I don't know. Why is it easy for me to talk to people and to, you know, I. To know if we can be friends or no, you know, it's okay if we don't agree in everything, but I do like this kind of communication. I don't want to be flat with the people. I want to know a little bit of them and if they want to know for me it's okay. So I think it's my, the way I do friendships with people that took me. I, I took it internationally. I say, I am making friends all around Mexico. Let's try in Switzerland. Let's see if I can make some friends there. I did make some friends and they were, um, for lucky, lucky me. They were a officers. So then I got, uh, engaged with the AO Foundation, and I do love that. I am working nowadays with them also. Uh, for example, uh, when I went to Nashville, I did find this group of very enthusiast, uh, colleagues, which are the Berkeley fellows. I can tell you that everybody has a special talent, uh, especially for example, Dr. Amed Omar from Egypt. He, as soon as I got, uh, in touch with them, with him, we, we had a click and. I was invited to participate in his research group, which is, um, an author of, of More Than 50 Research, for example. No. And, and he is encouraging, encouraging his students to, to do a do as he to publish and publish and publish. So I can see that that's the true benefit of having friendships that matters. You know, it's not just being friends, it's trying to work, uh, together. Um, in, in back in Nashville, for example, I was looking for maybe any chance to, to get, uh. Uh, traveling Fellowship info. That was another thing I was looking for. It's not just talking for talking, it's with a purpose. No. To get in touch with people, maybe searching for, um, the exchange of benefits. If I can do that, the entire hip foundation, uh, put some attention of them in Latin America. I think that's something invaluable for the whole region. If some, uh, doctors, some teachers of mine are listening to, listening to this and they see that maybe podcasts are nowadays the way, um, television evolved, for example, or, you know, the broadcasting, um, it's a new wave, well, a new way of communication, and I think it's. The interior approach is the future of communicate. If not, I will then be able to talk to you from Switzerland to Mexico with in California. It's crazy, but I do love it. Uh, that's the way I, I am doing podcast post podcasting right now. Uh, the last year was amazing to get in touch with a lot of people, uh, friends from New York, friends from new uh Belgium, some doctors from Asia, for example. I was invited to give a talk next, uh, February on the apo, the Asia Pacific, uh, orthopedic Association. So maybe I will be there for next February.
Joseph M. Schwab:Mm-hmm.
Francisco Gomez Torres:It's, it's the way things are happening. I'm not just sitting and with, uh, arms crossed. I'm looking forward to connect with people, as you say, but. That's, that's the way things are happening. I am.
Joseph M. Schwab:So you, you clearly have an interest in technology and you have an interest in using that technology to not, not only to learn, but also to teach and to engage. I'm curious about your use of technology in the operating room and let's, I just wanna start with a basic question about your your setup. Um, do you have a technology enabled or setup? Is it pretty basic? Is it more advanced? Can you walk me through what features kind of matter most to you in, in terms of your or setup?
Francisco Gomez Torres:Yeah. Well first of all, I would like to say that, uh, I did learn to perform hip and knee surgeries in the traditional way to begin with, you know, at the very first I wasn't able to, uh, manage their robotic arm. But nowadays we can do, we do have access through this kind of technology, especially in the private sector about the public sector is a little bit hard because of the economics. But now that we do have this kind of, um, liberty to, of freedom to choose. Well, we do perform with a robotic surgery in a site. Uh, we do have a, a tech guy, uh, who is taking care of it. Um, when we are performing some, um, surgeries, we do have this kind of, um, how do you say, like the, like the belly system, you know, to, to match the pre the prayer and the postop, even with a pre, uh, trans, um, uh, visualization of if we are okay. Uh, so I can say it's not like the most equipped, um, um, or, but it's not also like the most basic one. I think we do the, the f ourselves. Uh, I think there are doctors who are more, um, in a need of having everything, uh, but. I, I'm kinda, I don't want to get so, so used to this kind of technology that then I don't, I, I kind of forget how to make them traditionally because, well, another thing I would like to say is that apart from Mexico City, I do perform surgeries across the country. So I try to go, I don't know, maybe California, sometimes mores, maybe South Mexico. We do try to help in different ways, uh, to the people. Sometimes I do work, I perform surgeries with another, uh, surgeons who asked for my help. Were, were, um, kind of a, um, a Mexican, um, how do you say? We try to communicate to make things possible, but that's
Joseph M. Schwab:Sure
Francisco Gomez Torres:the way I don't have a robot
Joseph M. Schwab:within the, okay. Interesting.
