Three Hangodys at Dr. Rose

2021. September 8.

Prof. László Hangody’s own father was a general surgeon, and now two of Prof. Hangody’s three sons - Dr. László Rudolf Hangody and Dr. György Márk Hangody - have become orthopedic surgeons as well. Many doctors have an inherited vocation within their families, but it is very much a rarity for some surgeries to be performed together by a father and his two sons. At Dr. Rose Private Hospital, everything is provided to perform orthopedic surgeries and related research and innovation using state-of-the-art surgical techniques. We asked the Professor and his sons about family, sports, the profession, scientific research, and the future of orthopedics.

Három Hangody

It is a nice family tradition to pass on a love of the medical profession. Was that also obvious in the case of your sons?

Prof. László Hangody: I ​​can’t speak for other professions, but I think that in the case of medical dynasties, workplace and professional problems usually crop up quite frequently in discussions at home. This was the case for myself and my father - he was a general surgeon, and I was always interested in locomotor surgery, but there were always overlaps around a common theme. Now, in the case of myself and my sons, their specialization is the same as mine, but we also have the changing times. I still belong to the generation that initially performed virtually complete locomotor surgery. The current generation is already moving in a specialized direction. Fortunately, the area to which my activity narrowed - endoprosthetics, sports surgery, minimally invasive techniques and joint mirror surgeries - became my sons’ chosen areas, so we not only had, but will still have a common theme. The situation is even more special in that we work together in several workplaces and our areas of innovative research and development are similar. My eldest son received a scientific qualification related to the articular cartilage surface, and the middle one from background research related to patellar tendon surgery. The family infection reached my third son, András, in such a form that after graduating in tourism and hospitality, he is now undergoing training as an operating room assistant.

Was medical school the obvious choice after high school?

Dr. László Hangody: We grew up with this, but to begin with a medical career caused resentment in me, as the child only sees that his father is not at home due to the long on-call hours, so I was interested in economics during high school, and only in the last year did I opt for medical studies.

Dr. György Hangody: In childhood, the desire develops to follow in your father’s footsteps or do something similar. The name obliges - it’s always a kind of pressure on a person in terms of performance. Of course, it can look like we are always in someone’s shadow, but increasingly we are starting to grow out of that shadow and now people don’t necessarily think of us, or of me, as the professor’s son, but as Dr. György Hangody.

Why did you choose orthopedics?

Prof. László Hangody: My father graduated from university between 1945-51. This was the period after which specialization within surgery began. He worked as a general surgeon, but also performed musculoskeletal surgery, gynecology, and urology. By the time I started working, locomotor surgery was already a separate field. Based on the Austrian-Swiss-German model, separate accident surgery and separate orthopedics developed in Hungary. In my workplace, however, from the beginning, both areas were present - I was given a general approach to locomotor surgery and I also had a desire to deal with body cavity injuries and abdominal-chest surgical tasks. It was also lucky that arthroscopic surgery started at the beginning of my career, and I had perhaps a little more talent than average for this, and which then - within locomotor surgery - became a big trend, accounting for a third of the work. My sons were already born into this.

Dr. László Hangody: It was sympathetic in orthopedics that it was wide-ranging. A wide variety of patients - young, elderly, men, women - and various ailments can be cured, and a large percentage of orthopedic patients can be cured too. At first, I even considered gynecology and urology, but eventually orthopedics remained, and I’m glad it turned out that way.

It is thanks to our father that he assessed which area within orthopedic traumatology is worth doing together. The range of diseases, the surgical palette we encounter every day, can account for two-thirds of traumatological/orthopedic diseases. In this specialized world, this breadth of activity provides a sense of comfort.

Dr. György Hangody: Medical university was almost certain after high school, and by then I was also certain that I wanted a manual profession, and I actually committed to orthopedics in the 4th and 5th years of university. I consider myself very lucky because I love what I do, and the opportunity for development motivates me. In the long run, a good measure of the value of our work is that pre- and post-operative x-rays are always taken, and the results can be traced.

Professor, loyal to your workplaces from the beginning, is this kind of stability important?

Prof. László Hangody: I ​​was able to work in the same place from the beginning of my career. During my medical years I worked in several places as a surgical assistant, so I even got in touch with Uzsoki Hospital while still a student. Afterwards, I was so lucky to be able to work there. Just as I did not leave the country or the profession, nor did I leave my workplace. In addition, my work encompassed significant foreign consulting and surgical activities in the private sector, of which Dr. Rose Private Hospital is the most stable private clinical environment, providing the widest possible professional repertoire. I think that here, just like in my main job, over the years a very stable, good professional community and a very good team has developed. The size of Dr. Rose Private Hospital makes it suitable for serious professional work, and on the part of investors, it has always been emphasized that the appropriate infrastructural background is available. It is possible to progress from here, so much so that significant research and innovation is already taking place, which can also be a source of cohesive strength and a sense of success.

