Today I’m joined by Dan Sucato, Chief of Staff at Texas Scottish Rite for Children, an institution that currently sits at the top of the U.S. News & World Report rankings for pediatric orthopedics.

We start with Perthes, specifically, one of the most complex reconstructions we have for the post-Perthes deformity: femoral head reduction osteotomy. Dr. Sucato is one of the few surgeons worldwide to have published on this procedure. I was able to pick his brain about when he considers it, how he executes it, whether it can realistically be taught, and how to think about adolescents and young adults with painful, misshapen femoral heads who are still “too young” for arthroplasty. We dig into what problem FHRO is really trying to solve, how he selects patients, what he tells families about risk and recovery, and where he draws the line between attempting salvage and accepting that a hip is no longer reconstructable.

From there, we shift into leadership. I asked him what it actually means to lead a program that everyone else sees as “number one”: what metrics he trusts more than USNWR, how he balances volume, access, and complexity, and how he protects trainees and staff from chasing rankings instead of chasing better care. We talk about culture, humility, and how to build a place where people can speak up, disagree, and still move in the same direction.

It was a grounded, honest conversation about hard hips and real leadership.