Francisco Gomez Torres:I do collaborate a lot.
Joseph M. Schwab:do, do you, um, find difference in access to, to implants, different quality of implants depending on the place that you're operating at, whether it's public or private, or do you pretty much have the same type of implants available wherever you are?
Francisco Gomez Torres:Unfortunately, I, I don't know if that's unfortunate, but no, I do have like a, a whole options of, um, implants. Uh, I do, I would like to say that I do have my favorites. You know, I do perform mostly with three kind of uh, implants But you know, if I am back in Mexico State and they got these, these prosthetics because of the budget, let's make it, you know, uh, so I think. That we do have to be also very, um, versatile with these kind of mires. If you get used to a single thing, um, it can be, you can get into a trouble later. Um, and maybe it's the time for me, maybe later, um, when, when I, uh, you know, um, base totally my, my practice into a single uh, thing, then I will start doing with only one implant, one kind of implant. But nowadays I'm trying from everything.
Joseph M. Schwab:We, we have a question from one of our users on LinkedIn, um, about, specifically about implants, but about custom 3D titanium implants. Wanting to know if you have any, um, experience with those implants, and if so, if you've encountered any challenges with them.
Francisco Gomez Torres:Well, we do have a friend of us who is mostly into this. Um, with this technology, the thing that we have found is that after you have the cuts with have to be really specific through a TC for a C for example. Um, even when you perform. Very good. The surgery, um, you can't expect, you can expect everything because as it is a per a treat, d personalized, uh, a personalized, uh, system, you depend a lot in the activities this person is doing. We don't have the record of how this implant is going to work because it might be, it's so personalized that you can't have like rep reproducibility, um, of, of, um, how you say, um, cases before. No. So every case is different. We even have one day this, this person that, uh, the implant just came off from the, from IAC bone and we have to, to reenter and to, to fix it with more material, but you know. That was an experience we don't want to have again. And we have had more, um, a little bit more of experience with the trabecular implants that, um, you know, these, these, um, I, I did forgot the, the name, but we do have more, more practice with monds, with almonds. It's mostly more than 3D printed. Besides that it's expensive as well. The 3D printing thing. Yeah, I.
Joseph M. Schwab:Um, we do have one, uh, user who commented on LinkedIn. Um, and I'll, I'll just read the comment that I have here. It says, I believe that the reality of the Mexican healthcare system is so similar to the rest of Latin America. And so different from the American healthcare system where decisions often depend not on what the patient wants or what the surgeon prefers, but on what is available at the time of surgery in each case. Is that your experience?
Francisco Gomez Torres:Well, I have to say Joe, that I have heard that a lot of times. What about you? Do you find it like, uh, something crazy because yeah, it's a reality in the public service here in Mexico. Yeah. but I don't know. I don't know that maybe in Colombia is very different. Columbia is kind of more private thing.
Joseph M. Schwab:Um, my, so my only experience operating in Latin America was in Nicaragua, um, where we had an opportunity to go, um, as an educational, um, exchange when we were residents and what I recall from the. Uh, cases that. we did in in Nicaragua, at least at the place where we did them, um, the patients had to buy the implants out of, out, basically out of pocket. And so it was, you put in whatever they could afford, um, and if they couldn't afford, you took whatever you had that was, you know, on the shelf if there was something available or that could be donated by a company. Um, but it was a, an exceptionally different situation than what I've experienced in the US healthcare system and certainly different than in the, in the Swiss healthcare system. But it also sounds like it, that's a bit different. Yeah, a bit different than what you experience in Mexico City.
