From Croatia to South Africa: Chuck's Journey in Hip Surgery

From Croatia to South Africa: Chuck's Journey in Hip Surgery | AHF Podcast

Welcome to the AHF Podcast with your host, Joe Schwab! In this episode, we sit down with the trailblazing hip surgeon, Josip 'Chuck' Cakic. 🌍 Chuck shares his inspiring journey from Croatia to South Africa, his deep passion for hip surgery, and his innovative contributions to the field. Learn about his pioneering work in hip arthroscopy, the challenges he faced, and his role in introducing the anterior approach to hip surgery in South Africa. Whether you're an aspiring surgeon or just fascinated by medical innovation, this conversation is packed with insights and inspiration. 🔬💪 Don't miss it! #AnteriorApproach #AnteriorHipFoundation #AHF

Transcript

Joseph M. Schwab: 0:22

Hello again and welcome to the AHF Podcast. I'm your host, Joe Schwab. My guest today is Josip Cakic. He goes by Chuck, and he's a true pioneer in the field of hip surgery. Born and raised in Croatia and practicing in South Africa. I first met Chuck at this year's European anterior hip meeting where I learned not only a little about his life's journey, but about his passion for hip surgery, his sense of humor, and his gift for being an educator. Chuck, welcome to the AHF Podcast.

Josip "Chuck" Cakic: 1:00

Hello everybody. Thank you very much for having me.

Joseph M. Schwab: 1:04

Chuck, it's a true honor to have you on the show. I, I know you have a really interesting story and I would love if you could start by sharing a little bit about your story, a little bit about your background being born and raised in Croatia and eventually ending up in South Africa. Tell us a little bit about that.

Josip "Chuck" Cakic: 1:24

Well, you know, the, the life is unpredictable and I'm, I'm, I'm a leading example of that is I. When I finished my medical school and I did start doing internship in Zagreb, where I'm born in Croatia, um, and I was looking, I always wanted to be orthopedic surgeon. My passion was always orthopedic surgery, specifically sports parts of it. And it happened to be that during my medical school I. Uh, got in touch with a, with a phenomenal person, professor Kosky, who was, um, one of the Vienna school guys, and he introduced me to hip and into the, that phenomenal joint that I believe that is the center of universe, by the way. And I did some, my first researches in a, in a hip as a student, and I always wanted to be in a hip. And I always had kind of idea about the hip from looking into it from the sports side. But the life is different. So what happened is that I finished my internship and I couldn't get the job. They told me that I can get to orthopedic rotation in five to seven years. And I said, I'm not gonna be a waiter for so long. I'm gonna go somewhere else. And in meantime, that was a kind of a year that was already starting having, uh, problems in former Yugoslavia and we didn't know what's gonna happen. So combination of the factors basically. Was asking to look the other options. So I looked in Holland and uh, because as a student I was on exchange in Holland, so I knew people in Holland. But in meantime, my very good friend of mine, from my generation, from my class, he'll end up in South Africa and he found me and said, listen, you don't have to know Dutch. You can come to South Africa. English is perfectly fine. So in a period of literally 10 days, I decided to go. I got the visa, I got married, sold my car, bought a ticket, and arrived to South Africa. So that was basically all happening in 10 days. And, um, and the rest is history. I came here, I looked for the job, I got the job as soon as I got the job in, in, in the hospital, uh. As an intern, because I had to repeat my internship, I went to orthopedics department and I spoke to the prof who was a prof, kin at the time, a guy from Munich, German, and he told me, don't do any shortcuts. Start from the beginning, become a part of the team, and go forward from day one onwards. And that's what I did. And I did my internship, I did my senior house job. I did necessary exams and I became Registrating Orthopedics in 1995 and finished orthopedics. So that was, that was my, that was my trip up become in 1999, I became specialist. And when, for the fellowship, through the fellowship, I learned about more. I did fellowship in the hip arthroplasty, and that's what. Put me in touch with doing the research, put me in touch with the cross-linking and with the, the whole idea of cross-linking.'cause we didn't know what's going on. I mean, we're talking now 19 90, 19 99 going to, in that period of time. And I did research even before and, and, and that's how I landed up with the crosslinking because I dunno if the people now that. The first crosslinking in the world was starting in, in South Africa in 1957 actually. So, so, and it was published, uh, later on by Dr. Alala in, uh, one of the biomechanical researches and congresses. And the crosslinking was used for sterilization, not for improving the quality of polyethylene,

Joseph M. Schwab: 5:24

Mm-hmm.

