May 2, 2025 • 18 mins
Join host Joe Schwab on the AHF Podcast for Part 2 of our roundtable discussion with Dr. Alex Sah and Dr. Michael Blankstein. This week, we delve into the future of the anterior approach in total hip arthroplasty, the nuances of revision surgery, and challenges that still need to be addressed. We also explore enabling technologies like the Hana table and fluoroscopy, and discuss the importance of being versatile in surgical approaches. Don't miss insights on patient outcomes, surgical techniques, and key recommendations for surgeons considering adopting the anterior approach.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Joseph M Schwab (00:24):
Hello and welcome back to the AHF Podcast.
I'm your host, Joe Schwab.
This week we have part two ofour AHF Roundtable on moving
from posterior approach toanterior approach while already
in practice.
My guests are Dr.
Alex Sah and Dr.
Michael Blankstein.
This week we discussed theirthoughts on revision surgery,
(00:46):
and we learned what Mike hasbeen right about and what he's
been wrong about.
Let's get back to ourconversation.
you actually raise a really goodquestion, Mike, which is.
Um, so where do things go fromhere?
I mean, where does interiorapproach go from here or where
does, uh, total hip arthroplastygo from here?
(01:06):
What are the challenges we'veleft to conquer?
Alexander Sah (01:11):
That's a great question, Joe.
Things have gotten very goodwith the anterior approach, and
I think as you see the movementto the ASCs, you see outpatient
surgery, I think, I thinkanterior really lends itself to
those types of things.
I think we can still get betterin, uh, maybe even more
minimally invasive surgery, youknow, fewer releases,
potentially, uh, better woundhealing with our incisions and
(01:33):
how we manage the soft tissue.
So I think there are still areasfor improvement.
Uh, certainly we're seeing alarge increase in revision
surgery through the anteriorapproach.
I think we're going to see moreand more of that being
developed.
That's, That's, an area whereprobably tools and other
techniques and, and otherapproaches will, will help us
more as we learn how to dolarger and more complicated
(01:53):
revisions through the anteriorapproach.
I think there's room for growththere.
Michael Blankstein (01:58):
So if you look again at the current day
revision rates, according to theAmerican Joint Replacement
Registry, three top reasons areinfection.
dislocations and fracture.
So obviously where we shouldcontinue to work, put all our
effort is into preventinginfection, uh, or again
optimizing our patients better.
So if you had to choose one, Iwould say better patient
(02:20):
selection optimization.
of a peripatetic fractures, wehave gone a long way, and this
is my little plug for knowinghow to cement a total hip when
necessary.
is some really good data showingthat maybe these modern stems
These brooch only colored HAcoated stems, which happen to be
(02:41):
the anterior brooch friendlystems, the next seem to be
really decreasing the rates ofperiprostatic fractures.
So I actually think that if wecan do one thing, we should make
sure that we all control tests.
the right stems.
to a cement when we need to,monitoring and not a cable when
we need to.
So, track because thatcomplication can be keep an
prevented.
(03:01):
And Um, about respect toactually controls the
dislocations, um, traffic.
I think again, the rates are solow right now, and now we're
just finding out the, the finaldetails, which is, hey, if you
have somebody who's high riskand they have a abnormal hip
spine relationship, should youuse enabling technologies?
Should you use larger, um,Ceramic femoral heads, she used
(03:22):
dual mobility components, ormaybe it's just the approach.
And again, the rates are so low,but that's the one thing we're
all still chasing, that again,that perfection.
So I think these are probablythe top three things.
Um, uh, about the revisions tothe front, it's interesting.
That's where I'm going tochallenge the anterior approach
surgeons.
I think that, you know, Most ofthe advantages of the anterior
(03:47):
approach are in the earlyrecovery.
Now, when we're talking aboutthese big revisions, you know,
cup cages, a custom tri flange,all that stuff, I think you lose
those advantages through theanterior approach for pretty big
dissection.
So I think this is where itstill Don't be a one trick pony.
(04:07):
Be able to do both approacheswhen necessary.
If you can, don't feel thepressure.
