November 7, 2025 • 13 mins
The Great Debate: HANA Table vs. Standard Operating Table for Anterior Hip Replacement
Welcome to the AHF Podcast! In this second episode of the 2025 Great Debates series, host Joe Schwab introduces a spirited discussion on the use of HANA tables versus standard operating tables for anterior hip replacement. Surgeons Dr. Tania Ferguson and Dr. Atul Kamath present their cases—Ferguson advocating for the HANA table, citing its efficiency and reduced muscular injury, while Kamath argues for the versatility and cost-effectiveness of standard tables. This debate dives deep into technology, cost, surgical techniques, and the importance of the surgeon's skill. Join us for a compelling discussion that blends expert insights with a bit of humor. Don't forget to subscribe and share your thoughts in the comments! 🎙️🦴✨
Dr. Ferguson’s slide can be found here: https://youtu.be/3rwzuWt44yY?si=Rtqd6sRqDe8JJ_4y&t=470
Dr. Kamath’s slide can be found here: https://youtu.be/3rwzuWt44yY?si=PVp0pfdqeIsSwqU3&t=428
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Joseph M. Schwab (01:05):
Hello and welcome to the AHF podcast.
I'm your host, Joe Schwab forthe second in the 2025 Great
debates series.
We have a debate about the useof the HANA table versus a
standard operating table, and Ithought this would be a great
debate for a few reasons.
One.
It's a common question thatpeople ask, especially as
(01:28):
surgeons are beginning to doanterior approach in their
practice.
They're thinking about what'sthe equipment that they're gonna
need and what's the techniquethat they're gonna follow.
But more importantly, I love thetwo people debating.
Dr.
Tania Ferguson and Dr.
Atul Kamath, two people I'veknown and worked closely with.
(01:49):
For a number of years.
I have great respect for both ofthem.
And if you look at the AHFYouTube site, one of our most
enduring and popular videos withprobably the most views was one
of the original great debatesthat Dr.
Tania Ferguson was involved inback in 2017 or 2018.
(02:14):
And the comments are alwaysentertaining when they come in.
And so I knew these two would beexcellent at meeting the
criteria of talking the meritsof the case, but also ribbing
each other quite a bit.
And so I was really excited whenthese two stepped up to the
stage.
(02:34):
And let's hear it, the seconddebate, HANA, table versus
regular table.
The topic is, or the positionstatement is the Hana table is
the best way to perform anteriorapproach the pro position.
Dr.
Tania Ferguson.
The con position, Dr.
Atul Kamath.
Tania Ferguson (02:56):
All right, here's the deal.
The the point, the position isthat anterior approach surgery
done on the table is the bestway to do hip replacement.
That's obvious.
Can you do a hip replacement offtable?
Sure.
Let's remember where thatstarted.
It started by the people whocouldn't get their hospital to
(03:18):
pay for a HANA table.
That problem is gone.
The HANA table is now the leastexpensive technology that I use
in my operating room.
It's a done.
It's done.
Second of all.
The fact is that the best doneanterior approach on table far
exceeds the best done anteriorapproach off table regardless of
(03:43):
patient less muscle injury.
You can do an anterior approachon table in a primary hip
replacement in a patient withfairly normal body habitus
without any muscular injury atall, and we do all the time.
Is different than off tablewhere there is always some
(04:04):
muscular injury.
Furthermore, we can do itwithout any releases around the
femur versus on off table.
I'm sorry, where commonly thereare releases that need to be
done to get the femoralexposure.
Number three, difficult bodyhabitus.
Ben Domb left, I'm sorry, but ifyou'll remember him standing
(04:25):
here.
My tallest patient ever wasseven three with A BMI of 38.
Eight.
That is a very difficultoperation off table.
It's a difficult operation ontable, but it can be done
without any muscular injury.
Nevertheless, by virtue of theextension of the leg and the
manipulation of the extremitywith the use of the HANA table.
(04:49):
Number four.
I had a beautiful picture ofNick Mast doing an anterior
approach, total hip replacementon the HANA table with zero
assistants.
Zero assistants.
That cannot be done with offtable anterior approach surgery.
In the ASC where we have limitedresources, assistants are the
(05:14):
most expensive part of our teamof our operation.