Josip "Chuck" Cakic: 5:25

but never actually got onto the worldwide market for two reasons. Number one. A limit commercial limitation of upper hate and South Africa at the time. And secondly, it was a caramel color. It was a very much so color of the white coffee. So nobody want to buy it. Everybody wants to crystal bl white specimen not to have something which looks cock, you know? So that was, that was the, and I came across the patients. They were having a SANE implants and they were lasting. Instead of 5, 7, 10 years, the last 20, 25, 30 years. So that was beginning of my thesis and professor of the, the, the PhD that I did. But, um, and during the time of my, of my, um, fellowship. I came across of situations when I was facing the young people and, and the only option was a hip replacement. So I was, I, I was not happy with that and start looking around, start reading little bit and find, you know, actually in a, in a, some funny articles, newspapers, there's somebody is doing a hip arthroscopy. I didn't even know who that is. I didn't even have a clue what's going on. I just needed some blo in, in, in UK is doing it. Okay. Spoke to some of the local companies, says, guys, can you try to find out what's going on? Gimme some idea. And that was 1999. And I start looking into that and researching. And um, that was a beginning of, of the preservation in, in, in, in practice. Not in practice, but in, in kind of a, in a cradle first, like in the beginning. What, what was what? We didn't have equipment, we didn't have anything, and that company brought me a, some instrumentation that I believed, I can't say a hundred percent, that actually was a Dr. Glicks original set that, that something similar to it. So my first operation was basically taking a piece of bone out of the trauma into the joint. So that was the idea to look into the joint post-traumatic. Was the, uh, and that probably took about four hours, if I remember correctly. I dunno, I'm, maybe I'm exaggerating. But the problem was that I had ideas, I had a written, written kind of a guides how to do the procedure and where to look at it. And then I, I'm, I'm, I came across, uh, Dr. Bird's book. Somebody brought me from, from the states, and that was actually Revelation. Then I learned how to kind of, that that is possible, that can be done. And that's how we start with that. And then the problem was that when I finished my fellowship, I was fired from university. So I land up on a, on a, without a job. So I had to go to private practice and that's where my mentor. Dr. Professor Weber, he took me under the wing and I spent 10 years working with him and everything. What I know about the hips I learned from him besides preservation. But the point is that he was a John Charley's direct pupil, and he was a big hip replacement surgeon in the country, but he was the one who actually encouraged me to do something different and to go into the something. Is not gonna be only the hip replacement. And he was a guy who supported me from the beginning and that's, that was amazing from somebody who is a arthroplasty person to have that kind of encouragement. So that helped a lot and that includes anterior approach because this is few years later, I was unhappy with the big cuts. And that's how I start looking into the anterior approach, as you know. That was a time in the beginning of the 21st century when everybody was calling, calling a small incision, a minimal invasive procedure or minimal invasive surgery. So we was making a small cut, but we were still doing the huge damages. So in my tour, going with the hip laproscopy, visiting Dr. Tomberg, visiting Philip Oal was still working in a, in a Pittsburgh, going to France and visiting the, the, the anterior approach guys. Going to Belgium. I went through all of that process of learning and seen learning, getting exposed of different approaches in different, different way, how to do the procedures and it, it was almost going parallel, the hip laproscopy on one side and anterior approach on another side. So, so this is how I kind of try to change the way of looking into the hip, per se. That is not only. Open cut throw, you know, Damond, put something in it must be must something more into it. You know, it, it deserves better. If any other joint in the body, we can look for this little camera. Why not hip? You know? And that's, that's, that's what I believed in it and I kind of saw doing it. And that's it. That's what, that was my beginning.

Joseph M. Schwab: 10:47

let, let's focus a little bit on, on the arthroscopy for just a moment, uh, because I, I'm under the impression you're the first or one of the first surgeons to bring hip arthroscopy to South Africa. Do I have that right?

Josip "Chuck" Cakic: 11:03

Officially, yes. There was a couple of senior doctors that were telling me that they were doing something like that in the, in the eighties, but they were unsuccessful to perform any procedures. They were trying to put the camera into the joint as a kind of experiment or whatever, but they never managed to do any actually procedures. So, um, as, as a, as a, as a procedure, successful procedure, yes, I would say I was the first one in the country.