I think the pressure to do theanterior approach for a primary
hip, I got it, and I wasinfluenced by it.
To feel the pressure to dorevisions to the front, I mean,
Show me the data one day, maybe,but sometimes the posterior
ports is still the winner, no,these tough complex cases.
(04:31):
no, again, naturally moreextensive.
And I don't know my opinion.
Joseph M Schwab (04:36):
Yeah, I was going to say, Mike, I think you
raise a good point.
So we just actually finished aconversation with a group of
revision surgeons, uh, talkingabout doing revision anterior
approach.
And I would say, um, about halfthe surgeons.
incorporate some posteriorapproach in their revisions and
half don't.
(04:57):
Um, and that could be a productof the types of revisions that
they're seeing or other factors.
But, um, there were someanatomic factors that would push
one surgeon to go, you forinstance, on a posterior
approach versus an anteriorapproach.
But was a common theme that theyall raised as far as what, how
they felt that anterior approachin a revision scenario would
(05:21):
continue to benefit orpotentially even outperform
posterior approach, which is inthe reliability of the placement
of the components.
So in being able to reliablyrestore hip center, reliably
restore leg length and offsetand all of the anatomic
restoration that we aim for inanterior approach, um, is very
(05:44):
facilitated by, um, uh, the,nature of anterior approach
surgery being able to be done,um, uh, under guidance of
fluoroscopy.
Um, now I, I think it's, uh,just like we learned with the
development of anteriorapproach.
It's good that there are peopleout there who are taking those
(06:06):
chances and pushing thoseboundaries and, and learning
those things for us.
And we'll hope that the, thedissemination of the education,
you know, makes us all bettersurgeons in the end.
Uh, once we have the data.
to identify what are the bestways to go about But I think
that's a really good point ismaking, um, uh, a surgeon, a, a
(06:28):
well rounded surgeon, um, andbeing able to approach the hip
from whatever direction the hipneeds to be approached.
Um, I do have a, uh, oneadditional question for you,
Alex.
Um, tell me a little bit about,I, I, when I talk to people, I,
I refer to this as the fitcheck.
Give me a little bit about yourfit check.
So your, for anterior approach,you mentioned using the HANA
(06:50):
table, um, and you mentionedfluoroscopy.
Is that, uh, tell me a littlebit about what your standard,
uh, anterior approach setup is.
Alexander Sah (07:00):
Definitely, Joe.
Before I go to that, I am goingto just go back for one second,
just to highlight something youand Michael were talking about,
which is with all the modern daytraining of anterior approach.
I think there is value ofsurgeons to learn it.
do courses.
And even if they don't converttheir practice to Andrew hip
approach, I think there's stillthis value.
I think by seeing the anatomy,seeing the approach, as Michael
(07:20):
said, when you first start,things are upside down and
backwards, but I think that's agood thing as a hip surgeon.
I think it's good to understandthe anatomy from a different
angle and a different place.
And so I I've had othercolleagues who.
Go back to their posteriorapproaches after trainings, but
they say they appreciatelearning something different.
And I think that highlights whatyou just said about revision
(07:41):
surgery as well.
I think one of those benefitsare learning how to do those
complex revisions from thefront, help you appreciate and
just make you a better overallsurgeon.
So just wanted to follow up onyour comment.
Michael Blankstein (07:52):
One thing to say that I still keep the
posterior approaches a part ofmy practice.
There are cases where I loveshowing the residents.
I'm like, do you guys think weshould do this to the front?
And it's the biggest it's peoplewith the anatomy that just would
make the interior purchase sochallenging.
And we all know who we'retalking about.
We're talking about these bigdudes with huge beer bellies.
(08:15):
And they have these like skinnylittle thighs, right?
And sure, you could do itthrough the front, but you'll be
fighting in that belly theentire time.
And if you do it through theback, it's significantly easier.
Any conversion cases, previoushardware, um, cases that you
were just, you know, abnormalanatomy, you're worried.
(08:36):
So, again, I think we should,Um, never be one trick ponies in
orthopedics.
And that's probably been mybiggest message, I think, to the
community, both in the Okay.
Yeah.
