On today’s episode, I talk with Simon Thomas, Consultant Paediatric Orthopaedic Surgeon at the Bristol Royal Hospital for Children. Trained in both the United Kingdom and Canada, including under the legacy of John Wedge and Robert Salter in Toronto, Simon offers a perspective shaped by two systems with different approaches to developmental dysplasia of the hip.

We begin by examining how training lineage and institutional norms influence clinical decisions, particularly concerning surgical timing, the use of the Pavlik method, and criteria for progression to open or closed reduction.

We discuss the landmark study he co-authored with Wedge and Salter, following patients for over 45 years after open reduction and innominate osteotomy, and what such long-term data can teach us about survival, revision, and functional outcomes.

We talk about the strength of the evidence in orthopedic surgery and the reasons for the demise of a prospective randomized control trial set up in the UK, looking at the presence or absence of the ossific nucleus when considering surgical treatment of developmental dislocation of the hip that could not be implemented due to logistics, and turn to his work on the medial approach and how to balance the risk of complications with surgical completeness.

Finally, we zoom out and reflect on the broader themes: what defines success in pediatric hip surgery, what a 50-year prospective study should look like, and whether certification diplomas should be widespread

This episode is a masterclass in long-term thinking, featuring a thoughtful surgeon who has witnessed hips transition from Pavlik harness to total hip replacement.