Anterior Approach Revision (S+N Surgeon Roundtable)

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Can you really revise a failed total hip through the anterior approach? Three surgeons who do it every week explain when they stay anterior, when they still go posterior, and how they plan the exposure.

A practical roundtable on anterior approach revision hip arthroplasty for arthroplasty surgeons, fellows, and residents.

The knock on anterior approach revision has always been that it is not extensile. Eric Cohen, Kris Alden, and Molly Hartzler take that head-on: from the ASIS to the lateral knee, total femurs, cup-cages, and periprosthetic fractures are all on the table, and the recovery data increasingly favors the front. They also draw their lines honestly. One of them has not done a posterior revision in fifteen years; the other two still pick the approach case by case, and they explain exactly which red flags send them posterior.

The conversation gets specific quickly. How to diagnose and sequence a failed hip before approach even enters the discussion. How to plan an incision you can extend, and what to do with a prior bikini scar. Whether to excise the old scar and whether to keep or remove the capsule. How to regain your bearings with fluoroscopy and a functional standing pelvis film when the landmarks are gone. And on the acetabular side, how to balance defect fill, biomechanics, and cup orientation, when a single integrated revision system changes the plan, and where dual mobility and constrained liners actually belong.

It closes with the one mistake almost every surgeon makes when they first revise from the front, a guardrail for anyone early in the journey, and a look at where anterior approach revision is headed as implants and instruments finally catch up with the approach.

This episode was recorded in partnership with Smith+Nephew — Life Unlimited. The REDAPT Revision Hip System and OR3O Dual Mobility give surgeons a flexible, stability-focused approach to revision total hip arthroplasty — from compromised bone and fixation challenges to instability. Learn more at https://www.smithandnephew.com

⏱️ Chapters:
00:00 Introduction: anterior approach revision roundtable
02:17 Is anterior approach revision really extensile?
03:31 How modern revision cups changed screw and cup-cage decisions
05:59 Exposure and diagnosis before technique in teaching revision
07:12 Sequencing a failed total hip before choosing an approach
09:26 Red flags for going posterior instead of anterior
13:44 Acetabular bone loss and revision cup technology
15:20 Anterior approach revision for instability
18:29 Planning extensile exposure: bikini vs longitudinal incisions
26:20 Reopening the old scar and handling the capsule
30:24 Orientation without landmarks: fluoroscopy and stability testing
34:51 Filling defects and choosing an acetabular revision system
37:41 Dual mobility vs constrained liners in revision
41:49 The most common early mistake in anterior approach revision
42:43 Head size, dual mobility, and avoiding over-constraint
44:37 Parting advice and the future of anterior approach revision

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YouTube: https://www.youtube.com/@anteriorhipfoundation
Homepage: https://anteriorhipfoundation.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.

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