(08:58):
Right.
be able to do at least one otherapproach for these complex
cases.
And one of the, Sorry, I'mahead.
think we should keep it.
And some people say I've goneall in 100%.
I'm like, okay, fine.
(09:18):
But not maintain that previousskill set that you're good at?
Joseph M Schwab (09:23):
This episode of the A HF podcast is brought to
you by Mizuho, OSI.
The Hana table hasrevolutionized how I perform
anterior approach hipreplacements.
The precision and control itoffers are unmatched giving my
patients quicker recovery timesand better outcomes.
(09:44):
Orthopedic surgery is alwaysevolving, and tools like the
Hana Orthopedic table are whatpushes this field forward.
We're talking about a solutiondesigned by surgeons for
surgeons engineered specificallyfor anterior approach.
Hip arthroplasty, HANA optimizesevery step of the procedure.
(10:04):
No muscle detachment,unparalleled radiolucency
superior access.
If you wanna deliver the fullbenefits of this minimally
invasive approach for yourpatients, you need to do it on
the Hana.
You can just tell every detailthat went into the HANA has been
meticulously refined for hipprocedures.
(10:25):
Mizuho OSI is a proud foundingsponsor of the Anterior Hip
Foundation.
Committed to driving innovation,education, and advancing patient
care.
Join your peers at the AnteriorHip Foundation annual meeting to
see how HANA can help youachieve outstanding patient
outcomes.
(10:47):
And now.
Back to our podcast.
The question that, um, I hadposed to Alex, I'll, I'll now
pose kind of to both of youguys, which is, what does your,
uh, anterior approach set uplook like normally in your
hospital?
Are you using the HANA table?
Are you using a standard table?
(11:07):
Are you using fluoroscopy?
Is there any enablingtechnologies that they're using
on a regular basis?
Just give me a rundown.
And, and Alex, why don't westart with you?
Alexander Sah (11:17):
So for our setup, Joe, we do use the HANA table.
Certainly we like how easy it isto use, how consistent it is for
positioning.
Certainly with posteriorapproach, we're all familiar
with the person on the oppositeside of the table and how
variable their help can be whenthey're trying to move that leg.
So having a HANA table that willconsistently.
position.
The femur where we want it isdefinitely ideal and not going
(11:37):
to give that up, even thoughpeople can do it just buying off
table as well.
Sea arm, of course, who arehighly favorable, favorable for,
as we've talked about today, allthe advantages of it.
So definitely not giving that upeither.
And we do use ortho grid AItechnology.
So we did have our reps usingthe pen and doing outlines, and
that worked just fine.
(11:58):
But then Printer paper wentaway.
So we had to figure out somesort of technology and the A.
I.
And these current technologiesare so fast and reproducible.
It gives us great information.
So we've been very happy withhow that has worked for us.
And I've started using some ofthe automated impactors as well.
I didn't think I would.
I was resisting it.
I wanted to think I was stillyoung and that was really only
(12:19):
for the older guys with rotatorcut problems.
But I've actually seen somepotential benefits of it.
So I've been using that as well.
Michael Blankstein (12:27):
I like it.
It's amazing how similar we are.
Um, I, it's funny, I, I keep atab with myself of what I was
wrong about, what I'm rightabout.
An example, I thought thatoutpatient surgery.
It was a fad.
There's no way it's going to bewhere we're all, where we're all
doing.
And I was clearly wrong, youknow.
It's amazing how, how manypatients go home the same day.
(12:47):
I also thought the automatedimpactor was just a, whatever,
just for Americans who loveguns.
There's no way we need this, youknow, and clearly people really,
really like it.
And once you get used to it,yeah, it just makes the
operation a bit more fun.
So, um, so I use a very similarsetup.
I use the Hanna table.
(13:08):
I use a CRM.
It's my favorite advantage ofthe anterior approach.
use a, a anterior friendlyimplants and, um, and yeah,
that's pretty much the basicsetup.
One of the things that I do, um,Um, think about is the hip spine
relationship.
I used to really say untilsomebody figures it out, I'm not
(13:31):
going to get involved.
Like somebody, let somebodyfigure it out and then we'll,
um, we'll tackle it.