Joseph M. Schwab: 11:29

So given that hip arthroscopy was, let's say, virtually non-existent in South Africa at the time, can you walk us through what it's like to be the first, uh, what does it take to introduce a procedure and what, what sort of barriers, either logistical or or technological do you run into in a situation like that?

Josip "Chuck" Cakic: 11:56

So. Um, number one, I, I, I wasn't part of university. I was, I was, everything. What I did in my academic, my research and everything, I did everything through the private practice.'cause I had to feed my family, the wife to kids. You have to work. So I work in private practice and. When I came across of hip Laproscopy, as I said, I asked one of the local companies or agencies rather, and which through the work, it's a little bit different system that I believe in the rest of the world. Because we don't have tenders, we can actually, as a private doctors, in a private hospital, you can actually choose for each operation, whatever company you want. other words, the hospital per se, can't limit you to be for that year only for that. Product, you can actually have a variety. So there was, there was a company that brought me the first arthroscopy set, which I used it on a cadavers and I tried to figure it out what those notes are telling me. So this was a beginning, and then when I got across that particular patient, the first patient I used it. And it was successful. I managed to find it. I managed to make a bigger opening and then put the forceps inside and to take, take the instruments. And this was a combination of, because at that stage in my private practice, I was mainly doing from the sports sides, I was doing shoulders and knees. So I wasn't, I was very comfortable with, with 70 degree lens, which I haven't been using at that stage, but I was using, was only 30, but I was comfortable with arthroscopy as a procedure. So it was, that wasn't a problem. The problem was obstacles of getting into the joint. So that was the beginning. The biggest problem is that most of the procedures in the beginning, I didn't get paid because there were no codes. There's nothing to be, how you coded, how are you going to motivate that to do medical insurances?

Joseph M. Schwab: 13:52

Mm-hmm.

Josip "Chuck" Cakic: 13:53

So, so the, that was a big problem. I was coding the knees and shoulders, so combination of, of knee, knee codes and the shoulder codes because labrum is a labrum, a meniscus could be labrum and so and so forth. You know, ACL could be something and osteotomy could be something, but, and there is a code in South African book that can be used as the, allow you to use these more similar coding to what you're doing.

Joseph M. Schwab: 14:20

Mm-hmm.

Josip "Chuck" Cakic: 14:21

Something like that. So, so I had support from the companies obviously because they wanna sell and they saw something, but I didn't have a support from the institution in bureaucracy. So that was a problem for the, from gee whiz for a very long time. I mean, Dr. Bird visited me while I had a, still basically was doing all of that almost. Philanthropically, like, like not get paid and try to do something for, for just because I believed in

Joseph M. Schwab: 14:50

Mm-hmm.

Josip "Chuck" Cakic: 14:51

And that was the reason why we started actually a later on a South African ros, uh, hip oscopy society because in order to get in touch and in order to make, um. Communication with the medical insurance is if, if you're one person is a one story. But if you associate association, it's a different story. So between 2000, when I started 99, 2000 when I started, by 2011, when Sasha was started as a as association, we had literally nine doctor, eight doctors that they started. We're doing to the point, little bit of arthroscopy. So we sat together and that's, that's how Sasha started. But I didn't invent anything new. I actually copied Isha because I was introduced to Isha in 2008. I was one of the first members in Isha, and I met all of those phenomenal guys in Paris when everything started. And then in 2010. Ricky Villa introduced me to board. He asked me to come onto the board, and I became educational secretary for Isha. And based on what I was doing in the sense of education and organizing fellowships and everything through Isha in a, in a first year of my, my educational board position, I said, Hmm, let me do that for South Africa. And that's how in 2011 we started Sasha to have a documentation to have. Strength to have a position that we can go and negotiate with the insurances and that we can make it officially something that is actually we to these days exist. And obviously it's proven to be right, that we believe there's something right. But that was, those are the, those are the limitated limitations and mainly, mainly related to money. That's where the limitation comes into it.

Joseph M. Schwab: 16:51

When you talk about op opposition from hospitals and from, uh, the bureaucracy, I think was the phrase that you used, did you see any resistance from the medical community, at least at the beginning? And, and if so, what was your strategy for building, let's say, trust and, and credibility with your, your fellow surgeons?

