Christopher J. DeFrancesco, MD, recently returned to CHOP, joining the team as our newest attending pediatric orthopedic surgeon after pursuing additional training.
Here, Dr. DeFrancesco explains why he chose to specialize in pediatric hip care, his approach to hip preservation and how he cares for children and teens facing the prospect of hip surgery.
Question: What inspired you to specialize in pediatric orthopedic hip care?
Dr. DeFrancesco: I grew up playing sports, and my undergraduate studies were in mechanical and biomedical engineering. These factors pushed me toward orthopedics as I went into medical school. I figured I would specialize more in sports medicine or hand surgery early in medical school, but then I spent a year doing research with the orthopedic team at CHOP (The Ben Fox Fellowship). This was a pivotal year in my training, showing me the interesting breadth and impact of pediatric orthopedic surgery. That is really when I got interested in pediatric orthopedics, and my interest in hip surgery grew from there as I worked with people like Dr. Wudbhav “Woody” Sankar here at CHOP and Dr. Yi-Meng Yen at Boston Children’s.
What drew you to CHOP for training, and what excites you most about working at CHOP as a surgeon?
Coming to CHOP for fellowship was a bit of a homecoming. I am a Pennsylvania kid at heart. And I always felt like I belonged around the folks at CHOP. This division is really a special place that feels like a family.
But the decision to come back for a fellowship was more than that. As I researched training programs, it was clear that CHOP is the top pediatric orthopedic fellowship in the country. The volume, variety and complexity of cases is unmatched.
Returning as a faculty member is very exciting as well, because I am now on the other side of the line. Mentors have become partners, and now I have the chance (and challenge) to mentor students, residents and fellows. I look forward to the opportunity to carry on the great work of past and current leaders in our division.
Expertise and Services
What types of hip conditions do you treat most often?
The most common things that I see are shallow hip sockets (dysplasia) in adolescents or young adults, femoroacetabular impingement, and avascular necrosis. I also see lots of babies for concerns of developmental dysplasia of the hip (DDH).
How do you explain to families the advanced procedures you offer, like hip arthroscopy, periacetabular osteotomy (PAO), and total hip replacement?
I spend a fair amount of time explaining conditions and procedures using analogies and drawing pictures, both on paper and on the computer. I hope this helps families understand what they are facing and the procedures they may undergo.
CHOP is one of the few places offering total hip replacement for young patients. Why is that important for families to consider when searching for treatment?
For the lion’s share of patients that we treat, hip preservation (avoiding hip replacement) is the preferred route.
For the small proportion of our patients who have exhausted reasonable hip preservation procedures, total hip replacement is the next reasonable option. The conversation with these families – who have commonly seen several other providers and had various previous procedures – requires time and patience. Part of my job is to offer continuity of care within the supportive environment here at CHOP.
Patient Experience
At CHOP, many specialists — like surgeons, radiologists, nurses and physical therapists — work together to care for each patient. How does this team approach help kids get the best care?
You excel at what you do repeatedly, and taking care of kids is what we do day in and day out. All members of our team are used to taking care of our patients, along with all the related challenges that can crop up.
What can families expect during their first visit with you?
I really like to understand each patient’s history and expectations when I meet them. How many people have they seen before me? What sports and activities are important to them? Even if I don’t have an answer for them on the first visit, I hope that families walk out knowing that I care.
How do you approach care for children and teens who need hip surgery?
Many of our patients have been through a lot, and I think a team approach helps maximize outcomes for them. I like to get to know the patient and their family, and I’ll commonly ask them to see another specialist from our hip team, like Naomi Brown, MD, or Tom Swaffield, MD, who can do ultrasound evaluations and ultrasound-guided injections.
We really try to be systematic and objective in our evaluations, and this commonly includes diagnostic/therapeutic injections, as well as advanced imaging (such as MRI and CT scan). Most patients who sign up for a hip surgery end up seeing me at least twice before we decide to proceed with an operation.