But now with the enablingtechnology, it's actually easy
to figure out.
We have all the tools right now.
You just have to get a couple ofextra x rays with those x rays,
we can all start to figure outwhat's the idea.
personalized composition forthat patient.
(13:51):
So for my primary basic vanillacases, I do not use it.
But when I do see something,it's a bit more complex, where
you look at those x rays and yousay, well, that's way too much
of an inlet or an outlet view.
Or you see this fusion of thespine.
I wanted to see whether weshould get a different
(14:12):
composition, and I use a robotnavigation tool that, uh, think
it definitely allows you to evenimprove your accuracy even more.
idea behind that is that intheory, with this technology, we
can get rid of radiation.
So I'm still, I still have onemore phase of learning, which is
(14:32):
my favorite tool, which kind ofworks, but in theory, we may be
Joseph M Schwab (14:38):
what pearls do you have for maximizing your
time and your educationthroughout the process of, uh,
adopting, uh, anterior approach?
Um, and for instance, with asurgeon visitation, how do you
maximize your time?
Alexander Sah (14:56):
I think what was eye opening for me, Joe, really
was attending that Andrew HittFoundation meeting.
And I'm saying it truly.
Compared to all the othermeetings we go to it really is
one that is unique in terms ofeveryone there Loves the entry
hip surgery.
They love helping each other.
They love teaching.
It's not uh, argumentative atall.
You don't see people who areChallenging each other unless
(15:18):
they're trying to help eachother.
So there's no animosity.
That's really what's great aboutit There's some other Uh,
meetings where it's, it isdifficult to people want to
show, you know, poor outcomesor, um, show the negative
effects of other newtechnologies or uh, techniques,
but really the anteriorfoundation is very supportive
even when I was the only posterhip surgeon in the room.
And I remember that very fondly.
(15:39):
So I think taking advantage ofmeetings like that, I think
getting into the interhipcommunity and knowing your
peers, get to know your peers,they are all incredibly friendly
and helpful.
I think that helps you in yourjourney, not just when you're
beginning, But when you'regetting better or when you're
starting to do revisions or whenyou're in your 10th year of
practice, I think there's stillhuge benefit to learning from
(16:01):
your peers.
You don't want to operate in abubble.
You don't want to try to figurethings out for yourself.
There's so many people out therewilling to help and, and that's
why I can't wait to come to themeeting you're running in
Nashville in June.
That's going to be anotherexciting meeting and each year
is different and even better.
Joseph M Schwab (16:17):
We're looking forward to having you.
Michael, how about you?
Michael Blankstein (16:22):
Yeah, I agree again.
I think that, um, the community.
is really supportive.
I would say it's a five stepprocess.
If you're really consideringmaking that transition, I would
say to one of the courses andthey're usually industry
sponsored courses.
I actually think you should goto two courses, go to one, see
(16:42):
how X does it, take a break, seehow company Y does it, then ask
yourself, do I still want to doit?
If that's the case, then youshould go see another surgeon,
do it live.
And there with their setup.
Go see how they do four or fivehips.
Then find a surgeon to come backwith you and be there around if
(17:05):
you don't have somebody aroundfor the first day you're doing
it.
And then see how those patientsdo.
Reflect on it.
Don't switch 100 percent on.
See how you do and thenreassess.
And if then you think, you knowwhat, I'm ready, then you dive
all in.
Joseph M Schwab (17:25):
Well, gentlemen, thank you both for
talking to me today, for sharingyour stories.
I really appreciate hearing it.
And, uh, as you're both, uh, Iconsider good friends.
I, uh, I appreciate just theopportunity to see and talk to
you.
If you're a mid-career surgeonlooking to add anterior
approach, hip replacement toyour practice, we would love to
(17:45):
hear from you, drop us a commentbelow and tell us your story.
Or maybe you have a story totell about your own adoption of
anterior approach in yourpractice.
Leave it in the comments toshare with others.
Thank you for listening to thisepisode of the AHF podcast.
Remember to like and subscribeso we can reach a wider
(18:06):
audience.
