Managing Instability in AA Hips (S+N Surgeon Roundtable)

Yeah.

And so, Blair, for you, knowing that anterior approach in a revision setting typically doesn't have the same instability issues that you see in posterior approach.

How do you translate that information into a patient conversation without maybe sort of overpromising?

Yeah, for sure.

I mean, I try to give people whole numbers.

I find if you really get into the nuances of data that you get kind of blank stares during the headlight look.

So I tell people, we're looking at about a 1% to 2% risk of dislocation in this particular scenario and then you know if i still get funny looks i'm like you know two out of 100 people you know but um just trying to explain that it's it hap like it happens it's not zero and i think as we've been talking about um during this time is that you know sometimes there is this idea in the kind of popular public literature that like oh direct into your hips so you don't dislocate so some of that is just kind of re-educating people that that number is not zero We're looking at single digit, I say single digit risk, but the risk is there.

And then that's kind of like the baseline risk for everybody.

And then again, going back to kind of patient specific factors, it's like, well, do you have a lumbar spinal fusion? Do you have...

SI joint fusion? Do you have a history of seizures, Parkinson's disease? Do you have a connective tissue disorder? Is there anything else about that individual that makes me more concerned? And then that's a conversation I have with them where I say, okay, well, maybe this one to 2% is for the general public, but for you, I'm more worried because X, Y, or Z problem.

And so I think there's a little bit of that element, too, is just kind of giving people a baseline and then talking about them specifically to kind of make it more real for them.

And then to Chance's point, you know, if you're going in a revision setting, explaining to that person, like, look, I need to do a little bit more work to get the visualization that I need done.

in order to do the surgery appropriately.

So, you know, and even in a primary, I do a capsulectomy.

I'm taking the capsule out entirely.

And typically that reforms, you know, in about six weeks or so.

But again, kind of counseling patients that while this is a risk for your entire life, we're most concerned in those early, you know, couple of months while those soft tissues are healing and reforming.

But yeah, I think as concrete as you can be about numbers and specific concerns you have with that patient, I think that's really important.

And then I also that's a time when I start to talk to patients about like, well, what would I do in the OR to help mitigate your risk? Am I going to change my liner option? Am I going to make you a little bit long if I need to? And kind of tying in those elements of like, what is my plan A, B and C when I get in there? And I think that helps to make it a little bit more real for them.

So staying with that sort of patient-specific counseling, how do you separate, Blair, a patient's sort of modifiable risk factors for instability specifically from those you simply kind of need to plan around?

Yeah, absolutely.

I mean, I think going back to the bar stool, you know, challenge, you know, there are some kind of patient behavioral issues that you can talk to people about.

If they do drink a lot, I mean, that's something to talk about.

That's a well-established risk factor as patients with excessive alcohol consumption can be an increased risk for dislocation.

Maybe patients that have a seizure disorder, making sure that they're well controlled on their medication.