No assistants necessary when youhave a HANA table.
And number five, go back tosession one.
Revision hip replacement.
Not one of those presentersshowed a single image or video
(05:38):
of an off table revisionsurgery.
The table becomes critical inand it greatly facilitates all
operations.
But it absolutely facilitatesthe revision surgery, especially
with femoral exposure, difficultfemoral exposure in revision and
complex primaries that requirelong stem often are done on, uh.
(06:05):
You didn't see a single personup here this entire meeting, and
these are the people you've seenover the course of this meeting
Are the best surgeons doing theanterior approach period.
You did not see one singlerevision surgery demonstrated
off table.
With that, I will rest my caseand turn over the microphone to
(06:29):
my worthy opponent.
Atul Kamath (06:35):
So full disclosure, I think we are anterior
surgeons, not anterior plustable surgeons, right?
So, and uh, Tania insulting halfthe audience is not a good way
to, you know, start this off.
And, uh, it's, I I think ourgoal of surgery, of course is
efficiency and all the thingsTania talked about.
Um, but actually my opponentkind of missed a lot of
(06:56):
purported benefits of using atable, right?
Technology assistance.
Uh, positioning other thingsthat people talk about the
table, so we'll, we'll concedethat she missed all that.
I would say you actually, uh,have a rich history using, uh,
the table.
However, there's a lot ofbenefits.
Now.
We talk about cost and value.
Um, and I think the setup iseasier with off table.
(07:18):
Uh, there's no extradisposables.
You don't need a non-sterileassistant to help you maneuver
the table.
Um, the ergonomics of moving atable can be, uh, tough.
Uh, the HANA table is too bigfor the ASC I would contend,
right?
We have smaller ASCs, we have tobe more nimble.
Oh, and actually now I need twotables because I have two
operating rooms that I need tofurnish.
(07:38):
Um, and then also a lot of thestudies that you talked about
actually didn't mention anystudies, uh, related to soft
tissue preservation, efficiency,ergonomics outcomes.
There's been no study oncomparing the two.
So I would say dealer's choiceon using a table or not, and I
would say.
Um, it's really the anteriorapproach and your technique.
(07:59):
Uh, rather than a table that'sgonna get you there.
So I would say this is also aglobal meeting, right?
So not every, uh, country, notevery, uh, facility can afford
the HANA table.
As we talked about.
Uh, someone yesterday waited 12years in Brazil to get their
HANA table.
Um, and again, the cost is notinsignificant, especially, uh,
in your, uh, A ASC that you own.
(08:20):
Uh, I would contend that primaryand revision surgery are equally
done, uh, on table versus offtable.
So I think that's sort of, uh,the point of needing a table to
do a surgery, I think is, uh,definitely a fallacy as well.
Uh, and then I would sayprobably it's quicker to do
revision surgery off table.
The leg is more facile.
Uh, the intervals are more easyto, uh, access.
(08:41):
Uh, so again, I would probablysay, uh, and then probably the
risk of fracture with reductionmaneuvers is probably less with,
uh, off table than on table aswell.
So, um, you know, I, I thinkTania, you gotta really step up
a little bit here.
I think you gotta give yourselfmore credit.
You're better surgeon than youthink you are.
I think, you know, given theopportunity, you probably could
do this off table as well.
(09:02):
Um, your ability to usetechnology is not afforded.
By the table, it's by yourexpert, uh, ability to look at
fluoroscopy.
Your ability to get exposure isyour master of the anatomy, not
the table itself.
Uh, and perhaps, uh, theargument, uh, is less about
table or off table, but can weharness or teach the anatomy and
(09:23):
the technology better?
Uh, rather than, uh, using thetable as a crutch, uh, to get
exposure or a better outcome.
So with that, uh, maybe we caneven queue up my little, uh,
picture here.
Uh, I know we're not used toslides, but this is Tania trying
to shoot a gun, uh, with her,with her Hana table.
And this is one of the best, uh,pistol shooters in the world for
(09:45):
out of Turkey.
Uh, kind of just strolling up,uh, and getting a silver medal
in the Olympics.
So, uh, you know, Tania, Ithink, uh, give yourself some
credit.
I know you're better than that.
Uh, and again, table or notable.
We'll, we'll get you there.
Okay.