What role does rehabilitation play after hip surgery, and how do you support recovery?
Rehabilitation is paramount after surgery. I will sometimes tell patients that most of my work was done on the day of the operation, and after that, the ball is mostly in their court. I turn into a cheerleader and coach after surgery. And just like in sports, sometimes you need your coach to be soft and supportive, and sometimes you need some tough love. So, I like to follow these patients and encourage them as they navigate their path to recovery.
What do you enjoy most about working with children and teens?
The personalities we see in kids are always so interesting, and the kids I treat constantly make me smile. Sometimes they make me shake my head, and lots of times they make me laugh. It really is a blast to help them through what can seem like tough times.
Looking Ahead
What advances in hip care are you most excited about?
I really look forward to better metrics for conditions where the ball at the top of the thigh bone moves more than it should inside the hip socket, causing pain or discomfort (hip microinstability), as well as more objective indications for surgery in patients with borderline hip dysplasia. These are some of the more difficult surgical decisions and discussions, and we – as surgeons – have a way to go in this realm.
What do you want families to know about the future of hip care at CHOP?
We pride ourselves on being a comprehensive center for hip care. The future is bright here. Under the leadership of Dr. Sankar, we are positioned for continued success in the decades to come.
Life Outside of CHOP
Who are your role models?
I am really blessed to have so many great role models. I grew up with great parents who were registered nurses and taught me a strong work ethic. My football coaches from high school and college taught me so much about being a leader and working through adversity. And within medicine, I have been lucky to call so many people mentors including John Kelly at Penn; Peter Fabricant, Dan Green, Shevaun Doyle, Dave Scher, Mark Figgie and more at HSS; and Jack Flynn, Apurva Shah, Woody Sankar and more at CHOP. The list really goes on and on.
What do you enjoy doing outside of work?
My most important job is dad and husband, so I really look forward to the time I spend at home playing with my children and talking with my wife. I also like to exercise and watch lots of football on television.
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Christopher J. DeFrancesco, MD, recently returned to CHOP, joining the team as our newest attending pediatric orthopedic surgeon after pursuing additional training.
Here, Dr. DeFrancesco explains why he chose to specialize in pediatric hip care, his approach to hip preservation and how he cares for children and teens facing the prospect of hip surgery.
Question: What inspired you to specialize in pediatric orthopedic hip care?
Dr. DeFrancesco: I grew up playing sports, and my undergraduate studies were in mechanical and biomedical engineering. These factors pushed me toward orthopedics as I went into medical school. I figured I would specialize more in sports medicine or hand surgery early in medical school, but then I spent a year doing research with the orthopedic team at CHOP (The Ben Fox Fellowship). This was a pivotal year in my training, showing me the interesting breadth and impact of pediatric orthopedic surgery. That is really when I got interested in pediatric orthopedics, and my interest in hip surgery grew from there as I worked with people like Dr. Wudbhav “Woody” Sankar here at CHOP and Dr. Yi-Meng Yen at Boston Children’s.
What drew you to CHOP for training, and what excites you most about working at CHOP as a surgeon?
Coming to CHOP for fellowship was a bit of a homecoming. I am a Pennsylvania kid at heart. And I always felt like I belonged around the folks at CHOP. This division is really a special place that feels like a family.
But the decision to come back for a fellowship was more than that. As I researched training programs, it was clear that CHOP is the top pediatric orthopedic fellowship in the country. The volume, variety and complexity of cases is unmatched.
Returning as a faculty member is very exciting as well, because I am now on the other side of the line. Mentors have become partners, and now I have the chance (and challenge) to mentor students, residents and fellows. I look forward to the opportunity to carry on the great work of past and current leaders in our division.
Expertise and Services
What types of hip conditions do you treat most often?
The most common things that I see are shallow hip sockets (dysplasia) in adolescents or young adults, femoroacetabular impingement, and avascular necrosis. I also see lots of babies for concerns of developmental dysplasia of the hip (DDH).