Francisco Gomez Torres:Yes, yes. I can say that. Well, here as, as the p as the population is growing, um, like never before. The, the, the population is still growing as fast as 30 years ago, maybe a little bit more. Um, the, the institutions, They get, uh, stuck into trouble. We even had, uh, like 15 years ago, the, how do you say, the pensions, the jubilations.
Joseph M. Schwab:Yeah,
Francisco Gomez Torres:They were, took off the, of the federal budget because it wasn't, um, possible affordable for the government to keep those payments. So nowadays, uh, we don't have jubilations anymore. It's something crazy. You will have to work until you, you, you are incapable of. But it's mostly because we don't have the budget already. So imagine if that's the way, uh, things are happening. You can expect anything from a public service, uh, to give you on, on a prosthetics. Yeah,
Joseph M. Schwab:We have some great. questions coming in. I wanna read this one from Ancon,
Francisco Gomez Torres:that's great.
Joseph M. Schwab:orthopedic surgeon. Um, what common mistakes do you see surgeons make early on in their anterior journey, and how can they avoid them? What have you seen?
Francisco Gomez Torres:Well, I would like to tell you, uh, uh, even I do feel like I am an, uh, I am a young surgeon on this. I'm not the most experimented, uh, but I am on my cure already. I think one of the biggest mistakes was not, Um, not, not to locate the right, um, intermuscular, um, segment. You know, sometimes I was a little bit anteriorly, a little bit more, or in the, in the later cases I was creating a little bit posterior. So nowadays I do have like this kind of metric, uh, not only with hands, but also with the feeling.
Joseph M. Schwab:Mm-hmm.
Francisco Gomez Torres:And I do, um, now I, I can initiate my approach just right in the way, in the place I wanted to. To make a little flip of the fascia. That's the way to be. I don't know you if you have any trouble, um, because I think the approach is the 60% of the surgery, you know, the implants, you know, when they are well located, uh, to exposure, expose the femoral is another thing I would like to discuss. But, uh, I think mostly it's the approach. You have to be real secure in the approach and then the surgery will just flow as you want it to.
Joseph M. Schwab:The, I would say the biggest mistake that I see early learners, um, make in anterior approach is, um, some of them, some of them don't understand how many people have come before them and have made the exact same mistakes they've made. And they feel like with, as successful as anterior approach is that if they talk about anything they're having trouble with or that they're, uh, you know, a mistake that they've made or a difficulty that they've encountered, that they would somehow be looked down on when, what I have found, at least with the anterior hip foundation. Is a community of people who have made every single mistake that you can make with an anterior approach and would love to talk to anybody who is struggling, um, so that they can help them through it. Um, and it, it's the, the idea that you need to hide things that, um, are difficult for you, um, until you just get enough cases under your belt and they get better. Um, there are people who, who are out there who can help you. And, um, you're an example of how you do this. You reach out and you, you you know, You cross boundaries, you cross borders, you cross, uh, uh, cultures and, um, you try and find answers to the problems that you're encountering and the questions that You have. Um, another question came in. What specifically, specifically do you think needs to happen for anterior approach hips to become more common and even widespread across all of Mexico?
Francisco Gomez Torres:What will be? Hmm. I do think that, you know, an actualization in education, it's a must because if you, if you, you enter a fellow, okay. You enter into a hip reconstructive fellow, okay? But the teachers are doing lateral approach. And then the fellow ask, can we do maybe one anteriorly? But your, the practitioner doesn't, doesn't even know it. Or maybe they have here only bad, um, bad, uh, reviews about the anterior approach, and they are not trying to excel this myth. No, I hear that. It was like a crazy approach. Oh, no, it's not, it's not any better than the lateral or the posterior, just because they heard from somebody that heard. So I think that's the most, the mo the very most important, um, issue is to make an actualization or, or to improve, um, to make it put it on the table as an option.