Thank you.
Joseph M. Schwab (10:00):
Rebuttal.
Tania Ferguson (10:05):
Well, that was a nice slide.
Uh.
I'm sorry, I have a sixth point.
Could I please see my slide?
Atul Kamath (10:18):
Tania, I know you worked on this all morning.
Tania Ferguson (10:20):
I would like to talk about hip.
You threw this out on the video.
Uh, everything you just heard isfalse news.
I am officially canceling Atulfor his.
Debate against his own practice.
Atul Kamath (10:40):
That's a dead patient, Tania.
We can do ha table surgery on adead patient in a lab, but, but
in real life, in real life,
Tania Ferguson (10:47):
my opponent uses the HA table.
So that is.
All I have to say, if the miccould drop, I would do it.
Joseph M. Schwab (10:56):
One minute.
Rebuttal.
Atul Kamath (10:57):
You can start signing that certificate for me
for the award, but, uh,
Joseph M. Schwab (11:00):
please go and vote.
Atul Kamath (11:01):
I I preface it.
I use both, right?
I also do hip arthroscopy.
We do a lot of other things, butI, I think we should not be
beholden to saying the table isthe best way to do surgery.
It's the surgeon.
Don't, you know, sell yourselfshort Surgeon anatomy
principles, adjunctivetechnology can both be done.
Table, no table.
Uh, you know, uh, it doesn'tmatter.
(11:22):
So I think, uh, from thatstandpoint, I'm glad I convinced
you all that, uh, off table is,uh, easy and facile and the way
to go.
So thank you.
Joseph M. Schwab (11:32):
That was just great.
I'll put links to the differentslides that each of them used in
the show notes so that you cansee exactly what they were
referencing in each of thoseslides.
So, what do you use in yourpractice?
Do you use a Hana table?
Do you use some other sort oforthopedic table that helps
(11:54):
facilitate mobility of the leg,or do you use.
A standard operating table andwhy is it cost?
Is it just the way you weretrained?
Is it something else?
Does it have something to dowith the other technology that
you are using?
I really like the way they havethis debate, but I'm interested
to hear what you have to thinktoo.
(12:16):
Go ahead and drop a commentbelow.
Thank you for joining me forthis episode of the AHF Podcast.
As always, please take a momentto like and subscribe so we can
keep the lights on and keepsharing great content just like
this.
Please also drop any topic ideasor feedback in the comments
(12:36):
below.
You can find the AHF podcast onApple Podcasts, Spotify, or in
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation.
All one word.
Episodes of the AHF Podcast comeout on Fridays.
(12:58):
I'm your host, Joe Schwab,asking you to keep those hips
happy and healthy regardless ofwhether they're on table or off
table.
Hello and welcome to the AHF podcast.
I'm your host, Joe Schwab forthe second in the 2025 Great
debates series.
We have a debate about the useof the HANA table versus a
standard operating table, and Ithought this would be a great
debate for a few reasons.
One.
It's a common question thatpeople ask, especially as
(01:28):
surgeons are beginning to doanterior approach in their
practice.
They're thinking about what'sthe equipment that they're gonna
need and what's the techniquethat they're gonna follow.
But more importantly, I love thetwo people debating.
Dr.
Tania Ferguson and Dr.
Atul Kamath, two people I'veknown and worked closely with.
(01:49):
For a number of years.
I have great respect for both ofthem.
And if you look at the AHFYouTube site, one of our most
enduring and popular videos withprobably the most views was one
of the original great debatesthat Dr.
Tania Ferguson was involved inback in 2017 or 2018.
(02:14):
And the comments are alwaysentertaining when they come in.
And so I knew these two would beexcellent at meeting the
criteria of talking the meritsof the case, but also ribbing
each other quite a bit.
And so I was really excited whenthese two stepped up to the
stage.
(02:34):
And let's hear it, the seconddebate, HANA, table versus
regular table.
The topic is, or the positionstatement is the Hana table is
the best way to perform anteriorapproach the pro position.
Dr.
Tania Ferguson.
The con position, Dr.
Atul Kamath.
Tania Ferguson (02:56):
All right, here's the deal.
The the point, the position isthat anterior approach surgery
done on the table is the bestway to do hip replacement.
That's obvious.
