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2025 Great Debates: The HANA table is the best way to perform AA

• Anterior Hip Foundation • Season 2 • Episode 22

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The Great Debate: HANA Table vs. Standard Operating Table for Anterior Hip Replacement

Welcome to the AHF Podcast! In this second episode of the 2025 Great Debates series, host Joe Schwab introduces a spirited discussion on the use of HANA tables versus standard operating tables for anterior hip replacement. Surgeons Dr. Tania Ferguson and Dr. Atul Kamath present their cases—Ferguson advocating for the HANA table, citing its efficiency and reduced muscular injury, while Kamath argues for the versatility and cost-effectiveness of standard tables. This debate dives deep into technology, cost, surgical techniques, and the importance of the surgeon's skill. Join us for a compelling discussion that blends expert insights with a bit of humor. Don't forget to subscribe and share your thoughts in the comments! 🎙️🦴✨


Dr. Ferguson’s slide can be found here: https://youtu.be/3rwzuWt44yY?si=Rtqd6sRqDe8JJ_4y&t=470

Dr. Kamath’s slide can be found here: https://youtu.be/3rwzuWt44yY?si=PVp0pfdqeIsSwqU3&t=428

Joseph M. Schwab:

Hello and welcome to the AHF podcast. I'm your host, Joe Schwab for the second in the 2025 Great debates series. We have a debate about the use of the HANA table versus a standard operating table, and I thought this would be a great debate for a few reasons. One. It's a common question that people ask, especially as surgeons are beginning to do anterior approach in their practice. They're thinking about what's the equipment that they're gonna need and what's the technique that they're gonna follow. But more importantly, I love the two people debating. Dr. Tania Ferguson and Dr. Atul Kamath, two people I've known and worked closely with. For a number of years. I have great respect for both of them. And if you look at the AHF YouTube site, one of our most enduring and popular videos with probably the most views was one of the original great debates that Dr. Tania Ferguson was involved in back in 2017 or 2018. And the comments are always entertaining when they come in. And so I knew these two would be excellent at meeting the criteria of talking the merits of the case, but also ribbing each other quite a bit. And so I was really excited when these two stepped up to the stage. And let's hear it, the second debate, HANA, table versus regular table. The topic is, or the position statement is the Hana table is the best way to perform anterior approach the pro position. Dr. Tania Ferguson. The con position, Dr. Atul Kamath.

Tania Ferguson:

All right, here's the deal. The the point, the position is that anterior approach surgery done on the table is the best way to do hip replacement. That's obvious. Can you do a hip replacement off table? Sure. Let's remember where that started. It started by the people who couldn't get their hospital to pay for a HANA table. That problem is gone. The HANA table is now the least expensive technology that I use in my operating room. It's a done. It's done. Second of all. The fact is that the best done anterior approach on table far exceeds the best done anterior approach off table regardless of patient less muscle injury. You can do an anterior approach on table in a primary hip replacement in a patient with fairly normal body habitus without any muscular injury at all, and we do all the time. Is different than off table where there is always some muscular injury. Furthermore, we can do it without any releases around the femur versus on off table. I'm sorry, where commonly there are releases that need to be done to get the femoral exposure. Number three, difficult body habitus. Ben Domb left, I'm sorry, but if you'll remember him standing here. My tallest patient ever was seven three with A BMI of 38. Eight. That is a very difficult operation off table. It's a difficult operation on table, but it can be done without any muscular injury. Nevertheless, by virtue of the extension of the leg and the manipulation of the extremity with the use of the HANA table. Number four. I had a beautiful picture of Nick Mast doing an anterior approach, total hip replacement on the HANA table with zero assistants. Zero assistants. That cannot be done with off table anterior approach surgery. In the ASC where we have limited resources, assistants are the most expensive part of our team of our operation. No assistants necessary when you have a HANA table. And number five, go back to session one. Revision hip replacement. Not one of those presenters showed a single image or video of an off table revision surgery. The table becomes critical in and it greatly facilitates all operations. But it absolutely facilitates the revision surgery, especially with femoral exposure, difficult femoral exposure in revision and complex primaries that require long stem often are done on, uh. You didn't see a single person up here this entire meeting, and these are the people you've seen over the course of this meeting Are the best surgeons doing the anterior approach period. You did not see one single revision surgery demonstrated off table. With that, I will rest my case and turn over the microphone to my worthy opponent.