Joseph M. Schwab:The education, specifically the education. So how, how it does, and I'm gonna ask a little more detail about this, because one, I
Francisco Gomez Torres:What? One thing. One thing? Yeah. Yeah. I got you. I got you. Just to add a little bit, maybe for example, I am, I am, unfortunately, I don't have like, uh, a program to teach now or maybe the friends of mind who are working as freelancers or their own bosses. We don't have, like this program, a specific program of, of fellows, but we have, we we're avid to learn the entire week. Well, I think this has to be into a program. There are no programs where the entire approach is teach. I think that's the. Most important thing, the, the, the time one teacher starts performing Ontario, people will go there and try to learn, you know, as I did in Nashville, as I, as we are all doing.
Joseph M. Schwab:And I remember early on, so nowadays in, in the US and certainly both in the US and in Europe, it's quite common for any of the fellowships that, you go to to learn hip surgery, you're gonna learn anterior approach. That's very common at, at many, many fellowships. But when I was learning, there were not as many fellowships that were offering that as a regular opportunity. And the education was mostly coming from partnership with industry. Is that something that you can do in Mexico before the, the, the, teachers, so to speak? Um, take it on as can industry be a help in that?
Francisco Gomez Torres:Of course, I think that, uh, every time I do approach with a, with a rep, uh, and they just start talking me about, uh, their new hip system, it's okay, hey, oh, it's really great. This, it has, uh, trabecular metal, it hydroxy appetite, it has, uh, beamin, um, uh, how you say Polyol? And I say, is it possible to make it anteriorly or do you have any special instruments to make it a pro, um, anteriorly? And they say no, or they say yes. You know? So I think that's. The way I, I think the reps can get into this to making, um, the, the tools perfect for their implants or, or to make them unter. I do now have, for example, I was talking with, uh, nowadays with a, a new rep I haven't here before, and they are bringing a Korean, Korean, I think it is, uh, hip prosthetics, uh, that has its own instrumental to do with anteriorly. It's the first one I haven't, I have here, uh, hurt that is not American, for example. So, or, or, or like the bad, I dunno if we are, are able to talk, uh, about
Joseph M. Schwab:Hip Foundation, we are, we are free to use, uh, product names and in fact, we encourage it.
Francisco Gomez Torres:great. That's great because
Joseph M. Schwab:is, how's anyone gonna know what you're using? If you say, ah, I use this, and then they find something that looks like that. But maybe, I mean, use the name, it makes sense.
Francisco Gomez Torres:Yeah. Yeah. For example, I, yeah,
Joseph M. Schwab:you, I was gonna say, you're c we know, we received a comment, uh, as you were speaking from, uh, David Ktu Morales, who says, um, exactly the point that you were making. We need more surgeons performing this approach so that the implant companies start requesting the necessary implants and tools, even if they requested them today, the Mexican FDA, which he says Kofa PRIs, if that's, if I'm pronouncing that correctly, takes between three to five years to approve them. So, just to give an example, trabecular metal only became available in Mexico about five or six years ago. So if we want to have. For instance, the Actis stem, uh, collared implants, it'll likely take another three to five years before they arrive. So that sounds like exactly the point you were making. There needs to be this, um, relationship with industry to get the technology in And the implants in to facilitate the approach. So, so working with industry seems to make a ton of sense.
Francisco Gomez Torres:Yeah, I do remember, I do remember we had a talk, uh, a couple of weeks, uh, before, on a Saturday,
Joseph M. Schwab:Mm-hmm.