Can you do a hip replacement offtable?
Sure.
Let's remember where thatstarted.
It started by the people whocouldn't get their hospital to
(03:18):
pay for a HANA table.
That problem is gone.
The HANA table is now the leastexpensive technology that I use
in my operating room.
It's a done.
It's done.
Second of all.
The fact is that the best doneanterior approach on table far
exceeds the best done anteriorapproach off table regardless of
(03:43):
patient less muscle injury.
You can do an anterior approachon table in a primary hip
replacement in a patient withfairly normal body habitus
without any muscular injury atall, and we do all the time.
Is different than off tablewhere there is always some
(04:04):
muscular injury.
Furthermore, we can do itwithout any releases around the
femur versus on off table.
I'm sorry, where commonly thereare releases that need to be
done to get the femoralexposure.
Number three, difficult bodyhabitus.
Ben Domb left, I'm sorry, but ifyou'll remember him standing
(04:25):
here.
My tallest patient ever wasseven three with A BMI of 38.
Eight.
That is a very difficultoperation off table.
It's a difficult operation ontable, but it can be done
without any muscular injury.
Nevertheless, by virtue of theextension of the leg and the
manipulation of the extremitywith the use of the HANA table.
(04:49):
Number four.
I had a beautiful picture ofNick Mast doing an anterior
approach, total hip replacementon the HANA table with zero
assistants.
Zero assistants.
That cannot be done with offtable anterior approach surgery.
In the ASC where we have limitedresources, assistants are the
(05:14):
most expensive part of our teamof our operation.
No assistants necessary when youhave a HANA table.
And number five, go back tosession one.
Revision hip replacement.
Not one of those presentersshowed a single image or video
(05:38):
of an off table revisionsurgery.
The table becomes critical inand it greatly facilitates all
operations.
But it absolutely facilitatesthe revision surgery, especially
with femoral exposure, difficultfemoral exposure in revision and
complex primaries that requirelong stem often are done on, uh.
(06:05):
You didn't see a single personup here this entire meeting, and
these are the people you've seenover the course of this meeting
Are the best surgeons doing theanterior approach period.
You did not see one singlerevision surgery demonstrated
off table.
With that, I will rest my caseand turn over the microphone to
(06:29):
my worthy opponent.
Atul Kamath (06:35):
So full disclosure, I think we are anterior
surgeons, not anterior plustable surgeons, right?
So, and uh, Tania insulting halfthe audience is not a good way
to, you know, start this off.
And, uh, it's, I I think ourgoal of surgery, of course is
efficiency and all the thingsTania talked about.
Um, but actually my opponentkind of missed a lot of
(06:56):
purported benefits of using atable, right?
Technology assistance.
Uh, positioning other thingsthat people talk about the
table, so we'll, we'll concedethat she missed all that.
I would say you actually, uh,have a rich history using, uh,
the table.
However, there's a lot ofbenefits.
Now.
We talk about cost and value.
Um, and I think the setup iseasier with off table.
(07:18):
Uh, there's no extradisposables.
You don't need a non-sterileassistant to help you maneuver
the table.
Um, the ergonomics of moving atable can be, uh, tough.
Uh, the HANA table is too bigfor the ASC I would contend,
right?
We have smaller ASCs, we have tobe more nimble.
Oh, and actually now I need twotables because I have two
operating rooms that I need tofurnish.
(07:38):
Um, and then also a lot of thestudies that you talked about
actually didn't mention anystudies, uh, related to soft
tissue preservation, efficiency,ergonomics outcomes.
There's been no study oncomparing the two.
So I would say dealer's choiceon using a table or not, and I
would say.
Um, it's really the anteriorapproach and your technique.
(07:59):
Uh, rather than a table that'sgonna get you there.
So I would say this is also aglobal meeting, right?
So not every, uh, country, notevery, uh, facility can afford
the HANA table.
As we talked about.
Uh, someone yesterday waited 12years in Brazil to get their
HANA table.
Um, and again, the cost is notinsignificant, especially, uh,
in your, uh, A ASC that you own.
(08:20):
Uh, I would contend that primaryand revision surgery are equally
done, uh, on table versus offtable.
So I think that's sort of, uh,the point of needing a table to
do a surgery, I think is, uh,definitely a fallacy as well.