Josip "Chuck" Cakic: 17:14

Uh. In 2004, I did my first presentation on the South African Orthopedic Society Meet, were my results of the 51st hippies. And, um, by the time that I came to the podium, I think there was a three people left in the in audience, if that gives you the best answer.

Joseph M. Schwab: 17:41

What, what types of, were these all trauma cases that you were presenting or were they, were these more preservation cases by this point?

Josip "Chuck" Cakic: 17:50

There were of hip, oscopy presented all, all, everything that I put together between 2000 and 2004, I put it together in one paper. It says, this is what I did, this's, how many cases I did. So many converted into the hip replacement. So many are still happy. That's what it was, was there was no big academic science behind it. It's just something to intro to, to, to show to the people. And I must say by that time, Smith, the nephew, which obviously, uh, mark Philippon and Tom Bird did huge influence in United States in, in the development of Laproscopy Equipment and Oscopy as a name. So that came through Smit and Nephew, which does exist as individual company in South Africa, not as agency. Obviously that message came through and me being there with, with Tom Bird and Mark Philippon and being involved in that with those people, they actually kind of said, Hmm, maybe we can, we can do something with you. So I hadn't. Huge support from, from the, from them in South Africa. We built digital theater. They brought me actual hip instrumentation, which hospital bought it. So we had the first unit in South Africa that there was a capable of doing a hip microscopy. And then they start actually organizing the, uh, visitations education, visit, visitation with other doctors. Were coming to my theater and we will work together. And in the same way, uh, I was, we were organizing together the AVA workshops. So this was a platform that started with, that was basically all based on communication between the company and myself. And that was all done through, uh, uh, through them. Obviously with me being, being a consultant. Where the problem is to this space 25 years later is that is no interest in, uh, universities, purely and utterly that in South Africa there is, universities are so overwhelmed with the trauma and with other kind of pathologies that actually arthroscopy per se. That takes, as you know, significant time in theater. It's not like quick knee scope. It takes. Si significant time. It, there's, there's no actual interest in it at this stage. We're still trying, I'm still teaching the guys reg registrars, the junior consultants are coming, but they're coming to my private practice. So I'm associate with academics and with the department in a way that the senior registrars and a consult is coming to me. I'm not going to university. That, and I have obviously fellows, so that that is the arrangement that we have with ac, with academics, with the time the medical insurances accepted. The fact that a oscopy cuts reality and obviously I'm not strong enough in a way to present papers and everything else, is a one man with two hands and not having it. Backup power, but it helped knowing Tom Bird and Mark Philippon and other guys, and Ricky Villa and those guys who actually, uh, published and we had the documentation and we could use that to argue and to basically make back a deal. So this was, this was, uh, very, very important. And as you know, in a part of the time, that was the FAI was, um, questioned the United States of America by the assurances. I think that was somewhere around 2008, nine, somewhere in that times.

Joseph M. Schwab: 21:37

Mm-hmm.

Josip "Chuck" Cakic: 21:38

And then we helped out because we had the data that we could support it. And that's what our, what is so important to have Isha or Sasha or whatever you wanna call it, it's organization, a group. Because you can collect all the data together and you can support. And that's exactly what faria, what we did.

Joseph M. Schwab: 21:56

So these lessons that you learned, sort of growing hip arthroscopy in South Africa, bringing on a new procedure, um, seeking out maybe state-of-the-art or a new way of doing something, What lessons did you learn from that, that you began to apply once you recognized anterior approach was something that you wanted to? Learn more about, or maybe also, you know, uh, grow as a practice in South Africa.

Josip "Chuck" Cakic: 22:31

What I learned with the time, and I think the best example is the study that I did around, on, on, on the development on, on the DDH where I followed up 108. Patients that had a hip laproscopy and what's going on with them on a later stage. And 48% of them actually were converted to the hip replacement in a period of five years. it's maximum five years follow up, but some of them were converted, you know, in a period of a year, and some of them managed to survive two or three years. So depends how you are looking into, what do you classify success. Two years, three years, five years. What is the success of Hepatectomy? That's, that's questionable. That's very individual that we can put, define it ourselves, but for the patient is very individual. Um, the bottom line is that preservation, there is a limit in the madness. And it's the same is a limit in preservation, but you can't preserve everything. So that's why I put being in my mind an aist and. Wanted to preserve whatever I can preserve. It fit perfectly. My supine position for hip laproscopy and my supine position for, uh, anterior approach. So what I learned as a lesson is that my conversion to the hip replacement is much less than it was 10 years ago because I'm not as aggressive with the hippies as I used to be. And what I'm basing at all that my. Maybe 15, 10, 10 years ago, my consultation was half an hour to 45 minutes. Now my consultation, first consultation is an hour. I'm spending a much more time with the patient. I'm listening what they have to say. I'm listening to their symptoms, and I'm making a very careful decision if I'm going to put them into the dead basket or their basket, and I have to have a very, very. A clear picture what their expectations are, that person, and they are some of them, and they say, no, doc, I can't do you because you're doing a scope and I want you to put this stuff into my hip and save my hip. If you can save it, fine. If you can't save it, we try it. They are some people like that, but they are people who have expectations that you cannot give.

