Dr. Drake LeBrun

Dr. Jack Wong: All right, guys. Welcome back to another series of best provider spotlight. I’m here with my colleague Dr. LeBrun with a Fondren Orthopedic Group. Welcome.

Dr. Drake LeBrun: Hey, Dr. Wong. Thanks for having me. I appreciate I appreciate the invitation to be here.

Dr. Jack Wong: Yeah, for sure. So, for those of you who don’t know, Dr. LeBrun is a orthopedic surgeon. We’re Fondren Orthopedic Group who specializes in hip and knee replacement surgeries. So today I’m going to ask a couple questions so the viewers can get to know you. We’re going to talk all about the hip today. So the first question I have is what made you decide to be a orthopedic surgeon?

Dr. Drake LeBrun: Yeah. So so the answer actually pertains to hips. So it’s a good um first question to ask. So so I knew that I wanted to be a surgeon from a fairly young age. I sort of had this inkling in like even middle school, high school like I wanted to help people and I wanted to use my hands and there are a lot of different ways you can do that but the way that that came to be for me was being a surgeon. And so between college and med school I had the opportunity to travel abroad for a year to study surgery in lowincome low resource settings around the world. So I was in South America, Southeast Asia. I was in subsaharan Africa for an entire year looking at this and and the the experience that sort of got me hooked onto orthopedics and I never really looked back from happened in Peru. So I was helping some orthopedic surgeons from the states actually come down. They came down several times a year to the Amazon rainforest in central Peru. And essentially they came down for like two weeks at a time, did a bunch of orthopedic surgery, helped a lot of people, and then they would fly back home. And they had they had doctors on the ground in the interim to sort of help follow those patients. And I was essentially serving as a Spanish translator for for them. And the first surgery I saw them do was a hip replacement on a guy who was he was a father. He was an active man like in his 40s or 50s and had had a motorcycle accident. broke his hip, had no access to surgical care to fix it, and he basically became bedbound, unable to bear weight on his hip at all for years. He sort of lost the ability to provide for his family and really lost a lot of function. So, they did a hip replacement on this guy and I remember seeing him the next morning up and walking again for the first time in years. And from that point onward, I was like, “This is cool.” So, so I in med school, I entertained a lot of different things. I tried to keep an open mind, but at the end of the day, orthopedics was what I wanted to do with my life, especially hip replacement and knee replacement because I thought that the ability to do good with those procedures was so profound and um so that’s what got me into orthopedics and I you know I am here now as a hip and knee replacement surgeon.

Dr. Jack Wong: That’s awesome. Yeah, you definitely can see the transformation of patient that comes see us before surgery like hip and knee replacements and then after the replacement, you know, they’re like a completely different person, right? And it only gets better with the right rehab. So, we definitely appreciate, you know, what you guys do for our patients and just patients uh overall. So, that’s that’s great.

Dr. Drake LeBrun: Yeah.

Dr. Jack Wong: So, what makes you different from other orthopedic surgeons who do, you know, hip replacements?

Dr. Drake LeBrun: Yeah. So, so, um, I, so there’s sort of two ways to answer that question. So, I’ll give you the first sort of cheesy way, and then I’ll give you a more objective way. So, I, uh, really value like patient care and the human interaction. I like sitting down and spending time with patients. My clinic may run a little bit late as a result because I like to give every patient the same amount of time that I would give a family member. And so, so one of the things that I value or that that I like to practice is just being kind to people, listening to their story, understanding what they’re going through, shaking their hand, looking them in the eye, and understanding what’s going on, and not just treating their X-ray, right? I think it’s very easy, especially as an orthopedic surgeon, to treat an X-ray, but what I like to do is really like focus on the X-ray, understand what’s going on, but but treat the patient and what they’re going through. So, so that’s the the cheesy answer. The um I guess the more objective answer is I I came from an institution in New York. I trained there where we did the most hip and knee replacements in the country. We over 15,000 hip and knee replacements a year there. And then from there, I was able to train additionally in Europe. So, I was given the opportunity to learn how the Europeans do hip and knee replacement, especially like complex primary and revision surgery. So I got to train in Germany, Switzerland, the UK and Italy and understand a little bit more uh gain an international perspective on hip and knee replacement. And then I came back home to Texas and and now I’m here. So I I come with the perspective of a really high volume advanced center in New York as well as the perspective of how Europeans have been dealing with these same problems using slightly different approaches, different techniques uh and now and now practice that here in Houston.