If you have an idea for a topic,leave it in the comments.
Remember, you can find us inaudio podcast form in your
favorite podcast app, as well asin video form on YouTube slash
at anterior hip foundation.
All one word.
New episodes of the AHF Podcastcome out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
(18:29):
happy and healthy.
Hello and welcome back to the AHF Podcast.
I'm your host, Joe Schwab.
This week we have part two ofour AHF Roundtable on moving
from posterior approach toanterior approach while already
in practice.
My guests are Dr.
Alex Sah and Dr.
Michael Blankstein.
This week we discussed theirthoughts on revision surgery,
(00:46):
and we learned what Mike hasbeen right about and what he's
been wrong about.
Let's get back to ourconversation.
you actually raise a really goodquestion, Mike, which is.
Um, so where do things go fromhere?
I mean, where does interiorapproach go from here or where
does, uh, total hip arthroplastygo from here?
(01:06):
What are the challenges we'veleft to conquer?
Alexander Sah (01:11):
That's a great question, Joe.
Things have gotten very goodwith the anterior approach, and
I think as you see the movementto the ASCs, you see outpatient
surgery, I think, I thinkanterior really lends itself to
those types of things.
I think we can still get betterin, uh, maybe even more
minimally invasive surgery, youknow, fewer releases,
potentially, uh, better woundhealing with our incisions and
(01:33):
how we manage the soft tissue.
So I think there are still areasfor improvement.
Uh, certainly we're seeing alarge increase in revision
surgery through the anteriorapproach.
I think we're going to see moreand more of that being
developed.
That's, That's, an area whereprobably tools and other
techniques and, and otherapproaches will, will help us
more as we learn how to dolarger and more complicated
(01:53):
revisions through the anteriorapproach.
I think there's room for growththere.
Michael Blankstein (01:58):
So if you look again at the current day
revision rates, according to theAmerican Joint Replacement
Registry, three top reasons areinfection.
dislocations and fracture.
So obviously where we shouldcontinue to work, put all our
effort is into preventinginfection, uh, or again
optimizing our patients better.
So if you had to choose one, Iwould say better patient
(02:20):
selection optimization.
of a peripatetic fractures, wehave gone a long way, and this
is my little plug for knowinghow to cement a total hip when
necessary.
is some really good data showingthat maybe these modern stems
These brooch only colored HAcoated stems, which happen to be
(02:41):
the anterior brooch friendlystems, the next seem to be
really decreasing the rates ofperiprostatic fractures.
So I actually think that if wecan do one thing, we should make
sure that we all control tests.
the right stems.
to a cement when we need to,monitoring and not a cable when
we need to.
So, track because thatcomplication can be keep an
prevented.
(03:01):
And Um, about respect toactually controls the
dislocations, um, traffic.
I think again, the rates are solow right now, and now we're
just finding out the, the finaldetails, which is, hey, if you
have somebody who's high riskand they have a abnormal hip
spine relationship, should youuse enabling technologies?
Should you use larger, um,Ceramic femoral heads, she used
(03:22):
dual mobility components, ormaybe it's just the approach.
And again, the rates are so low,but that's the one thing we're
all still chasing, that again,that perfection.
So I think these are probablythe top three things.
Um, uh, about the revisions tothe front, it's interesting.
That's where I'm going tochallenge the anterior approach
surgeons.
I think that, you know, Most ofthe advantages of the anterior
(03:47):
approach are in the earlyrecovery.
Now, when we're talking aboutthese big revisions, you know,
cup cages, a custom tri flange,all that stuff, I think you lose
those advantages through theanterior approach for pretty big
dissection.
So I think this is where itstill Don't be a one trick pony.
(04:07):
Be able to do both approacheswhen necessary.
If you can, don't feel thepressure.
I think the pressure to do theanterior approach for a primary
hip, I got it, and I wasinfluenced by it.
To feel the pressure to dorevisions to the front, I mean,
Show me the data one day, maybe,but sometimes the posterior
ports is still the winner, no,these tough complex cases.
(04:31):
no, again, naturally moreextensive.
And I don't know my opinion.