Francisco Gomez Torres:a Sunday. I was, I was talking to you that, uh, a Johnson and Johnson, uh, rep came to me to say, Hey, you have a great time at, at, uh, Palm Beach. Right? Uh, we met you there. Yeah. And he was talking, we were talking about the, the, I invite him to the, to the office and he showed me the implants he have and stuff. And as I was talking with him, because. I attend to a palm beach in a neo course where we had some kind of tech, you know, some kind of hip replacements, some kind of knee replacements, which were very similar but different to the ones we used in Nashville, for example, in Nashville with, we use the Sise. He was asking me is the number one and or number two, and then we research. But for example, and I, I, I asked him, why don't we have Sise in Mexico? And he says, he said like, Ooh, doctor First and Mexico, you should, you should seek for Chile or Brazil, where the FDA from those countries is not as bureaucratic as the Mexican one is. So he. If, if that was his first comment is because it's a very, uh, hard thing to make to introduce these implants into a country. So he said you are like 10 years behind. Chile might be five, Brazil may be three, and then it's Mexico. Uh, you know, so, so you should start looking what's happening in Colomb or Chile to see what's coming to Mexico. It's like really? Do they have king size there now? So king size is coming maybe in 20, I don't know, but
Joseph M. Schwab:it's, yeah.
Francisco Gomez Torres:like some kind of
Joseph M. Schwab:It's kinda like you have a little bit of time machine you get to see into the future a little bit. It's just, uh, it's unfortunately the present for others. But, um, and so I know I, I do, uh, we've been, um, talking for, uh, for almost 50 minutes now, which is great, and I, I, but I want to see, I know you had mentioned you had some questions for me and so I wanted to be respectful of your time and I'm happy to answer any questions that you might have.
Francisco Gomez Torres:Thanks a lot Joe. I mean, I don't want to to extend this that much, but I would really like to ask you as a leader you are because, well, people that follows the HF already know that you are. Now you are the ex-president of, of past president from the a HF, but I would like to know how was your, um, how would you say, mandate, what did you, how did you feel with your mandate for an institution? Well, uh, uh, foundation that it's, um, kind of junk as we might say, without with these, um, eight years nowadays is having the EHF and if you have some, uh, issues through it, or how was it possible that you, you got to be a president?
Joseph M. Schwab:Yeah. Um, well, so you know, the question about the mandate and, and the, the organization itself and its youth, youth and inexperience in an organization comes with some benefits and some drawbacks. And the benefits are, are great. You don't know what you don't know. And so you oftentimes take on things that, um, uh, maybe somebody who's a little more experienced or a little wiser would say, I wouldn't do that. But you do it and it ends up, uh, you know, sometimes being a, a big success. Um, we have always focused, um, our main thrust, uh, for the A HF has always been the annual, uh, meeting, um, which every year continues to, to grow and grow in popularity, in size, in, um, offerings. And that's, you know, my mandate for this year was to continue that trajectory. Um, and the one thing I'll say that all of us in the leadership, uh, team of the A HF, and we have so many fantastic people, um, you know, helping us. Uh, and I mean, I can, I, I can embarrass them all by name, but they know who they are, um, who do amazing things to put that, that meeting on. Um, but you know, the goal of continuing that meeting, growing it, um, and trying something a little bit new or a little bit different every year, um, this is the first, I would say within the last two years is the first time that the entire leadership. Team has felt like, um, whether we do anything or not, the a HF will continue. Like it's, it has, it's not a mature organization, but it's gotten to the point of maturity where it's a, it's a train that's moving along the track and it would take some effort to stop it at this point. So we, we all feel very comfortable with where we're moving. As an organization, um, I am exceptionally proud of the fact that we get to hand over the reins to Dr. Charles Lowry, who is my vice president. Um, he's an incredibly skilled, uh, gifted surgeon. He's an incredible person. He's an incredible visionary. Um, and I, I couldn't think of a better person to hand the organization off to. And it, it's, it next year is only gonna get better. And I don't know how, and I don't know why, and I don't know, I don't know when, but it's going, it's gonna just keep getting better and better. So it's, it's been a, it's been one of my professional highlights, um, of my career is to, to be honored to, to work with the people at the Anterior Hip Foundation.
