AHF Podcast

What changes as an anterior approach hip practice matures, from your first cases to a high-volume outpatient program?Two hip surgeons share what becomes automatic, what still needs a plan, and what it takes to bring anterior approach total hip replacement into the surgery center.In this S+N Surgeon Roundtable, Chance Gray and Jessica Hooper trace the arc of an anterior approach practice. They talk about the moment the approach stops feeling new, when you can hand more of the case to a trainee and still know how to bail out, and the mistakes surgeons make when they scale up too quickly, from missing anatomic warning signs on preoperative X-rays to underestimating how one hard case ripples through the whole day.The conversation then turns to implants and logistics: how modern collared triple-taper stems and single-tray instrumentation designed for the anterior approach have shortened cases and widened what one stem can handle, where cemented fixation still earns its place, and what an ambulatory surgery center demands of sterile processing, tray design, anesthesia protocols, and the whole care team. They also cover the warning signs that a team is moving to outpatient surgery too fast, standardizing workflows across a multi-surgeon group, preoperative planning and 3D templating, automated impaction, and engaging patients in their recovery with step counts and remote monitoring.This one is for arthroplasty surgeons, fellows, and residents building or growing an anterior approach practice, especially anyone weighing a move to the ASC. It closes with the lessons that took each surgeon the longest to learn, and why slow good can eventually become fast good.Brought to you by Smith+Nephew — Life Unlimited. The CORI Surgical System, CORIOGRAPH Pre-Op Planning, and the CATALYSTEM Primary Hip System together offer a complete solution for primary total hip arthroplasty.https://www.smithandnephew.com⏱️ Chapters:(00:00) - Intro (02:22) - What becomes automatic with anterior approach experience (04:31) - Building an outpatient anterior approach program (08:44) - Moving past the anterior approach learning curve (10:30) - Common mistakes when scaling anterior hip surgery (12:44) - How modern hip stems changed the anterior approach (18:36) - When a cemented stem still makes sense (24:36) - Taking anterior hip replacement into the ASC (27:21) - Warning signs you're moving to outpatient too fast (30:06) - Standardizing a multi-surgeon hip program (38:38) - Anticipating patient risk before outpatient surgery (41:42) - Preoperative planning and 3D templating (47:57) - Automated impaction for femoral broaching (51:52) - Engaging patients in their recovery (57:37) - Building a healthy anterior approach culture (01:00:56) - Lessons that took the longest to learn (01:07:05) - Outro Listen to the AHF Podcast on your preferred platform:Show page: https://jvomedia.com/shows/ahf-podcastApple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHcLinkedIn: https://www.linkedin.com/showcase/ahf-podcastInstagram: https://www.instagram.com/jointventureorthoYouTube: https://www.youtube.com/@anteriorhipfoundationHomepage: https://anteriorhipfoundation.comThis 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#AnteriorApproach #TotalHipArthroplasty #THA #OutpatientArthroplasty #ASC #TripleTaperStem #CementedStem #AutomatedImpaction #3DTemplating #ChanceGray #JessicaHooper

Hip resurfacing never went away; it went quiet. Paul Beaulé of The Ottawa Hospital and the University of Ottawa explains what really failed in the metal-on-metal era, who should get a resurfacing today, and how he does it through the anterior approach.Paul has offered resurfacing for a quarter of a century, since his fellowship with Harlan Amstutz in Los Angeles, and today it makes up about 30% of a practice that also covers hip preservation and total hip arthroplasty. He separates resurfacing from the large-head metal-on-metal total hips that dragged it down, explains what the registries caught early and what they missed, and argues that a new implant should change one thing at a time.From there it gets practical: which patients he offers a resurfacing and which he steers toward a total hip, the dental analogy he uses to explain the choice (filling, crown or implant), and what five-year data on ceramic-on-ceramic resurfacing show for women and smaller femoral heads. On the anterior approach, he walks through femoral exposure on a positioning table with no posterior capsular release, and explains why he now blames notching of the anterior femoral neck and off-center pin placement, more than blood supply, for early neck fractures. Paul discloses that he is a designer of a ceramic-on-ceramic resurfacing implant.He also takes on the skeptics' strongest objections, from "total hip is good enough" to revision difficulty and surgeon volume, and names the one he takes most seriously: how much acetabular bone the cup removes. For hip surgeons deciding whether resurfacing belongs in their practice, and for anyone who wants to know where it fits next to hip preservation and total hip arthroplasty.⏱️ Chapters:00:00 Introduction: hip resurfacing's second act01:25 Learning hip resurfacing with Harlan Amstutz04:57 What really went wrong in the metal-on-metal era07:22 Hip registries and lessons for new implants11:48 Follow-up for well-functioning metal-on-metal hips13:36 The ideal hip resurfacing patient today15:43 Who should not get a hip resurfacing18:29 Resurfacing vs total hip: the dental analogy20:11 Ceramic-on-ceramic resurfacing bearings23:53 Evidence on ceramic bearings: noise, women, small heads29:05 Red flags that would end a new resurfacing design30:22 Hip resurfacing through the anterior approach34:25 Femoral exposure in anterior approach resurfacing37:44 How the anterior approach lowers neck fracture risk42:20 Answering the skeptics of hip resurfacing46:03 Acetabular bone stock: the strongest objection48:19 Where hip resurfacing goes in the next decade51:06 Advice for surgeons learning hip resurfacingListen to the AHF Podcast on your preferred platform:Show page: https://jvomedia.com/shows/ahf-podcastApple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHcLinkedIn: https://www.linkedin.com/showcase/ahf-podcastYouTube: https://www.youtube.com/@anteriorhipfoundationHomepage: https://anteriorhipfoundation.comThis 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.#AHFPodcast #AnteriorHipFoundation #HipResurfacing #PaulBeaule #AnteriorApproach #HipArthroplasty #MetalOnMetal #CeramicOnCeramic #HipPreservation #FemoralNeckFracture #PatientSelection #OttawaHospital