Joseph M. Schwab: 24:50

Yeah.

Josip "Chuck" Cakic: 24:50

And that's the lesson that I learned to listen to the people and to try to make at least. Possible mistakes. Back to the 5,000 years ago, Hippocrates says, do no harm.

Joseph M. Schwab: 25:03

So as you're learning anterior approach, tell me a little bit about that journey you, you mentioned with arthroscopy It, was. Um, learning, uh, you know, through, uh, Tom Bird's book. Tell me a little bit about how you sought out your education for anterior approach.

Josip "Chuck" Cakic: 25:24

It, that journey started almost the same time as I did at my fellowship with NG approach because Prophet Weiberg was, as I said, he was a Charley guy, and, uh, one of the first, you know, first two months I have to do the charney wiring, which I wouldn't recommend to anybody anyway. The whole process of chandley is, um, is beautiful. You, you can put a foot inside. And it's a beautiful reconstructive procedure, but it's not, in my mind, it's not for primary. So I was looking into how to avoid such a collateral damage, rather you, and, and we start with a, with a, with the whole idea of, of making incision smaller and smaller. And then I brought to Prof Webert Doors book about anterior approach, which came out somewhere around 2005. We looked into that book and we looked into the thing says, okay, let's try to make incisions smaller. Let's try to avoid these damages. Eventually we managed to come down to making a lateral approach or, uh, variation of lateral approach through the 10 centimeter cut. Obviously the depends on the patient. You can't do that on a, on elephant, but nevermind. It was a very much so smaller. But it, I wasn't happy with that because I then, I started reading, um, about. Um, anterior approach as, as being anatomically anterior approach. So the first patient that I visit was in, in Belgium, late Dr. Devita, who, who was doing a figure of, of four, and he was, uh, I believe one of the first guys in in Belgium who did that. And I looked at it and it was fun. But South Africans are big people. They are the then figure of four. You need to have four assistants to keep that leg in position. You know, my opinion, it's my, a little bit of humility, but the point is that it wasn't something that I was, I was impressed with anatomy. I was impressed with the procedure, but it not reproducible for me in my environment. Then I went to Switzerland and spent time with Theus Michel, who was doing his way of doing it. Which was, uh, kind of, uh, upside down in my mind. So I said, no, this is not for me. Then I visit Dr. Berger, who doing, who was doing a double incision procedure, and I liked it. I really liked it because for us in South Africa, trauma is, is, is a bread and butter, and we know how to put a femoral nail down the shaft. That procedure was based on that. Basically you were putting the prosthesis through the separate incision as a femoral nail, and we started zebra, we started, we did, uh, so many cases, but then was stopped for whatever reason globally that procedure was stopped, but that was a very, very good idea. How would. Go into in, in my practice. Would that be so successful? I don't know. But my patients that I did for now, thank God they're very good and they are happy with it. And then I end up doing it entry approach French Way. The company came to me and they knew, I mean, people talk, people gossip people, uh, speak around, so they knew that I'm experimenting with something. So the company came, says, we met somebody in France. Would you like to go and see the entry approach through the. This way. Okay. Never heard of it. Let's go. And that's it. I married the procedure and I'm still married. That's it. And I, and main reason for me is it's reproducible using a table. I can put 140 kilo person, I can put a three meter person, I can put a small little guy. I did operation with a stump. I did with amputation. I did the different operations and different people. It's always the same. And that's what makes, and obviously because hip microscopy basically on the same table.

Joseph M. Schwab: 29:28

Mm-hmm.