How much is participation in education and science part of your daily lives?

Dr. György Hangody: Educating is the so-called endowment, since the Uzsoki Hospital’s orthopedic traumatology department is also the Semmelweis University department of traumatology, due to our father. General medical students, pharmacists and specialist candidates come to us for practice, and we teach in three languages ​​all the time.

Dr. László Hangody: Our department participates in university education and considering that we started the healing pursuit in such a way that we already had a scientific degree by then, so our participation was obvious. In many ways, teaching is good because it provides a motivation for ongoing preparation. We need to keep our knowledge current, and this colors our daily work. It is clear from students and specialist candidates’ questions how dynamically medical development is evolving and the level one needs to maintain as a doctor.

Getting an academic degree early was our father’s influence, as he advised us to graduate after college while one is not so committed - one doesn't have a family, a career or any established attachments yet, hence it's much easier to see it through. We are grateful to him for ’squeezing’ this out of us.

Dr. György Hangody: The PhD degree is becoming increasingly difficult to obtain, the Semmelweis University Medical School training is world famous and recognized everywhere. After three years of training, fulfilling various criteria, I earned a PhD in 2017. My brother, in 2015, did his PhD defense. Our professional life is very similar, with me two years behind him. There is a rivalry between us in a good sense, which also adds to our development. Luckily, in 2013, we both started working at the same time, so we have the same requirements for on-call duty, we can operate the same amount and we work in the same places.

Dr. László Hangody: In medicine, but especially in orthopedics and traumatology, implant companies, given that they are professions with a high demand for implants, love to invest. They put quite a lot of energy into improvements, usually looking to the authorities in a given country to help them with a particular project. Manufacturers are constantly seeking experts who are recognized within their profession. In Hungary, my father is a sought-after consultant. Due to the large number of inquiries, he has formed a team from his immediate staff, and my brother and I are currently involved in this work in relation to artificial intelligence and other surgical innovations. In conjunction with this, other traumatology projects are running in the hospital that we are involved with, which is also thanks to our departmental status. For example, I am now involved in a study to treat a shin fracture. These themes and projects bring new tasks.

Dr. György Hangody: Research work always encourages one to excel, and the scientific degree, in addition to the fact that this is a kind of expectation nowadays, is always a measure of value. Today, scientific activity is very regulated, it is difficult to get articles accepted, and it often takes 1-1.5 years for them to be published. Our current research topic is related to artificial intelligence. Guided by artificial intelligence algorithms, we try to map the surface of the cartilage. In the case of a 40-year-old patient who has suffered a car accident, it is not necessarily good to have a prosthesis implanted, as a prosthesis has a certain lifespan and of course there is a possibility of complications. In such cases, implantation of large bony cartilage blocks may provide a solution in the future. My brother is researching the transplantation of osteochondral allografts. This means that a bone-cartilage block is taken from a donor's knee joint and implanted in the injured knee joint of a patient who has been injured in an accident. This idea is very good, but it has its indications/criteria, beyond the technical difficulties. The challenge is that we can’t always perfectly match the size, as the size and curvature of the donor knee joint doesn’t necessarily fit our patient. The most suitable patient for implantation could be selected based on an MRI scan controlled by artificial intelligence algorithms, thus eliminating the problem of sizing and fit. In artificial intelligence research, we work with experts in various fields: with artificial intelligence experts, mathematicians, computer scientists, and radiologists.

Professor, how do you see the future of orthopedics?

Prof. László Hangody: In the research/scientific line, and in patient care, I think that one of the main trends is the minimally invasive direction of care. When I started working, it was routine that if someone had a knee cartilage ring injury, which is one of the most common forms of injury, then we cut up the patient’s knee and the surgery was followed by six months’ recovery. As arthroscopic surgery became widespread in the second half of the 1980s, the practice developed within ten years that, apart from endoprosthetic surgeries, we practically no longer opened the knee joint as we could do everything else arthroscopically. At the time, we said that we had practically reached the peak of the performance of minimally invasive endeavors for the knee joint because prosthetics would never be able to be performed with a minimally invasive technique. Then came the turn of the millennium, and minimally invasive endeavors also appeared in endoprosthetics. And even if we don’t insert the prostheses through a keyhole, we do the surgeries in a way that causes the least discomfort possible. So, one of the main trends is to increase the number of minimally invasive interventions. The other is that the problems, the degenerative diseases that have caught us out so far and for which we have only been able to offer compromise solutions up to now, can be operated on with some kind of biological augmentation support. So, we perform surgeries not only with a knife or an arthroscope, but we also try to call on biology for help, and this cartilage surface damage is starting to materialize in patient care as well. Here, we also use a degradable regenerative scaffold to replace a cartilage surface, as a result of which a completely destroyed cartilage surface will be replaceable with new living cartilage. Thanks to this, in some cases endoprosthetic interventions may not even be necessary in the distant future. So, the innovation and research fronts are starting to turn absolutely in the direction of a biological approach. In summary, I believe that today’s advanced endoprosthetic options provide an excellent solution to severe hip, knee, shoulder, and ankle joint abrasion and degeneration, but today’s modern locomotor surgery can already offer promising biological solutions to timely-observed large joint wear and injured cartilage surface damage.