A Toronto hip surgeon on what two weeks in the operating rooms of leading US anterior hip surgeons changed in his own practice, and what American hospitals could learn from Canada.For hip surgeons weighing the AHF Traveling Fellowship, and for anyone working to make anterior approach care more efficient inside a hospital system.This is the third and final conversation with the 2026 AHF Traveling Fellows. Host Joe Schwab sits down with Justin Chang, an adult hip and knee surgeon at Humber River Hospital in Toronto who trained at St George's, University of London, and the University of Toronto. Trained in the posterior approach, he switched to the anterior approach when he started practice and now uses it for 95 percent of his hips. He joined the fellowship to build confidence with complex and revision cases.What he brought home started in the OR: hooking a cobra retractor on the Hana table's ladder, trading a Charnley for a Gelpi, nail conversions in Houston, complex revisions at OrthoCarolina, and the soft tissue restraint that separates good anterior surgeons from masters. The bigger lessons came from around the surgery: sterilization and tray flow, OR time tracking, PA-supported teams, and how a high-volume surgeon stays present with every patient. He also makes the case that a generation trained almost exclusively in the anterior approach will need to do its hardest revisions from the front, and explains why he expects hip resurfacing to make a comeback.Coming from a fee-for-service system where two weeks away means two weeks without income, he is candid about the cost, and about why the network of host surgeons and co-fellows he built was worth it. Asked what American surgeons could learn from Canada, his answer is efficiency: how Humber River runs an efficient anterior hip workflow inside a public hospital.Thinking about applying for the 2027 AHF Traveling Fellowship? Applications run through the Anterior Hip Foundation, linked below.⏱️ Chapters:00:00 Meet 2026 AHF Traveling Fellow Justin Chang02:27 Switching from posterior to anterior approach03:55 What the fellowship teaches beyond surgical technique07:43 Anterior approach retractor tips and Hana table tricks10:50 Nail conversion and complex revision via anterior approach13:20 Why young surgeons will revise through the anterior approach16:41 Anterior hip surgery in the US vs Canada18:29 What US hospitals can learn from Canada about efficiency19:32 Soft tissue handling and what surgical mastery looks like21:35 How master surgeons communicate with patients at high volume23:36 Bringing home OR time tracking, OrthoGrid, and PA teams26:22 Is the AHF Traveling Fellowship worth two weeks away?30:18 Future of anterior hip surgery: revisions and resurfacing32:09 Advice for future fellows: practice building and marketing33:45 The biggest takeaway that wasn't a techniqueListen to the AHF Podcast on your preferred platform:Show page: https://jvomedia.com/shows/ahf-podcastApple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHcLinkedIn: https://www.linkedin.com/showcase/ahf-podcastYouTube: https://www.youtube.com/@anteriorhipfoundationHomepage: https://anteriorhipfoundation.comThis 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#TravelingFellowship #AnteriorApproach #AnteriorHip #TotalHipArthroplasty #HipReplacement #RevisionTHA #HipResurfacing #HospitalEfficiency #OrthopedicSurgery #SurgicalMentorship #JustinChang

