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

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Dislocation after anterior approach total hip replacement still runs around 2% in the first two years — so what actually moves that number?

Three hip surgeons work through instability prevention end to end, from the first clinic visit to the final construct.

The anterior approach has pushed dislocation rates in the right direction, but it has not solved instability — and the belief that it has is where surgeons get caught. In this roundtable, Jeff Barry, Blair Ashley, and Chance Gray work through what the database and registry literature actually show, why anterior approach hips come out the front and the back rather than predictably out the back, and how much of that risk is genuinely modifiable.

The conversation gets specific quickly. They disagree productively on whether instability risk can be optimized in the patient at all, or whether it is simply a surgeon's problem to engineer around. They cover cup targets in the setting of hip-spine mismatch, what a standing AP film really tells you, the intraoperative stability checks each of them refuses to skip, and how to escalate a construct — head size, lateralized liners, offset and length, dual mobility — without letting the most constrained option become the default.

This one is for arthroplasty surgeons, fellows, and residents building their own instability algorithm, and for anyone who has looked at a well-positioned cup on a postoperative film and wondered what they missed. It closes with each surgeon's single piece of advice for avoiding that lesson the hard way.

⏱️ Chapters:
00:00 Introduction and what the data says about dislocation
03:47 Why instability prevention starts in the clinic
05:57 Cup position first when diagnosing an unstable hip
08:30 How anterior and posterior hips dislocate differently
12:34 Instability risk after revision anterior approach surgery
14:28 Counseling patients on dislocation risk and risk factors
19:14 Why instability is a surgeon problem, not a patient problem
22:55 Planning for hip-spine mismatch in anterior approach hips
27:32 Explaining the hip-spine relationship to patients
31:48 Where CT-based planning tools fit into instability risk
35:09 Dual mobility and high offset stems for high risk patients
40:22 Non-negotiable stability checks before you close
45:32 Intraoperative red flags and navigation beyond fluoroscopy
50:04 Escalating head size, lateralized liners, and offset
56:24 Are constrained liners obsolete in the dual mobility era
1:00:43 An end-to-end instability prevention algorithm
1:07:39 Parting advice on preventing dislocation

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This podcast is intended for educational and informational purposes only.

This episode was recorded in partnership with Smith+Nephew — Life Unlimited.
Learn more at https://www.smith-nephew.com

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

#HipInstability #HipDislocation #TotalHipArthroplasty #THA #AnteriorApproach #DualMobility #Spinopelvic #RevisionHipArthroplasty #ConstrainedLiner #JeffBarry #BlairAshley #ChanceGray