Josip "Chuck" Cakic: 29:29

So I can do both procedures in a bo identical way of draping, preparing. Doing everything in the same way in an at same position.

Joseph M. Schwab: 29:40

And so how did you get connected to the European anterior hip meeting? Was it through these connections in France or were there additional connections that that got you involved in that meeting?

Josip "Chuck" Cakic: 29:52

I met the mad guy in 2010 when Ricky Villa approached me to become a part of Isha board. The other person who was approached was Richard v uh, Richard, uh, field. So Richard Field and myself, we know each other for, since basically 2010 or nine. And, um, we stayed very good friends, I mean colleagues and everything else. So he invited me to come to to London this year. And that was it. That was, I suppose, uh, also I think the Feder Lord had a certain interest in it or influence into it because he knew that I'm was doing it since my first. My first, uh, uh, anterior approach was in December, 2006. So somewhere there, yeah. The first private one was in January, 2007, but I did some of them in a, in a, in a, uh, with, with somebody else and, and I was visiting in 2006. The France, actually the first person in South Africa who did it was a few, few months before me, was a. Doctor by name Ybe from Cape Town. So two of us, we were going together for, for the training to Paris, and that's how we started.

Joseph M. Schwab: 31:04

Tell me a little bit about the population of surgeons in South Africa doing anterior approach. Is there, is it still relatively small? Is it a growing population? Um, or has it, uh, you know, has it blossomed?

Josip "Chuck" Cakic: 31:18

Uh, yeah, I wouldn't say that is blossomed. Uh, I think it's, uh, uh, it's a, it's, it's a, again, mea and he's not represented into, or MEA is, I'm saying MEA is a name for, for, in my mind that is a, an entry approach with the table. That's, that's what I'm talking about, is represented in South Africa with agency, not with the region company. So that agency tried to follow the same rules and patterns of education. So it's a very strict, very Swiss, if you will. So you cannot do it on your own. You have to pass the certain rules. You have to go and visit, you need to go for the education, then you need to do the cadaver workshop. Then you need to have a a, so many surgery done with a consultant, and then you have to do so many surgery yourself. With a consultant presence. So it's, it's it's ongoing process. And that in, in, in South Africa, in private sector that I'm talking about, because essentially we have two universe, we have a private sector that covers in a region, about 15 million population out of the 60 with a medical issue, private medical insurance center, and you have a government system. In a government system. Anterior approach was not as. Seen as as a, as a, as going, as, as, uh, fast as in a private, but the junior, again, influence of the education, influence of the meetings, influence of the journals brought to the, to the, to the surface that, well, we need to learn that. We need to know that that is, that is what is all about. So yes, in South Africa, we published that paper last year. In 2024, when we look into the, answering the questions of, from South African Society, there is a, in a region about, uh, 36% of population of, of South African Orthopedic Society, they are doing it or they're interested to convert into the interior approach. Approach. So it, it is, it is a, it is a, in significantly increased interest in it. I mean, since London I was involved in, it was in June, so in last two, three months, whatever, I was involved within two cadaver workshops. So altogether that was about 12 surgeons. They were interested in it and another four surgeons were coming through my theater for visitation. So it is, especially the junior guys, they are, uh, very much so. In line with being educated in anterior approach, and I'm sure if we repeat the same study in about two to three years, we gonna double those.

Joseph M. Schwab: 34:05

Yeah, and it, it sounds like those numbers are, are very similar to what we see in Australia, which is around a third of surgeons either doing or, or highly interested in anterior approach. Um, one of the things that I get, uh, the benefit of, I guess when I travel is I get to meet, um, young surgeons who, many of whom listen to the podcast, which is great and are interested in what more experienced surgeons like yourself. Um, have to say about, uh, you know, advice, sort of life advice. And so, you know, you mentioned in your story having multiple mentors that sounds like were very influential in your career and the choices that you made. Um, for the young surgeons who are listening and who are interested in orthopedics, what advice would you give to them?