Dr. Jack Wong: That’s awesome. Would you say the uh techniques that you learned in New York compared to Europe is wildly different or there’s a lot of similarities and just like very tactical differences?

Dr. Drake LeBrun: They’re they’re mostly similar. I would say 80 to 90% of what we do is similar, right? And there is a lot of overlap, right? We have Americans who go to Europe to train and we have Europeans who come to the states to train. And some of the people I learned from in Europe had previously trained in the institution I trained at in New York, right? So, so most of it’s similar. I think there are some unique differences in in sort of specific treatments for specific conditions. For example, in Germany, I really went to the epic European epicenter for infection care. So, infected hip and knee replacements and understanding how they treat those in one surgery rather than two, which is how we’ve mostly done it here in the states for a really long time. understanding that doing bikini approach um anterior approach hip replacements in Switzerland at the place where they sort of originated that idea which is a slight modification of how most surgeons do anterior approach hip replacements here. So the subtle things most of the surgeries most of the techniques are the same the patient care is excellent across the board but just learning some subtle differences about how they do things there I think I was able to collect and bring back home.

Dr. Jack Wong: Yeah, for sure. And you know, you bring up a good point about, you know, spending the time with the patient. Um, because we send several patients your way and, you know, when they come back, they’re always like, yeah, you know, Dr. LeBrun actually spend the whole session with me. And that’s surprising to them because, you know, their prior experience with other surgeons is they get in, X-ray, and then they’re out the door in like 10 minutes, and they’re still like wondering, well, I had a bunch of questions, but, you know, he only saw me for a few minutes, so now I guess I have to make an appointment to see wherever, right? So, we really appreciate that about you just, you know, giving patients the time to answer questions and clear up any thing that might be um, you know, scary and fearful. Right. Because I think that managing expectation is a a a big thing for a lot of patients, especially if it’s their first hip replacement. Right.

Dr. Drake LeBrun: Right. Right. And I think that’s so true. And what I what I’ve learned a lot from from the past is helping manage other surgeons patients and understanding that, you know, after surgery, if they have questions about swelling, if they have questions about how long they’re going to have pain, if they have questions about what level of function they’re going to have at two weeks, four weeks, six weeks, what have you, I sort of like to take all that information and provide all of that on the front end. And admittedly, some patients are going to ask those questions anyway, but I think it’s helpful to manage their expectations early. And I know we’re talking about hip replacement, not knee replacement today, but for knees, for example, I tell most patients like, “You’re not going to like me very much for the first three to four weeks because the recovery is really hard.” And I have patients come back at week three and week four saying, “You’re right. I don’t I I sort of like you, but I don’t like you that much right now.” And it’s better to have warned them than to for it to sort of come as a surprise. Um, but but I do I do like spending time with patients, but to be honest with you, all those patients that you’ve referred to me, they may like me, but they love y’all. So, you know, it’s a two, right? You take care of the front end, we take care on the back end, and it just becomes a great relationship. So, um, thank you for what you what you do for for everybody.

Dr. Jack Wong: Yeah. So, can you tell me about um who is your ideal patient for hip replacement?

Dr. Drake LeBrun: Yeah. So my ideal patient for a hip replacement is someone who is very motivated, who understands their own health and wants to be better, who wants to have more function and a higher quality of life than what they have and they feel like their function and quality of life is impaired by their hip. Right? And the other thing too is I really will not talk about surgery until a patient has tried several other techniques first. Right? So that would that would include things like anti-inflammatories, Tylenol, activity modification, stopping doing the things that make their hip hurt every time, right? Stopping running, go to cycling or something else. Physical therapy is an important one. I want them to have tried that. Right? And and other things like injections, right? So if they’ve tried everything and they come to me and say, “Look, I I just want better function. I want my hip to start hurting.” That’s the ideal patient. If a patient comes in having not tried any of those things, I won’t really broach the topic of hip replacement other than as sort of like a this is something we might talk about down the line. Right. So ideal patient is someone who is motivated, wants better function, quality of life, less pain, and has tried a bunch of other techniques first.