Francisco Gomez Torres:That's so great to, to hear the, the ne The next question will be, uh, what did you see for the future of the A HF? Where is it pointing? Because we did have, uh, like this European meeting last month, so I would like to know, how do you say, do you, would you see the a HF maybe in the next five years or any point you would like to, you know, figure
Joseph M. Schwab:Well, the, the good news about being the, the immediate past president is I get to say all sorts of wild and crazy things that we could do in the next five years. And I have to, I get to rely on a whole other group of people to make it happen. But, um, you know,
Francisco Gomez Torres:not pressure, but
Joseph M. Schwab:there's no pressure. I, I mean, we, we have a, we have a vision to, to, um. You know, kind of take a page from you and expand, uh, our outlook internationally. Um, and whether that's through direct collaborations or support of other organizations or, um, whether it's through, you know, directly creating organizations in different regional areas. Um, we haven't quite figured that out yet. But, you know, there were a number of us from the leadership team at the A HF who were at the European anterior hip meeting, um, and participated as the faculty. It was, um, a great experience talking with the European surgeons. It was a great, um, it felt very much like the same sort of, um, collegial family environment that we, uh, put on for the A HF. Um, I know there's interest in doing this in, in Latin America, in South America, there's been tremendous interest from the ocean region and Australia and New Zealand. Um, and, you know,
Francisco Gomez Torres:The Australians are, for example, a big, big, uh, team, right? Uh, the entire, uh, approach is happening a lot in Australia, as I can see.
Joseph M. Schwab:they're almost 40% anterior approach. Yeah. Um, and you know what, I know I'm answering questions, but I just got one that came in on LinkedIn that I, I'm curious to hear your thoughts on. Do you have experience, I'm doing anterior approach through a bikini incision, and, uh, that's question, that's the first part of the question. And the second part is, can you give from your perspective, um, uh, an outlook on computer assisted or computer navigated a hip replacement surgery in Mexico and Latin America? So bikini incision and computer assisted computer navigated
Francisco Gomez Torres:Well, I can tell you, that about talking about the, the bikini incision. I even had got a, a earlier discussion through LinkedIn with you where we were discussing should it be, you know, like horizontal, uh, vertical, uh, you know, angulated with a, a Glip. So as you, I would like to, to pick this, uh, quest. These, um, words you told me that is not what the incision is creating is that you have to understand that there has been plenty of patients, a lot, millions, if not, that are having better results in any kind of incision is not the incision for start. Now if you are asking about, um, the issues one or the, or the other, have, we can say that the, the vertical incision, it, uh, break more longer hands lines. So there might, there you can expect a little bit more of, uh, healing tissue issues, but doing it, uh, through a bikini incision, it might be, you know, you might attend to that question, but, um, the bikini incision is not, uh, extent of having, uh, cutaneous problems also, you know, but it might be a little bit more aesthetic because you are close to the, to the, the part where the skin, uh, faults. But I mean, it's not the most important, uh, part of the surgery and. To, to, to close that question, I would like to say that you have to be comfortable with the, the work you are having. You have to, to think in what's happening inside or even deeper. And the bikinis just, well, the signature, you know, that you will keep performing bare day by day.
Joseph M. Schwab:You, you have to know what you're doing under the skin and to make the, the quality of the incision be the deciding factor about
Francisco Gomez Torres:yeah,
Joseph M. Schwab:or not. yeah. I agree. Uh, and how about computer navigation?
Francisco Gomez Torres:Yeah. Well, I do, I, I, I haven't been able to, to perform a robotic assisted surgery with a direct anterior approach, but I do have some colleagues that are doing it right now with the Macco system. I can't even tell you that. Uh, a month ago, the, first Rosa Hip, uh, surgery was performed at the very next door of a surgery I was having. So, and it was another colleague of mine who I do anterior approaches with him sometimes, but, um, I, I do know the patient is going excellent through with that system and with that direct anterior approach, it is possible about doing, um, uh, navigation. Surgeries. I haven't done it, done them. I think, um, I don't know. Well, my generation is not looking forward a lot into navigating, but we do are, we are having the whole attention to the robotics, um, issue. Maybe I even have well in, in between my eyes. The case of Dr. Za and the team in use, he is, uh, developing to, instead of having like this whole robotic arm, you just have your machine gun in the hands and perform the surgery.
