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.