July 2025

Beyond complex revision THAs involving bone loss, pelvic discontinuity, or post-traumatic and developmental anatomical deformities, the most interesting case this year was the treatment of a congenital hip dislocation previously managed with conservative surgery in childhood. A robotic-assisted primary THA was performed. Thanks to personalised 3D planning and robotic assistance, the implant was optimally positioned despite the altered anatomy, resulting in an excellent functional outcome.

Probably the most challenging case of my career was a revision THA fixed in place by a large periarticular osteoma in the context of chronic sepsis. The procedure required a dual surgical approach to safely release the joint, followed by combined acetabular and femoral reconstruction. The complexity was both technical and strategic due to major soft tissue damage and residual infectious risk.

The most enlightening and rewarding case was the management of a patient with hip osteoarthritis in the context of a selective myopathy of the trunk extensors. This neuromuscular condition had led to a severe sagittal spinal deformity with camptocormia and a previously failed spinal fusion. The patient underwent a complex three-stage surgical strategy: first, a two-step spinal fusion combining an anterior approach with ALIF at L4-L5 and L5-S1, followed by a pedicular subtraction osteotomy (PSO) with extensive correction and extension of instrumentation up to T4 with iliac fixation. This was subsequently completed by a total hip arthroplasty using a dual mobility cup implanted at 40° of inclination. The overall goal was to restore sagittal alignment and upright posture. This case stands as a clear illustration of how both spine and hip surgical background and individualised surgical planning can restore both function and posture in highly complex clinical scenarios.

I particularly dread post-infectious sequelae cases, most often following repeated episodes of periprosthetic joint infection (PJI). These patients have often undergone multiple prior revisions, resulting in severe acetabular bone loss, compromised pelvic fixation, and — most critically —extensive damage to the abductor mechanism and surrounding soft tissues. In such scenarios, traditional reconstructive principles are undermined: surgical planes are distorted, tensioning is ineffective, and the stabilising muscular envelope is no longer functional. The risks of instability, mechanical failure, and unsatisfactory outcomes remain high despite careful planning and the best surgical intent. These are the most humbling and demanding cases we face as reconstructive hip surgeons.

One of the most insightful articles I read this year was published in The Bone & Joint Journal and focused on the use of machine learning to predict the risk of instability after total hip arthroplasty based on spinopelvic parameters.

Is it feasible to develop a supervised learning algorithm incorporating spinopelvic mobility to predict impingement in patients undergoing total hip arthroplasty? Bone Jt Open. 2024 Aug 14;5(8):671–680.

It offered a compelling perspective on how artificial intelligence could be integrated into preoperative planning to support individualised implant positioning and risk stratification. As someone deeply involved in robotic-assisted surgery and kinematic alignment, I found the potential synergy between data science and surgical decision-making particularly inspiring.

Given my specific areas of interest and our current research focus on THA functional positioning the integration of complex lumbopelvic kinematic data into 3D planning and robotic surgery, this article aligns perfectly with our priorities and ongoing studies.

There’s a certain ambivalence in how I spend my time outside the operating room — no doubt influenced by the pace and demands of our profession. On one hand, I tend to maintain a high level of activity through sports and other dynamic pursuits, a natural extension of the intensity of surgical life.

On the other hand, I have a deep affinity for all forms of art — particularly music, painting, and literature. These interests allow me to step away from a world that is often driven by precision, logic, and pragmatism, and to reconnect with a more emotional, introspective, and balanced dimension. Whether it’s through silence, artistic contemplation, or reading, I find a quiet counterpoint to the technical rigour of daily practice.

This summer, I’ll be travelling to Peru and Bolivia with my wife and our three children. These holidays are above all a cherished opportunity to come together as a family and share meaningful experiences away from daily routines. We’re particularly drawn to Latin America — its rich cultures, diverse landscapes, and unique ways of life. Exploring South America as a family allows us to reconnect with one another while discovering new perspectives that go far beyond the geographical journey.

Just last week, I operated on a 31-year-old patient with the largest native-hip synovitis I’ve ever encountered — a PVNS that had been slowly and silently eating away at the joint for years. A mix of patient and doctor delay. Fascinating pathology and challenging surgery.

I can’t name just one, but successfully managing chronic hip infections — especially when the patient has endured multiple failed treatments — is always immensely rewarding. Seeing them walk away pain-free after such a long journey is a great feeling.

Those same chronic infections! Whether it’s a one- or two-stage revision, they’re technically and emotionally challenging for everyone involved.

I’ll have to get back to you on that — a few are bookmarked, and I want to do them justice.

Building and creating — houses, gardens, outdoor spaces. And when winter comes: skiing, preferably off-piste.

We’ll stay at our country house north of Stockholm, and also plan a week of hiking up north — Abisko and hopefully into Sarek. It’s true wilderness, with reindeer, the midnight sun, and blissfully no phone signal.