How do you explain to families the advanced procedures you offer, like hip arthroscopy, periacetabular osteotomy (PAO), and total hip replacement?
I spend a fair amount of time explaining conditions and procedures using analogies and drawing pictures, both on paper and on the computer. I hope this helps families understand what they are facing and the procedures they may undergo.
CHOP is one of the few places offering total hip replacement for young patients. Why is that important for families to consider when searching for treatment?
For the lion’s share of patients that we treat, hip preservation (avoiding hip replacement) is the preferred route.
For the small proportion of our patients who have exhausted reasonable hip preservation procedures, total hip replacement is the next reasonable option. The conversation with these families – who have commonly seen several other providers and had various previous procedures – requires time and patience. Part of my job is to offer continuity of care within the supportive environment here at CHOP.
Patient Experience
At CHOP, many specialists — like surgeons, radiologists, nurses and physical therapists — work together to care for each patient. How does this team approach help kids get the best care?
You excel at what you do repeatedly, and taking care of kids is what we do day in and day out. All members of our team are used to taking care of our patients, along with all the related challenges that can crop up.
What can families expect during their first visit with you?
I really like to understand each patient’s history and expectations when I meet them. How many people have they seen before me? What sports and activities are important to them? Even if I don’t have an answer for them on the first visit, I hope that families walk out knowing that I care.
How do you approach care for children and teens who need hip surgery?
Many of our patients have been through a lot, and I think a team approach helps maximize outcomes for them. I like to get to know the patient and their family, and I’ll commonly ask them to see another specialist from our hip team, like Naomi Brown, MD, or Tom Swaffield, MD, who can do ultrasound evaluations and ultrasound-guided injections.
We really try to be systematic and objective in our evaluations, and this commonly includes diagnostic/therapeutic injections, as well as advanced imaging (such as MRI and CT scan). Most patients who sign up for a hip surgery end up seeing me at least twice before we decide to proceed with an operation.
What role does rehabilitation play after hip surgery, and how do you support recovery?
Rehabilitation is paramount after surgery. I will sometimes tell patients that most of my work was done on the day of the operation, and after that, the ball is mostly in their court. I turn into a cheerleader and coach after surgery. And just like in sports, sometimes you need your coach to be soft and supportive, and sometimes you need some tough love. So, I like to follow these patients and encourage them as they navigate their path to recovery.
What do you enjoy most about working with children and teens?
The personalities we see in kids are always so interesting, and the kids I treat constantly make me smile. Sometimes they make me shake my head, and lots of times they make me laugh. It really is a blast to help them through what can seem like tough times.
Looking Ahead
What advances in hip care are you most excited about?
I really look forward to better metrics for conditions where the ball at the top of the thigh bone moves more than it should inside the hip socket, causing pain or discomfort (hip microinstability), as well as more objective indications for surgery in patients with borderline hip dysplasia. These are some of the more difficult surgical decisions and discussions, and we – as surgeons – have a way to go in this realm.
What do you want families to know about the future of hip care at CHOP?
We pride ourselves on being a comprehensive center for hip care. The future is bright here. Under the leadership of Dr. Sankar, we are positioned for continued success in the decades to come.
Life Outside of CHOP
Who are your role models?
I am really blessed to have so many great role models. I grew up with great parents who were registered nurses and taught me a strong work ethic. My football coaches from high school and college taught me so much about being a leader and working through adversity. And within medicine, I have been lucky to call so many people mentors including John Kelly at Penn; Peter Fabricant, Dan Green, Shevaun Doyle, Dave Scher, Mark Figgie and more at HSS; and Jack Flynn, Apurva Shah, Woody Sankar and more at CHOP. The list really goes on and on.
What do you enjoy doing outside of work?
My most important job is dad and husband, so I really look forward to the time I spend at home playing with my children and talking with my wife. I also like to exercise and watch lots of football on television.
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