Uh, and then I would sayprobably it's quicker to do
revision surgery off table.
The leg is more facile.
Uh, the intervals are more easyto, uh, access.
(08:41):
Uh, so again, I would probablysay, uh, and then probably the
risk of fracture with reductionmaneuvers is probably less with,
uh, off table than on table aswell.
So, um, you know, I, I thinkTania, you gotta really step up
a little bit here.
I think you gotta give yourselfmore credit.
You're better surgeon than youthink you are.
I think, you know, given theopportunity, you probably could
do this off table as well.
(09:02):
Um, your ability to usetechnology is not afforded.
By the table, it's by yourexpert, uh, ability to look at
fluoroscopy.
Your ability to get exposure isyour master of the anatomy, not
the table itself.
Uh, and perhaps, uh, theargument, uh, is less about
table or off table, but can weharness or teach the anatomy and
(09:23):
the technology better?
Uh, rather than, uh, using thetable as a crutch, uh, to get
exposure or a better outcome.
So with that, uh, maybe we caneven queue up my little, uh,
picture here.
Uh, I know we're not used toslides, but this is Tania trying
to shoot a gun, uh, with her,with her Hana table.
And this is one of the best, uh,pistol shooters in the world for
(09:45):
out of Turkey.
Uh, kind of just strolling up,uh, and getting a silver medal
in the Olympics.
So, uh, you know, Tania, Ithink, uh, give yourself some
credit.
I know you're better than that.
Uh, and again, table or notable.
We'll, we'll get you there.
Okay.
Thank you.
Joseph M. Schwab (10:00):
Rebuttal.
Tania Ferguson (10:05):
Well, that was a nice slide.
Uh.
I'm sorry, I have a sixth point.
Could I please see my slide?
Atul Kamath (10:18):
Tania, I know you worked on this all morning.
Tania Ferguson (10:20):
I would like to talk about hip.
You threw this out on the video.
Uh, everything you just heard isfalse news.
I am officially canceling Atulfor his.
Debate against his own practice.
Atul Kamath (10:40):
That's a dead patient, Tania.
We can do ha table surgery on adead patient in a lab, but, but
in real life, in real life,
Tania Ferguson (10:47):
my opponent uses the HA table.
So that is.
All I have to say, if the miccould drop, I would do it.
Joseph M. Schwab (10:56):
One minute.
Rebuttal.
Atul Kamath (10:57):
You can start signing that certificate for me
for the award, but, uh,
Joseph M. Schwab (11:00):
please go and vote.
Atul Kamath (11:01):
I I preface it.
I use both, right?
I also do hip arthroscopy.
We do a lot of other things, butI, I think we should not be
beholden to saying the table isthe best way to do surgery.
It's the surgeon.
Don't, you know, sell yourselfshort Surgeon anatomy
principles, adjunctivetechnology can both be done.
Table, no table.
Uh, you know, uh, it doesn'tmatter.
(11:22):
So I think, uh, from thatstandpoint, I'm glad I convinced
you all that, uh, off table is,uh, easy and facile and the way
to go.
So thank you.
Joseph M. Schwab (11:32):
That was just great.
I'll put links to the differentslides that each of them used in
the show notes so that you cansee exactly what they were
referencing in each of thoseslides.
So, what do you use in yourpractice?
Do you use a Hana table?
Do you use some other sort oforthopedic table that helps
(11:54):
facilitate mobility of the leg,or do you use.
A standard operating table andwhy is it cost?
Is it just the way you weretrained?
Is it something else?
Does it have something to dowith the other technology that
you are using?
I really like the way they havethis debate, but I'm interested
to hear what you have to thinktoo.
(12:16):
Go ahead and drop a commentbelow.
Thank you for joining me forthis episode of the AHF Podcast.
As always, please take a momentto like and subscribe so we can
keep the lights on and keepsharing great content just like
this.
Please also drop any topic ideasor feedback in the comments
(12:36):
below.
You can find the AHF podcast onApple Podcasts, Spotify, or in
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation.
All one word.
Episodes of the AHF Podcast comeout on Fridays.
(12:58):
I'm your host, Joe Schwab,asking you to keep those hips
happy and healthy regardless ofwhether they're on table or off
table.
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