Joseph M. Schwab:Do. Uh, I'm curious, do you think it's more likely that an implant company or that a, a company like a Johnson and Johnson or Zimmer Biomet, um, would be more likely to bring down a robot to Mexico than they would a new set of implants? Um, it it just because of the size, uh, and impact that, that might have. Because I, I'm curious to hear that you have Rosa, but you don't have concise, and you just got trabecular metal five years ago. You know, that's, that's interesting. Right?
Francisco Gomez Torres:Yeah, that's the way the cocky crumble is as somebo, somebody said. But, uh, I think, I think, uh, I would like to take your words again, doctor, because I, as I told you before, you are like a mentor in a center certain, certain remote way. I think the most important thing must be to have a centered approach, uh, uh, centered patient approach. It's not about the tech. It's not about the market. It's not about the new robot, the new hip, the, the new implant. It's if the patient is having better results, we should do it. If it's just because there is a new robot on the market. That's not the objective or, or the reason why the robots should come here or the new set of implants. If we have the evidence that is working. Okay. There is a, there is a reason to, but if you're having the robot and your results are being just even uglier than the traditional approach, well maybe it's not what you have to be looking for. Right? So,
Joseph M. Schwab:Interesting. Well,
Francisco Gomez Torres:yeah.
Joseph M. Schwab:Dr. Gomez Torres, I wanna thank you for, for really actually being kind of our test subject right on doing, uh, a live a HF podcast and engaging, uh, with a live audience. We've had, uh, you know, a pretty steadily, about 15 to 20 people watching us. We've had, I think, some excellent comments and questions, uh, from our users. And, um, I, I just want to encourage you, everything you've been doing to engage with the international orthopedic community, uh, I want to say you're an inspiration to, to other surgeons, and I would encourage you to keep doing what you're doing keep fighting the good fight.
Francisco Gomez Torres:Thanks a lot Joe. It's such an honor to be part of your guests. Guests. Now, I can't say, um, that maybe having a podcast and do these international, uh, meetings, um, you know, to get some friends and stuff will take me to this place now, now. I wouldn't imagine that. So I'm really, um, thankful with you, with, uh, Lila, with all the whole a HF for the Oracle Fellowship, everything, because these things happened. Just because you are not seated waiting for the date to pass, you have to keep pushing forward. So I do, um, would like to say once, once again, thank you for hearing and thank you for having a feedback, a feedback for me and well, Latin America. I hope they, they hear your words.
Joseph M. Schwab:I, I, I hope they hear your words, and I'm gonna take a moment to bring Lila on. Um, just to thank her for, uh, doing this in the background. Lila, thank you for, uh, for, uh, being on the, the podcast. Oh. Have you muted yourself? Uh, excellent. Um,
Lilah Menashe:Can you hear now?
Joseph M. Schwab:now we can hear
Lilah Menashe:Oh yeah. Hi. It was such a pleasure working together and, you know, looking for different topics to discuss today. Uh, you were very committed, Dr. Gomez Torres, so I really appreciate it. So, for all our listeners, it took a little bit of work and effort from all us to put it together. So I, I just hope you enjoyed it.
Joseph M. Schwab:and we
Francisco Gomez Torres:Even, the earthquake,
Joseph M. Schwab:to do it again. Yeah. Even through an earthquake. Oh my gosh. I hope everybody's okay. All right. Thank
Francisco Gomez Torres:was the announcement that the HIV was happening right now.
Joseph M. Schwab:That's created the earthquake. Well, thank you Dr. Gomez Torres. Thank you, Lila. Um, I'm gonna, yeah, we'll do this here. And, um, I just want to say thank you, all of you, uh, for joining us for this live episode of the A HF podcast. And if you can please take a moment to like and subscribe. You'd be helping us find more people just like you to share this type of content with. And if you have any ideas for a future episode or topics you wanna see us discuss from any portion of the world, drop it in the comments below. You can find our normal episodes of the a HF 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 A HF Podcast come out on most Fridays. I'm your host, Joe Schwab, asking you to help keep the hips in Latin America and wherever you are happy and healthy. I.