Dr. Jack Wong: For sure. Yeah. So I know when it comes to total hip replacement, you have the anterior approach and a posterior approach. Can you talk a little bit about like what each of them are and kind of what the recovery process look like or what the differences are pros and cons of each?

Dr. Drake LeBrun: Absolutely. It’s a great question. There’s, you know, this is a conversation that gets brought up a lot when I talk about hip replacement with patients. So, currently in 2025, there are two primary ways to do a hip replacement. There are others out there, but these are the two that 99% of surgeons do. Anterior approach and posterior approach. What that really means is from the front and from the back, right? Posterior approach it’s really it posterior means like back but it’s really more from the side whereas anterior approach is more from the front. Okay. There are pros and cons to each of these approaches. I will tell you that about 90 to 95% of the hip replacements I do are anterior approach hip replacements. If I wanted a hip replacement for myself or for a family member, I would recommend or want an anterior approach if I were a good candidate for it. Okay. Not everyone’s a good candidate for it. And that’s why about 5 to 10% of my hip replacements are posterior approach hip replacements. And posterior approach is a perfectly good way to do a hip replacement. And I I train doing more posterior than anterior hips in training. And now in practice, I’m mostly anterior approach. So the principal benefit of an anterior approach hip replacement is stability. So the risk of dislocation and this is not just my numbers, this is like national numbers. The risk of dislo dislocation after an anterior approach is about one in a thousand. whereas it’s about one in a 100 after a posterior approach. Okay. So that’s a factor of 10 difference. That’s a big difference, right?

Dr. Jack Wong: Yeah.

Dr. Drake LeBrun: So that is the biggest I think advantage. The other advantage in my hands for anterior approach hip replacement is that when I do an anterior approach, I have X-ray in the room and I’m checking my work as I go. So there are no surprises. Like the X-ray that I get in surgery is the exact same X-ray that I see in the PA when the patient gets it in recovery, right? And it’s because when you do an anterior approach, the patient is just lying on their back and it’s very easy to get an X-ray and to to assess what you’re doing implant-wise inoperatively. So the disadvantages of anter approach are some patients have numbness over their thigh after surgery and sometimes that is persistent. Rarely does that bother them long term, but in order to do that surgery, there’s a nerve that basically crosses right over where our incision normally is. And some patients have numbness in their outer thigh after surgery. The other issue, and this goes into patient selection, is that some patients can have wound issues, meaning that the wound does not heal that well. And so what I’ll do every time I look at a patient who’s a candidate for hip replacement, I’ll look at the skin around where I’m going to make the incision. And if the skin does not look good, let’s say there’s possible infection brewing around that area, like some cellulitis or something, I will absolutely not do an anterior approach hip replacement. If the skin is very very thin, I will not. And if they have if they have an abdomen or belly that’s sort of overhanging where I would do the incision, I will not do that and I’ll do posterior instead. Okay. So, contrast to posterior approach. I think posterior approach has a couple distinct advantages. One is rarely if ever do patients have wound complications after surgery. Rarely. Uh the skin heals up really nicely. to uh the exposure, the ability to actually do the surgery is is really easy once you once you do it. The surgery, I think, is a little bit quicker if you do it from the back than from the front. From the front takes a little bit more time. Um the downside of it is that you do have to take the glutius maximus muscle and basically split it in half and then put it back together. You’re not necessarily cutting the muscle, but you are splitting a very large muscle and putting it back together. And there are two muscles that you do have to cut and then you repair back together. Okay, that’s the that’s sort of the downside of posterior approach. The principal downside of course being that the risk of dislocation is a little bit higher than an anterior approach. Overall, both approaches are very good. My patients who have either are equally happy. The data would suggest that in the first six weeks after surgery, patients with anterior approach tend to recover faster than patients with posterior approach. and at one year or even six months after surgery, they’re all doing the same. Right? So, it’s a it’s a short-term benefit for anterior approach. The long term is about the same. The one caveat to that is the dislocation risk is is lower in anterior approach.

Dr. Jack Wong: That’s a great answer. That’s a common question we get asked all the time. And for most part, most of our patients we see in the clinic who come to us after hip replacement are poster approach. And the very few that we get that are anterior approach, like you said, they recover so much faster. um as far as like that first six weeks and stuff. So definitely in line with kind of what you’re discussing for sure.

