Managing Intraoperative and Early Complications (S+N Surgeon Roundtable)

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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 complications
02:17 What turns a hip complication into a cascade
05:04 Femoral fractures and calcar cracks start with exposure
08:08 Dorr A vs Dorr C femurs: reaming and stem choice
11:27 Broaching dense canals and automated impaction
14:02 Managing an intraoperative calcar crack or femoral fracture
18:26 Protecting the lateral femoral cutaneous nerve
21:48 Hemostasis, visualization, and when to stop and reset
27:44 Early dislocation after hip replacement and navigation
31:22 Preventing wound complications and incisional wound vacs
35:18 Early infection after hip replacement: when to escalate
38:10 Checklists and nurse navigators that catch problems early
41:08 Escalation triggers and when to bring in help
44:53 Complication lessons that shaped their careers

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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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#HipComplications #PeriprostheticFracture #CalcarFracture #TotalHipArthroplasty #THA #AnteriorApproach #LFCN #PJI #AutomatedImpaction #AlexGaukhman #MollyHartzler #StephenDuncan