Josip "Chuck" Cakic: 34:57

If I can answer with something else, it's that when I travel around, I try to get into, visit somebody like you in your home, in your theater, and I'm trying to learn from you. So the message is very, I mean, I, I met Joel Madam many years ago on the meetings and things like that, but um, last time when he was in South Africa, we spent more time together. And I thought, you know, what? If this guy after so many years can use a X-ray in theater, for example, and I'm having a 3000 operations and I'm not using it, why should I not start using it? Uh, the message is it's never late to learn, and it's never late to change and to adapt and to get better. So. Wherever I go, I try to listen. I try to learn. I try to change. I try to make it better. So I think for the juniors, that's the best message. Always. Wherever you go, instead of going twice to the, with the guys in a pub for a beer, go once and spend some time with somebody in theater and try to pick up the detail because we all different and. Long, long time ago, my prof told me while I was a student, says, if you want to be good in medicine, you need to know English, German, and Italian. There's a completely different, and Italian and French he met says, this are completely different cultures and everybody thinks different, and you pick up the best out of the three and you're going to put your own soup. And that was the best message that I ever heard and to these days. I respect American Logic. I respect English Logic, but they so much into Italians. There's so much in the Germans, there's so much in the French and, and we all have to read, learn from each other, and we all gonna get better.

Joseph M. Schwab: 36:59

Uh, well, I. think that's a great message for our young learners, but it raises a question. So 3000 hips in you learn to use fluoroscopy. Are, are there other technology? Or, uh, innovations that you're looking for on the horizon, things that get you excited or things that concern you.

Josip "Chuck" Cakic: 37:21

Both. Um, I'm like, like any orthopedic surgeon, I like toys. So, so this is, this is, this is, this is what, what the companies knows and they're selling us toys on daily basis, you know, and even though it's the same thing, it's just new. So we want it. But the point of the matter is that we need to be very cautious. Uh, uh, are we going to use a computer, I mean computer, the robotic surgery to replace surgery? That, that, that is something that scares me because I, why do I have a fellows? Uh, because I wanna know who's gonna operate on me. It's as simple as that. And, and I don't want DaVinci to operate on me. I want somebody else. I want somebody who has a brain to hands and can make a decision. I'm, I'm probably rough, but the point of the matter is, is that my problem is that what if something technically happens and you need to convert? And as far as I know, the conversion from robotics into the manual surgery is not so simple. Um, I'm at the moment, very much so involved into, uh, into the navigation related to the hip laproscopy, because navigation is a tool, is something that can help us on our, I mean, using a map. Using A GPS, especially if your map is in a hand to your co-driver, which happened to be your wife, and then you don't know where you are. But the point is that the point is that there is a place for the new things, but that doesn't mean that our basic education and basic training has to begin with the new technology. I think that new technology can be adjuvant through the basic training. That is, that is what I, me, um, after so many years of traditional and uh, um, kind of experience, I would, I want to know if somebody using robotic pH enough, but can you do that operation in the same manner without the rock? That's, that's my question. Preparation of surgery, anything around the surgery, fine. We can use any technology we want, but when it comes to the finesse of the hand and eye hand coordination, hmm, that's, I would like to know that that surgeon knows how to switch the autopilot and go land properly.

Joseph M. Schwab: 39:50

Do you have any final sort of inspiring message for any of our listeners, especially the young surgeons out there?

Josip "Chuck" Cakic: 39:59

Okay. I wouldn't be where I am without my family and my, my support. Uh, that's the first thing. Don't, don't ever forget who's, who is behind you and who supports you. That's, that's the first thing you can go forward. Medicine and being a surgeon is not a job. It is a life legacy. That is your life. That is a 24 settle, and your partner has to, I'm extremely lucky that, that we live as a team, so I don't have a problem with that. We had a crisis like everybody does, but that is the most important. In my opinion, most important thing to try, when you go up and you wanted to improve, you want to go up the ladder, whatever, you will never succeed it if you don't have a support you. That support gives you the energy, that support gives you everything that you can go forward. And if you go forward, just try to listen more than talk. I never learned that, but anyway. But it's so much to absorb and so much to take it, and, uh, much less to criticize and much less to say

Joseph M. Schwab: 41:24

I really wanna, uh, thank you Chuck, for agreeing to appear and for being our guest here on the AHF podcast.

Josip "Chuck" Cakic: 41:32

My absolute pleasure. Thank you again for having me. It was absolute pleasure. Enjoy.

Joseph M. Schwab: 41:37

Thank you for watching this episode of the AHF podcast. As always, please take a moment to like and subscribe so we can keep the lights on and keep sharing great content and great conversations just like this. Please also drop any topic ideas or feedback 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. Episodes of the AHF Podcast come out on Fridays. I'm your host, Joe Schwab, asking you to keep those hips happy, healthy, and humble.