Dr. Drake LeBrun: Yeah. Yeah. I think there there’s there’s a lot of talk about like muscle sparing approaches in hip replacement and I think people equate the anterior approach to a muscle sparing approach. I think to some degree that is true. We don’t take any muscles and split them in half like we do in the posterior approach. We take the TFL which is a muscle in the outer part of your thigh and sort of move it aside and then it just falls back into place when we’re done. Um, so I think there is something to be said for that. Like we’re not cutting as much muscle when we do it from the front. That said, when we do it from the back, we put those muscles back where we found them anyway. So I don’t I don’t think I don’t think that’s what makes the difference. In other words, I think at the end of the day, both both of them tend to do pretty well, but the recovery is just a little bit quicker with an anterior approach.

Dr. Jack Wong: Yeah. So you mentioned that like six weeks usually first six weeks easier uh recovery for anterior typically but for the full gambit would you say it takes about a year to recover from total hip replacement whether it’s anterior or posterior?

Dr. Drake LeBrun: It’s a good question. So so I tell patients that they’ll be about 95% better by two to three months. Okay. So the full recovery after hip replacement takes longer than that. I would say somewhere in the four to six month range. I definitely think if you define recovery as sort of like no more pain and back to the activities you like to do, I think it takes somewhere around 3 to 6 months to get there. If you define it as like I’m so much better than I was before, it just takes like two months to get there, right? Or less. But even then, you know, if you’re looking more forward to like a year or more, of course, patients are going to continue to get stronger, right? they’re going to get back to the activities they like to do. They’re going to be able to walk more. They’re going to be able to play whatever sports like they they do or or like playing with the grandkids or what have you. They’ll be able to do that better. So, I do think there’s continued recovery, right? It’s it’s not like it’s not like you’re bad at two months, but in two months and one day you’re excellent. It’s sort of like a gradual recovery. Um uh but yeah, I would say about 95% of the way there is when you’re you’re at two months.

Dr. Jack Wong: Awesome. Cool. What’s something that most people don’t know about hip replacement that they should know before getting a total hip replacement?

Dr. Drake LeBrun: Yeah, so um I have a lot of patients that come in and they try to push it off as long as they possibly can and I completely understand the tendency to want to push off a major surgery. Undoubtedly understand that. But the our data looking at patients who have hip arthritis and following them over time, most patients who get a hip replacement tend to say they wish they had done it sooner, right? And I think that’s just because they sort of wait until the hip is really gone. Like bone on bone arthritis, lots of bone spurs, very very stiff, very functionally limited, using a walker, using a cane. And an intervention a few years earlier probably would have led to a few years of better quality of life. And I don’t think people really appreciate that until they’re already past having the surgery.

Dr. Jack Wong: Yep. And what is um like how long does a total hip replacement last for if they take care of it and do all the rehab and you know lifestyle changes afterwards?

Dr. Drake LeBrun: Yeah. So that’s a another great question. So I tell patients that at 10 years about 90% of patients still have their same hip replacement and at 20 years it’s about 80%. So at 30 years it’s in the 60 to 70% range. So 30 years out from their surgery the vast majority of patients still have their hip replacement. And then I I clarify that by saying that data is based on implants we put in 30 years ago. Right? Because we don’t know like we’ve made modifications and improvements to the hip replacements that we have now. We don’t know what a a hip replacement that was only developed in 2024, how long that’s going to last until 204. So, so it’s but we do think that we’ve taken what we have done in the past and made it a little bit better. So, um long story short is about 80% at 20 years, 60 to 70% at 30 years.

Dr. Jack Wong: Okay. Yeah, that’s that’s a great answer. Um what’s your thoughts on getting physical therapy before or after hip replacement surgery? And um is there like more cases of physics needed after a anterior approach versus you know posterior approach in your opinion?