Joseph M Schwab (04:36):
Yeah, I was going to say, Mike, I think you
raise a good point.
So we just actually finished aconversation with a group of
revision surgeons, uh, talkingabout doing revision anterior
approach.
And I would say, um, about halfthe surgeons.
incorporate some posteriorapproach in their revisions and
half don't.
(04:57):
Um, and that could be a productof the types of revisions that
they're seeing or other factors.
But, um, there were someanatomic factors that would push
one surgeon to go, you forinstance, on a posterior
approach versus an anteriorapproach.
But was a common theme that theyall raised as far as what, how
they felt that anterior approachin a revision scenario would
(05:21):
continue to benefit orpotentially even outperform
posterior approach, which is inthe reliability of the placement
of the components.
So in being able to reliablyrestore hip center, reliably
restore leg length and offsetand all of the anatomic
restoration that we aim for inanterior approach, um, is very
(05:44):
facilitated by, um, uh, the,nature of anterior approach
surgery being able to be done,um, uh, under guidance of
fluoroscopy.
Um, now I, I think it's, uh,just like we learned with the
development of anteriorapproach.
It's good that there are peopleout there who are taking those
(06:06):
chances and pushing thoseboundaries and, and learning
those things for us.
And we'll hope that the, thedissemination of the education,
you know, makes us all bettersurgeons in the end.
Uh, once we have the data.
to identify what are the bestways to go about But I think
that's a really good point ismaking, um, uh, a surgeon, a, a
(06:28):
well rounded surgeon, um, andbeing able to approach the hip
from whatever direction the hipneeds to be approached.
Um, I do have a, uh, oneadditional question for you,
Alex.
Um, tell me a little bit about,I, I, when I talk to people, I,
I refer to this as the fitcheck.
Give me a little bit about yourfit check.
So your, for anterior approach,you mentioned using the HANA
(06:50):
table, um, and you mentionedfluoroscopy.
Is that, uh, tell me a littlebit about what your standard,
uh, anterior approach setup is.
Alexander Sah (07:00):
Definitely, Joe.
Before I go to that, I am goingto just go back for one second,
just to highlight something youand Michael were talking about,
which is with all the modern daytraining of anterior approach.
I think there is value ofsurgeons to learn it.
do courses.
And even if they don't converttheir practice to Andrew hip
approach, I think there's stillthis value.
I think by seeing the anatomy,seeing the approach, as Michael
(07:20):
said, when you first start,things are upside down and
backwards, but I think that's agood thing as a hip surgeon.
I think it's good to understandthe anatomy from a different
angle and a different place.
And so I I've had othercolleagues who.
Go back to their posteriorapproaches after trainings, but
they say they appreciatelearning something different.
And I think that highlights whatyou just said about revision
(07:41):
surgery as well.
I think one of those benefitsare learning how to do those
complex revisions from thefront, help you appreciate and
just make you a better overallsurgeon.
So just wanted to follow up onyour comment.
Michael Blankstein (07:52):
One thing to say that I still keep the
posterior approaches a part ofmy practice.
There are cases where I loveshowing the residents.
I'm like, do you guys think weshould do this to the front?
And it's the biggest it's peoplewith the anatomy that just would
make the interior purchase sochallenging.
And we all know who we'retalking about.
We're talking about these bigdudes with huge beer bellies.
(08:15):
And they have these like skinnylittle thighs, right?
And sure, you could do itthrough the front, but you'll be
fighting in that belly theentire time.
And if you do it through theback, it's significantly easier.
Any conversion cases, previoushardware, um, cases that you
were just, you know, abnormalanatomy, you're worried.
(08:36):
So, again, I think we should,Um, never be one trick ponies in
orthopedics.
And that's probably been mybiggest message, I think, to the
community, both in the Okay.
Yeah.
(08:58):
Right.
be able to do at least one otherapproach for these complex
cases.
And one of the, Sorry, I'mahead.
think we should keep it.
And some people say I've goneall in 100%.
I'm like, okay, fine.
(09:18):
But not maintain that previousskill set that you're good at?
Joseph M Schwab (09:23):
This episode of the A HF podcast is brought to
you by Mizuho, OSI.