Every hip surgeon will eventually crack a calcar or fracture a femur — what separates a manageable complication from a cascade is what happens next.Three hip surgeons walk through intraoperative and early complications after anterior approach total hip replacement, from the first broach to the first weeks at home.Complications come with hip arthroplasty, and the anterior approach has its own: femoral fractures and calcar cracks during broaching and seating, lateral femoral cutaneous nerve symptoms, bleeding that degrades visualization, and the wound and infection questions that surface in the first days after discharge. In this roundtable, Alex Gaukhman, Molly Hartzler, and Stephen Duncan talk through where those problems really start and how they handle them when they happen.The conversation stays practical. Exposure is the root of most femoral injuries, and they explain how they adapt to tight and wide canals with diaphyseal reaming and stem choice, where automated impaction makes seating more reproducible, when a calcar crack needs only a cerclage cable and when it calls for a diaphyseal-engaging stem — and why cementing a cementless stem is never the fix. On the soft-tissue side, they cover protecting the TFL and the LFCN, targeted hemostasis, and when to stop, pull the retractors, and reset rather than push through.After surgery, they work through an early dislocation, the role of navigation, incisional negative pressure therapy, and how nurse navigators, patient photos, and checklists catch problems before they are delayed. This one is for arthroplasty surgeons, fellows, and residents — especially anyone still on the anterior approach learning curve. It closes with the complication lesson each surgeon learned the hard way, and what still deserves humility every time they step into the OR.Brought to you by Smith+Nephew — Life Unlimited. The CORI Surgical System, CORIOGRAPH Pre-Op Planning, and the CATALYSTEM Primary Hip System together offer a complete solution for primary total hip arthroplasty.https://www.smithandnephew.com⏱️ Chapters:00:00 Introduction: intraoperative and early hip complications02:17 What turns a hip complication into a cascade05:04 Femoral fractures and calcar cracks start with exposure08:08 Dorr A vs Dorr C femurs: reaming and stem choice11:27 Broaching dense canals and automated impaction14:02 Managing an intraoperative calcar crack or femoral fracture18:26 Protecting the lateral femoral cutaneous nerve21:48 Hemostasis, visualization, and when to stop and reset27:44 Early dislocation after hip replacement and navigation31:22 Preventing wound complications and incisional wound vacs35:18 Early infection after hip replacement: when to escalate38:10 Checklists and nurse navigators that catch problems early41:08 Escalation triggers and when to bring in help44:53 Complication lessons that shaped their careersListen to the AHF Podcast on your preferred platform:Show page: https://jvomedia.com/shows/ahf-podcastApple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHcLinkedIn: https://www.linkedin.com/showcase/ahf-podcastYouTube: https://www.youtube.com/@anteriorhipfoundationHomepage: https://anteriorhipfoundation.comThis 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#HipComplications #PeriprostheticFracture #CalcarFracture #TotalHipArthroplasty #THA #AnteriorApproach #LFCN #PJI #AutomatedImpaction #AlexGaukhman #MollyHartzler #StephenDuncan

Three 2026 AHF Traveling Fellows on what two weeks in the operating rooms of the highest-volume anterior hip surgeons in the US taught them that no video could.For early-career hip surgeons weighing the fellowship, and for anyone trying to turn anterior approach technique into surgical judgment.This is the second of three conversations with the 2026 AHF Traveling Fellows. Host Joe Schwab sits down with Jadye Kee, a joint replacement surgeon in community practice in Bryan-College Station, Texas; Pat Maher, a hip and knee surgeon at EvergreenHealth in Kirkland, Washington; and Leo Zalikha, a Stanford-trained reconstruction surgeon now practicing in Long Beach, California. Three very different practices, two weeks on the road from Hoag in Irvine to Anderson Clinic, the Southern Joint Institute in Nashville, and Louisville, and one shared question: what actually changed when they got home?The answer starts in the OR but does not stay there. The fellows describe the small things nobody voices on video, from capsule tagging and retractor timing to a calcar release that depends on how the femur drops, and what it meant to be able to ask the surgeon why. They work through judgment versus technique, how to know when the femur is released enough, when a long femoral revision still belongs posterior, the on-table versus off-table question, and how to bring high-volume habits back to a community hospital with a different patient population. Along the way: BMI cutoffs and widening indications, value-based care, and why the OR is always an N of one.What stayed with them most was not a maneuver. It was watching how surgeons at the top of their field run a room, empower a team, and give their time to the people coming up behind them, and the kind of mentors they now want to be. They close with the case for why their group beat the first one, and a one-sentence answer to what the fellowship gave them that no technique could.Thinking about applying for the 2027 AHF Traveling Fellowship? Applications run through the Anterior Hip Foundation, linked below.⏱️ Chapters:00:00 Meet the 2026 AHF Traveling Fellows01:21 What three early-career surgeons wanted from the fellowship05:48 Itinerary: Hoag, Anderson Clinic, Nashville, Louisville09:53 Watching experts up close: why every step has a reason15:24 Judgment vs technique in anterior hip replacement19:40 Bringing high-volume lessons back to a community hospital22:12 Good vs great surgeons, and finding your own technique26:42 Patient selection, value-based care, evidence vs experience31:54 Long femoral revisions and on-table vs off-table34:24 OR culture and flow: fluoro setup, walkie-talkies, two rooms38:35 The kind of mentor they want to become42:55 What the fellowship really offers beyond technique46:20 Day one again, and where they hope to be in five years52:03 Which 2026 fellows group was better?54:00 The takeaway that wasn't a technique, and applying for 2027Listen to the AHF Podcast on your preferred platform:Show page: https://jvomedia.com/shows/ahf-podcastApple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHcLinkedIn: https://www.linkedin.com/showcase/ahf-podcastYouTube: https://www.youtube.com/@anteriorhipfoundationHomepage: https://anteriorhipfoundation.comThis 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#TravelingFellowship #AnteriorApproach #AnteriorHip #TotalHipArthroplasty #HipReplacement #RevisionTHA #OrthopedicSurgery #SurgicalMentorship #ValueBasedCare #JadyeKee #PatMaher #LeoZalikha