Lessons from a Total Hip Replacement at Southpaws
Written by Dr James Simcock
BVSc (Hons), MANZCVS (Internal Medicine), Diplomate ACVS-SA & ECVS
Registered Specialist in Small Animal Surgery | Director, Southpaws Specialty, Emergency & Referral Hospital
Recently, one of our THR cases reminded me exactly why I’ve spent so much time over the past decade thinking, talking, and teaching about teamwork in surgery.
We were performing a routine total hip replacement on a healthy young Kelpie – a patient we’d already successfully operated on the opposite side with an excellent result. The acetabular cup seated perfectly. Then, during femoral canal preparation, the heart rate dropped from a steady 100–120 bpm to 18. Blood pressure remained stable, but there was no response to repeated doses of glycopyrrolate or atropine.
Our anaesthesia nurse spoke up immediately. No hesitation, no waiting to be asked. That’s the culture we work hard to maintain at Southpaws – a genuinely flat hierarchy where every team member knows their voice matters and is expected to use it when something doesn’t feel right.
We paused, connected quickly with our specialist anaesthetist for a live ECG review, identified a critical electrolyte abnormality that had developed intra-operatively, brought in our ECC specialist for management advice and stabilised the patient. We then completed the femoral preparation, stem placement, lateral bolt, and head seating safely. The owners opted for overnight monitoring at our Malvern site, where our colleagues provided seamless continuity of care. The patient recovered uneventfully and went home on schedule.
It was a stark reminder that in procedures as complex and multi-phased as THR, technical skill is necessary but nowhere near sufficient.
Post-operative radiograph showing bilateral total hip replacement.
Why THR Is the Perfect Lens for Teamwork
Total hip replacement involves a long chain of interdependent steps: initial client communication and diagnostics, surgical planning and templating, anaesthesia and patient positioning, multiple surgical phases, intra-operative decision-making under pressure, recovery, post-operative imaging and care, and long-term follow-up (including that important 12-month radiographic check). Each phase affects the next. A problem in one area ripples through the rest.
No single person – no matter how skilled – can own every variable. Mastery of THR (or any demanding procedure) is as much about building and leading an entire team as it is about personal competency.
What the Evidence Shows
The human literature is compelling. Teams with poor teamwork are almost five times more likely to experience complications or death (Mazzocco et al., 2006). Structured team training interventions have reduced mortality by 18% across large numbers of facilities and patients (Neily et al., 2010). Improved nurse-physician collaboration is linked to lower 30-day mortality and failure-to-rescue rates.
In our own world, the veterinary data is still emerging but points in the same direction: coordinated, psychologically safe teams are associated with higher job satisfaction, lower burnout, better efficiency, and – most importantly – better patient care.
Aviation and military medicine got here decades ago. They didn’t improve safety by building better planes or weapons; they did it by building better teams – role clarity, psychological safety (anyone can speak up without fear), structured communication, briefings, checklists, and deliberate practice. Veterinary surgery is on the same journey.
How We Live This at Southpaws
This isn’t theoretical for us. We see the impact every week in the operating theatre and across the hospital.
Psychological safety and a genuinely flat hierarchy gradient sit at the core. The nurse who spoke up in that THR case didn’t do it despite our culture – she did it because of it. In high-stakes moments during complex procedures, that reduced authority gradient catches problems early and lets the whole team respond faster and more effectively. It also creates an environment where junior team members grow faster and contribute more.
Pre-operative check-ins and checklists bring the entire theatre team together before we start. Everyone understands the plan, the potential challenges specific to that patient, and their individual role. External noise and personal baggage get left at the door so we can focus completely on the task at hand. For complex or high-stakes cases, I add a personal “vibe check” – a quick, deliberate moment to lift the energy in the room, reset everyone to a positive, solution-focused mindset, and ensure we’re mentally and emotionally aligned. It sounds simple, but it makes a tangible difference to how the team performs when things get challenging.
Team familiarity and consistency from meaningful volume matters enormously. We perform around 40 total hip replacements each year across patients from 4 kg to over 90 kg. With that many cases, the systems become robust and resilient. The multitude of steps – from initial radiographs and templating through to the 12-month follow-up – are handled with high accountability and self-management. Familiarity doesn’t breed complacency; it breeds the kind of quiet confidence, proactive communication, and mutual trust that prevents things from being missed even when the unexpected happens.
We also invest in structured communication, clear role definition, and genuine cross-department collaboration. Surgery doesn’t happen in isolation from anaesthesia, ECC, diagnostic imaging, or the nursing and post-operative care teams. When everyone shares the same mental model and feels safe to contribute, the patient wins – every time.
Your Practice as Part of the Extended Team
When you refer a patient for THR or any complex orthopaedic case, we don’t see it as a hand-off. We see it as extending the team. Your knowledge of the patient’s full history, the owner’s dynamics and expectations, and the initial clinical picture is invaluable context that helps us deliver better care.
We welcome pre-referral discussions and value your input throughout the journey. We aim to keep you fully informed – not just with discharge summaries, but with the thinking behind key decisions and clear, practical plans for ongoing care that you can be involved in locally where it makes sense for the patient and owner.
The goal is simple: your client experiences seamless, high-quality, supportive care from the whole veterinary team, and you feel confident and supported as their primary veterinarian.
What This Means for Your Clients (and Your Practice)
Owners of pets needing advanced surgery are often anxious and overwhelmed. When they experience a calm, coordinated, communicative team that clearly works together – and that visibly includes their trusted GP – their stress drops and their trust rises. Compliance improves. Outcomes improve. And they remember the practices that “got them to the right people and stayed part of the journey.”
For you, it means referring complex cases doesn’t have to mean losing the client relationship or carrying the full cognitive and emotional load alone. It means partnering with a team that shares your standards and your commitment to the patient and owner – and that actively works to make you look good in the eyes of your clients.
A Personal Note
After more than 20 years and hundreds of total hip replacements across the full spectrum of patient sizes – from tiny 4 kg dogs to giant 90+ kg breeds – I can say with certainty that the biggest leaps in quality and sustainability haven’t come from new implants or techniques alone. They’ve come from investing in the people and systems around the surgery.
It lets me stay focused on the technical craft I love while knowing the non-technical elements – the ones that so often determine success or failure in demanding procedures – are world-class. It also creates a workplace where our team can thrive long-term rather than burning out.
This is why the topic of teamwork, psychological safety, and building high performing cultures are so close to my heart. Better teams don’t just produce better surgical outcomes; they create more sustainable careers, stronger workplaces, and ultimately better care for all the animals and families we serve.
If any of this resonates – or if you’d like to chat about a specific case, get a second opinion on a tricky orthopaedic patient, or even talk about how to strengthen teamwork, communication, and psychological safety in your own hospital – we’re here.
At Southpaws, we see ourselves as part of your team for both the clinical conversations and the cultural ones. Reach out any time. We’re only a phone call or email away, and we’re always happy to help.
Southpaws is stronger together – and that includes all of us working alongside you for the animals and families we serve.
References
Mazzocco et al., Surgical behaviours and patient outcomes. Am J Surg 2009 May; 197(5): 678-85.
Neily et al., Association between implementation of a medical team training program and surgical mortality. JAMA 2010 October 20; 304(15): 1693-700.
