Complex primary THA with AA (S+N Surgeon Roundtable)

Send us Fan Mail

What do you do the moment a calcar crack appears? Where does the cup go when the spine won't move? And which complex primary belongs in an ASC — and which one absolutely doesn't?

This episode launches a six-part surgeon roundtable series recorded in partnership with Smith+Nephew — peer-to-peer conversations aimed at one thing: practical, reproducible techniques you can take back to your operating room. First up, the complex primary total hip: severe dysplasia, post-traumatic anatomy, obesity, osteoporosis, and Dorr A femurs — the hips where the margin for error shrinks and the plan gets tested.

Three guests join Joe Schwab: Dr. Jessica Hooper, who leads an outpatient joint program and knows what complex work can be done safely in an ASC; Dr. Stephen Duncan, who operates from hip preservation through revision and sees exactly which traps in a primary set up the revision that follows; and Dr. Chad Watts, a high-volume hip surgeon focused on making every step repeatable.

The conversation gets concrete fast: structured planning two weeks out (CT for version, long-leg standing films — "hope is not a plan"), go/no-go criteria for the anterior approach, the low-small-medial cup strategy in dysplasia versus the oversized-cup trap, locking-screw cups in deficient bone, why triple-taper stems changed the fracture picture, automated impaction, the full decision framework for an intraoperative calcar crack, controlled medialization under fluoro (and the case for sharp reamers), where each surgeon falls on the spinopelvic spectrum, when dual mobility earns its place, and what changes between ASC and hospital workflows — including how to teach plan B and plan C so, as Dr. Duncan puts it, "plan C should not be chaos."

⏱️ Chapters:
00:00 A new roundtable series
02:06 Keeping high-risk primaries safe in an ASC
02:59 The step Chad Watts never skips
04:08 The traps that set up tomorrow's revision
05:05 What dysplasia and post-trauma change in the plan
07:39 When not to go anterior
09:00 Non-negotiables: templating, version, limb length
10:25 "Hope is not a plan": CT and long-leg films
11:41 Restoring the hip center without over-lengthening
15:09 A preservation mindset in dysplasia
16:51 Dorr A femurs: exposure and broaching principles
18:17 Where fractures happen — and how to prevent them
19:57 Intraoperative cues to slow down
23:00 Stem design, triple tapers, and automated impaction
28:18 Calcar crack: the decision framework
34:33 Keeping the room calm and controlled
35:39 Avoiding over-reaming in compromised bone
37:21 Hitting narrow cup targets under fluoro
40:13 How much does spinopelvic mobility matter?
44:01 Where dual mobility earns its place
46:24 Reproducible workflows: ASC vs. hospital
50:23 "Plan C should not be chaos"
51:48 Closing advice: mindset shifts and patient selection

Listen to the AHF Podcast on your preferred platform:
Buzzsprout: https://ahfpodcast.buzzsprout.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487
Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHc
LinkedIn: https://www.linkedin.com/showcase/ahf-podcast
YouTube: https://www.youtube.com/@anteriorhipfoundation
Homepage: https://anteriorhipfoundation.com

This episode was recorded in partnership with Smith+Nephew — Life Unlimited.
Learn more at https://www.smith-nephew.com

This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

#AnteriorHipFoundation #AHFPodcast #TotalHipArthroplasty #THA #AnteriorApproach #HipReplacement #Dysplasia #CalcarFracture #DorrA #DualMobility #SpinopelvicMobility #OutpatientSurgery #SmithNephew #OrthopedicSurgery

Smith+Nephew
We design and manufacture technology that takes the limits off living.

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.