The Hana table hasrevolutionized how I perform
anterior approach hipreplacements.
The precision and control itoffers are unmatched giving my
patients quicker recovery timesand better outcomes.
(09:44):
Orthopedic surgery is alwaysevolving, and tools like the
Hana Orthopedic table are whatpushes this field forward.
We're talking about a solutiondesigned by surgeons for
surgeons engineered specificallyfor anterior approach.
Hip arthroplasty, HANA optimizesevery step of the procedure.
(10:04):
No muscle detachment,unparalleled radiolucency
superior access.
If you wanna deliver the fullbenefits of this minimally
invasive approach for yourpatients, you need to do it on
the Hana.
You can just tell every detailthat went into the HANA has been
meticulously refined for hipprocedures.
(10:25):
Mizuho OSI is a proud foundingsponsor of the Anterior Hip
Foundation.
Committed to driving innovation,education, and advancing patient
care.
Join your peers at the AnteriorHip Foundation annual meeting to
see how HANA can help youachieve outstanding patient
outcomes.
(10:47):
And now.
Back to our podcast.
The question that, um, I hadposed to Alex, I'll, I'll now
pose kind of to both of youguys, which is, what does your,
uh, anterior approach set uplook like normally in your
hospital?
Are you using the HANA table?
Are you using a standard table?
(11:07):
Are you using fluoroscopy?
Is there any enablingtechnologies that they're using
on a regular basis?
Just give me a rundown.
And, and Alex, why don't westart with you?
Alexander Sah (11:17):
So for our setup, Joe, we do use the HANA table.
Certainly we like how easy it isto use, how consistent it is for
positioning.
Certainly with posteriorapproach, we're all familiar
with the person on the oppositeside of the table and how
variable their help can be whenthey're trying to move that leg.
So having a HANA table that willconsistently.
position.
The femur where we want it isdefinitely ideal and not going
(11:37):
to give that up, even thoughpeople can do it just buying off
table as well.
Sea arm, of course, who arehighly favorable, favorable for,
as we've talked about today, allthe advantages of it.
So definitely not giving that upeither.
And we do use ortho grid AItechnology.
So we did have our reps usingthe pen and doing outlines, and
that worked just fine.
(11:58):
But then Printer paper wentaway.
So we had to figure out somesort of technology and the A.
I.
And these current technologiesare so fast and reproducible.
It gives us great information.
So we've been very happy withhow that has worked for us.
And I've started using some ofthe automated impactors as well.
I didn't think I would.
I was resisting it.
I wanted to think I was stillyoung and that was really only
(12:19):
for the older guys with rotatorcut problems.
But I've actually seen somepotential benefits of it.
So I've been using that as well.
Michael Blankstein (12:27):
I like it.
It's amazing how similar we are.
Um, I, it's funny, I, I keep atab with myself of what I was
wrong about, what I'm rightabout.
An example, I thought thatoutpatient surgery.
It was a fad.
There's no way it's going to bewhere we're all, where we're all
doing.
And I was clearly wrong, youknow.
It's amazing how, how manypatients go home the same day.
(12:47):
I also thought the automatedimpactor was just a, whatever,
just for Americans who loveguns.
There's no way we need this, youknow, and clearly people really,
really like it.
And once you get used to it,yeah, it just makes the
operation a bit more fun.
So, um, so I use a very similarsetup.
I use the Hanna table.
(13:08):
I use a CRM.
It's my favorite advantage ofthe anterior approach.
use a, a anterior friendlyimplants and, um, and yeah,
that's pretty much the basicsetup.
One of the things that I do, um,Um, think about is the hip spine
relationship.
I used to really say untilsomebody figures it out, I'm not
(13:31):
going to get involved.
Like somebody, let somebodyfigure it out and then we'll,
um, we'll tackle it.
But now with the enablingtechnology, it's actually easy
to figure out.
We have all the tools right now.
You just have to get a couple ofextra x rays with those x rays,
we can all start to figure outwhat's the idea.
personalized composition forthat patient.
(13:51):
So for my primary basic vanillacases, I do not use it.