Both of you played water polo with cutting-edge teams. What kind of boost did you get from the sport that is also tangible in your daily work?

Dr. László Hangody: We have both played water polo for years in the world elite Hungarian first class. Hungarian Cup and Universiade medals represent the greatest success for us, but the cutting-edge water polo and team sports experience means even more. It has taught us many things and also applies to today’s challenges. My brother is with the Ferencváros OB I, BL-winning water polo team, and I am the team doctor for KSI, a youth development association. As a result, many competitors turn to us for help. There are two types of athletes in my experience. One type is very afraid of themself and very scared of every little symptom that is otherwise understandable as they are professional athletes - for them, career is an existential issue. The other type is over-motivated, does everything possible to recover, and doesn’t even think that a serious injury could put an end to their career. If we look at a disease group and derive statistics, we can see that there are certain injuries after which about 70% can return to pre-injury levels and 30% cannot. But you can’t know that in advance, and no one wants to be in the 30%.

The sport has taught me many things. We can build our adult careers on the strong physique developed as a result of intense sports in childhood. In connection with our work and daily life, sport is unequivocally part of our lives. After a week without movement, I already feel bad. This provides the necessary physique for standing in the operating theater and outpatient care.

Dr. György Hangody: I ​​have been the Fradi water polo team’s doctor since 2017. It is a very lucky thing to be a doctor as a former water polo player with a water polo team. From my own experience, I know what types of injury need to be taken seriously, what can be done with a particular pain or injury, and I can also give practical advice.

The elite athlete always wants to bounce back as soon as possible. A top athlete always wants to return to their own level, and it’s a kind of compromise or frustration when someone can’t represent the level, after their injury, that they are otherwise predestined to. The truth is, with elite athletes, on the one hand it’s easy because they’re terribly motivated, sometimes they even outperform during rehabilitation. For them, determining the date of surgery is more difficult regarding competition periods. On the other hand, it is difficult in every respect because their own expectations, club and various level programs/responsibilities have a major impact on the timing of a particular surgery and rehabilitation. Of course, the common goal is always the same - the optimal therapeutic result, which is the key to furthering a sports career. With regard to coordinating the interests of the current individual/club/team, professional knowledge, one’s own experience and the ’empathy’ developed as a result can help you make good decisions.

What is it like to work together?

Dr. László Hangody: Working together is - as my brother said - like fruit on a tree that has slowly ripened over the years and can now really be harvested. It’s a great happiness, not to mention the security that envelops both professionally and emotionally when you work with your own family members within an operating room and know each other’s vibrations exactly.

Naturally, this is also the case with other colleagues with whom we work a lot, but it is still a very special and lucky situation. It’s a good feeling when, here at Dr. Rose Private Hospital, the three of us perform eight surgeries assisting one another. This is a special experience, because the professional-emotional harmony means we can also provide our patients with a plus that would be more difficult to create without such familial-professional harmony.

Dr. György Hangody: It must be a huge source of pride for a father, in my opinion, that we can operate as three Hangodys. I think this is a curiosity. A couple of weeks ago, on a day of surgery, we had eight surgeries, four for our father, two for Laci, and two for me. We operated in a different line-up for each surgery, which is definitely a rarity. The fantastic thing about this for us is that we’re palletizing by the operating table, and I really don’t want to be immodest, but besides talent it matters a great deal who one studies alongside. Seeing this harmony, our brother, who earned a master’s degree in tourism hospitality, joined us and started training as a surgical first assistant after graduating. We hope that he will also work with us in the long term.

Prof. László Hangody: I ​​think the best thing that can happen to a person is to work with their own children. My main activity at Uzsoki Hospital and at Semmelweis University respectively is a similar constant cooperation - with colleagues, students, specialist candidates - in addition to everyday healing activities, in terms of knowledge transfer and education. It is a great joy to be able to pass on one’s knowledge to those you love most. And it’s a magnificent experience, because I see the genetic patterns that I believe I discover in myself. I have already had a look back at my own journey, I know when it went in the right direction, what my difficulties were, and I can also measure my success. I see in my children that they have talent for certain things, for which I help their development. I think that in this sense, our joint work and joint discussions work very well. They accept and sample for themselves what I have achieved - obviously they don’t want to restrict themselves to this level as they want to go even further - but they see my professional work and can judge what I did well and what they would want to do differently.