Dr. Drake LeBrun: Yeah so that is a great question. One of the things that I look for when I’m looking for a good surgical candidate is like have they tried everything else right and everything else certainly includes physical therapy and so I will ask them have they tried that right and if and then if the answer is yes then that sort of checks that box. If the answer is no, then it’s a conversation because if they have severe bone on bone arthritis, they failed multiple injections, they failed anti anti-inflammatories and Tylenol and everything else, then I’m not going to necessarily send them to PT because I think that patient’s ready for a hip replacement, right? But if they have mild to moderate degenerative disease and they also have issues, let’s say like with their back or with their knee and and I think that physical therapy would be of some functional benefit to them before surgery and I don’t necessarily think they’re there yet to have surgery, then absolutely I would refer them to physical therapy. And I think that a patient coming in with better strength, better mobility, more baseline function is a patient that’s going to have better strength and better mobility and more function after surgery. Right? So the way they get that is through physical therapy. So I do think it is important to do pre-operatively. Post-operatively, I think physical therapy is important for a subset of patients, right? So I don’t necessarily prescribe PT for 100% of the patients I operate on. I do total hip score for but I do for patients who I think would benefit from it. And that can be a number of different patients. So for example, you know, I’ve got patients who have Parkinson’s who who are having a hip replacement, a patient with a mobility disorder like that, I want them to go to physical therapy, right? I want them to be able to mobilize better in a safe environment. patients who have other issues going on and many do for example if they also have back issues if they’ve got knee issues if they’ve got contrlateral hip issues and I think that their mobility is going to be slowed by the other issues they have going on and I will refer them to physical therapy uh patients who have had revision hip replacement meaning it’s like a redo hip replacement surgery I think those patients recover much slower and I think it’s helpful to go to physical therapy early for mobility and later on for strength and range of motion strength and range of motion are not things that I want to be working on immediately after hip replacement because I really want the soft tissues to heal. I think that’s a important part of it. Um, but later on down the line, like six weeks after, that’s when I would initiate physical therapy for those patients. So, so it is important. It’s just not something I would necessarily prescribe for all patients.

Dr. Jack Wong: Yeah, that that totally makes sense. Um, every patient is different, so you have to pretty much gauge where they’re at and decide what’s the next best course of action. So that totally makes sense for sure.

Dr. Drake LeBrun: Yeah.

Dr. Jack Wong: What does the process look like to work with you?

Dr. Drake LeBrun: Yeah. So I’ll normally see patients in the office. Um I see patients in Kingwood and I see patients downtown at Texas Orthopedic Hospital. Uh so I’ll see patients in the office. We will get X-rays of your hip sometimes of your back and uh have a long conversation about what’s bringing you in, what bothers you, what you’ve tried thus far, what you haven’t tried. I’ll do an exam and then review the X-rays with you. I’ll print them out. We’ll draw on them. I’ll show you what a normal hip looks like and then I’ll compare it to what your hip looks like and then we’ll have a conversation about what to do next, right? And so I want I want to sort of put everything together so that the patient understands my thought process. I don’t just want to say walk in and say you need a new hip. I want to walk in and basically have a patient feel like they are on the same page as I am as to why they need a hip replacement, if they do, what the alternatives are, what the risks and benefits are. So after that happens, if I think they need something like physical therapy, I’ll refer I’ll refer them to y’all. If if I think a patient needs some anti-inflammatories or an injection, then I’ll do that. And for that subset of patients who have tried everything and they’re good surgical candidates, we’ll talk about surgery and what that process entails.

Dr. Jack Wong: Yeah. Awesome. If there is one thing you want to be known for, what would it be? Dr. LeBrun,

Dr. Drake LeBrun: good patient care. Like it goes back to what I was saying earlier. Like I want to be known as as the doctor that people can come to and be able to tell their story and get someone to actually listen to them, examine them, figure out what is going on, and then decide on a treatment plan together with them and their family. That’s what I want to be known for. I mean, I would love to be known as like the slickest surgeon around, but that’s not what we can see, right? Patients don’t necessarily see how slick you are in the O. They see your demeanor, your bedside manner, right? And so that’s what I would like to know.

Dr. Jack Wong: That’s awesome. And how can people get in touch with you?

Dr. Drake LeBrun: Yeah, so a couple different ways. They can either call our office, they’ll get my assistant, Riley, who’s always available, and our phone number is 3466159391. And then they can also uh email our office at leastfondonder.com. Both of those ways will will get Riley or myself and and they’ll be able to schedule an appointment that way.

Dr. Jack Wong: Awesome. Thanks for your time, Dr. Ron. Really appreciate it.

Dr. Drake LeBrun: It’s my pleasure. Thank you so much, Dr. Wong, for having me. I appreciate it.

Dr. Jack Wong: Yeah, for sure.