The View From Outside the US (2026 Traveling Fellows - Ep 3)

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A Toronto hip surgeon on what two weeks in the operating rooms of leading US anterior hip surgeons changed in his own practice, and what American hospitals could learn from Canada.

For hip surgeons weighing the AHF Traveling Fellowship, and for anyone working to make anterior approach care more efficient inside a hospital system.

This is the third and final conversation with the 2026 AHF Traveling Fellows. Host Joe Schwab sits down with Justin Chang, an adult hip and knee surgeon at Humber River Hospital in Toronto who trained at St George's, University of London, and the University of Toronto. Trained in the posterior approach, he switched to the anterior approach when he started practice and now uses it for 95 percent of his hips. He joined the fellowship to build confidence with complex and revision cases.

What he brought home started in the OR: hooking a cobra retractor on the Hana table's ladder, trading a Charnley for a Gelpi, nail conversions in Houston, complex revisions at OrthoCarolina, and the soft tissue restraint that separates good anterior surgeons from masters. The bigger lessons came from around the surgery: sterilization and tray flow, OR time tracking, PA-supported teams, and how a high-volume surgeon stays present with every patient. He also makes the case that a generation trained almost exclusively in the anterior approach will need to do its hardest revisions from the front, and explains why he expects hip resurfacing to make a comeback.

Coming from a fee-for-service system where two weeks away means two weeks without income, he is candid about the cost, and about why the network of host surgeons and co-fellows he built was worth it. Asked what American surgeons could learn from Canada, his answer is efficiency: how Humber River runs an efficient anterior hip workflow inside a public hospital.

Thinking about applying for the 2027 AHF Traveling Fellowship? Applications run through the Anterior Hip Foundation, linked below.

⏱️ Chapters:
00:00 Meet 2026 AHF Traveling Fellow Justin Chang
02:27 Switching from posterior to anterior approach
03:55 What the fellowship teaches beyond surgical technique
07:43 Anterior approach retractor tips and Hana table tricks
10:50 Nail conversion and complex revision via anterior approach
13:20 Why young surgeons will revise through the anterior approach
16:41 Anterior hip surgery in the US vs Canada
18:29 What US hospitals can learn from Canada about efficiency
19:32 Soft tissue handling and what surgical mastery looks like
21:35 How master surgeons communicate with patients at high volume
23:36 Bringing home OR time tracking, OrthoGrid, and PA teams
26:22 Is the AHF Traveling Fellowship worth two weeks away?
30:18 Future of anterior hip surgery: revisions and resurfacing
32:09 Advice for future fellows: practice building and marketing
33:45 The biggest takeaway that wasn't a technique

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This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

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