But when I do see something,it's a bit more complex, where
you look at those x rays and yousay, well, that's way too much
of an inlet or an outlet view.
Or you see this fusion of thespine.
I wanted to see whether weshould get a different
(14:12):
composition, and I use a robotnavigation tool that, uh, think
it definitely allows you to evenimprove your accuracy even more.
idea behind that is that intheory, with this technology, we
can get rid of radiation.
So I'm still, I still have onemore phase of learning, which is
(14:32):
my favorite tool, which kind ofworks, but in theory, we may be
Joseph M Schwab (14:38):
what pearls do you have for maximizing your
time and your educationthroughout the process of, uh,
adopting, uh, anterior approach?
Um, and for instance, with asurgeon visitation, how do you
maximize your time?
Alexander Sah (14:56):
I think what was eye opening for me, Joe, really
was attending that Andrew HittFoundation meeting.
And I'm saying it truly.
Compared to all the othermeetings we go to it really is
one that is unique in terms ofeveryone there Loves the entry
hip surgery.
They love helping each other.
They love teaching.
It's not uh, argumentative atall.
You don't see people who areChallenging each other unless
(15:18):
they're trying to help eachother.
So there's no animosity.
That's really what's great aboutit There's some other Uh,
meetings where it's, it isdifficult to people want to
show, you know, poor outcomesor, um, show the negative
effects of other newtechnologies or uh, techniques,
but really the anteriorfoundation is very supportive
even when I was the only posterhip surgeon in the room.
And I remember that very fondly.
(15:39):
So I think taking advantage ofmeetings like that, I think
getting into the interhipcommunity and knowing your
peers, get to know your peers,they are all incredibly friendly
and helpful.
I think that helps you in yourjourney, not just when you're
beginning, But when you'regetting better or when you're
starting to do revisions or whenyou're in your 10th year of
practice, I think there's stillhuge benefit to learning from
(16:01):
your peers.
You don't want to operate in abubble.
You don't want to try to figurethings out for yourself.
There's so many people out therewilling to help and, and that's
why I can't wait to come to themeeting you're running in
Nashville in June.
That's going to be anotherexciting meeting and each year
is different and even better.
Joseph M Schwab (16:17):
We're looking forward to having you.
Michael, how about you?
Michael Blankstein (16:22):
Yeah, I agree again.
I think that, um, the community.
is really supportive.
I would say it's a five stepprocess.
If you're really consideringmaking that transition, I would
say to one of the courses andthey're usually industry
sponsored courses.
I actually think you should goto two courses, go to one, see
(16:42):
how X does it, take a break, seehow company Y does it, then ask
yourself, do I still want to doit?
If that's the case, then youshould go see another surgeon,
do it live.
And there with their setup.
Go see how they do four or fivehips.
Then find a surgeon to come backwith you and be there around if
(17:05):
you don't have somebody aroundfor the first day you're doing
it.
And then see how those patientsdo.
Reflect on it.
Don't switch 100 percent on.
See how you do and thenreassess.
And if then you think, you knowwhat, I'm ready, then you dive
all in.
Joseph M Schwab (17:25):
Well, gentlemen, thank you both for
talking to me today, for sharingyour stories.
I really appreciate hearing it.
And, uh, as you're both, uh, Iconsider good friends.
I, uh, I appreciate just theopportunity to see and talk to
you.
If you're a mid-career surgeonlooking to add anterior
approach, hip replacement toyour practice, we would love to
(17:45):
hear from you, drop us a commentbelow and tell us your story.
Or maybe you have a story totell about your own adoption of
anterior approach in yourpractice.
Leave it in the comments toshare with others.
Thank you for listening to thisepisode of the AHF podcast.
Remember to like and subscribeso we can reach a wider
(18:06):
audience.
If you have an idea for a topic,leave it in the comments.
Remember, you can find us inaudio podcast form in your
favorite podcast app, as well asin video form on YouTube slash
at anterior hip foundation.
All one word.
New episodes of the AHF Podcastcome out on Fridays.
I'm your host, Joe Schwab,asking you to keep those hips
(18:29):
happy and healthy.
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