Atul Kamath:

So full disclosure, I think we are anterior surgeons, not anterior plus table surgeons, right? So, and uh, Tania insulting half the audience is not a good way to, you know, start this off. And, uh, it's, I I think our goal of surgery, of course is efficiency and all the things Tania talked about. Um, but actually my opponent kind of missed a lot of purported benefits of using a table, right? Technology assistance. Uh, positioning other things that people talk about the table, so we'll, we'll concede that she missed all that. I would say you actually, uh, have a rich history using, uh, the table. However, there's a lot of benefits. Now. We talk about cost and value. Um, and I think the setup is easier with off table. Uh, there's no extra disposables. You don't need a non-sterile assistant to help you maneuver the table. Um, the ergonomics of moving a table can be, uh, tough. Uh, the HANA table is too big for the ASC I would contend, right? We have smaller ASCs, we have to be more nimble. Oh, and actually now I need two tables because I have two operating rooms that I need to furnish. Um, and then also a lot of the studies that you talked about actually didn't mention any studies, uh, related to soft tissue preservation, efficiency, ergonomics outcomes. There's been no study on comparing the two. So I would say dealer's choice on using a table or not, and I would say. Um, it's really the anterior approach and your technique. Uh, rather than a table that's gonna get you there. So I would say this is also a global meeting, right? So not every, uh, country, not every, uh, facility can afford the HANA table. As we talked about. Uh, someone yesterday waited 12 years in Brazil to get their HANA table. Um, and again, the cost is not insignificant, especially, uh, in your, uh, A ASC that you own. Uh, I would contend that primary and revision surgery are equally done, uh, on table versus off table. So I think that's sort of, uh, the point of needing a table to do a surgery, I think is, uh, definitely a fallacy as well. Uh, and then I would say probably it's quicker to do revision surgery off table. The leg is more facile. Uh, the intervals are more easy to, uh, access. Uh, so again, I would probably say, uh, and then probably the risk of fracture with reduction maneuvers is probably less with, uh, off table than on table as well. So, um, you know, I, I think Tania, you gotta really step up a little bit here. I think you gotta give yourself more credit. You're better surgeon than you think you are. I think, you know, given the opportunity, you probably could do this off table as well. Um, your ability to use technology is not afforded. By the table, it's by your expert, uh, ability to look at fluoroscopy. Your ability to get exposure is your master of the anatomy, not the table itself. Uh, and perhaps, uh, the argument, uh, is less about table or off table, but can we harness or teach the anatomy and the technology better? Uh, rather than, uh, using the table as a crutch, uh, to get exposure or a better outcome. So with that, uh, maybe we can even queue up my little, uh, picture here. Uh, I know we're not used to slides, but this is Tania trying to shoot a gun, uh, with her, with her Hana table. And this is one of the best, uh, pistol shooters in the world for out of Turkey. Uh, kind of just strolling up, uh, and getting a silver medal in the Olympics. So, uh, you know, Tania, I think, uh, give yourself some credit. I know you're better than that. Uh, and again, table or no table. We'll, we'll get you there. Okay. Thank you.

Joseph M. Schwab:

Rebuttal.

Tania Ferguson:

Well, that was a nice slide. Uh. I'm sorry, I have a sixth point. Could I please see my slide?

Atul Kamath:

Tania, I know you worked on this all morning.

Tania Ferguson:

I would like to talk about hip. You threw this out on the video. Uh, everything you just heard is false news. I am officially canceling Atul for his. Debate against his own practice.

Atul Kamath:

That's a dead patient, Tania. We can do ha table surgery on a dead patient in a lab, but, but in real life, in real life,

Tania Ferguson:

my opponent uses the HA table. So that is. All I have to say, if the mic could drop, I would do it.

Joseph M. Schwab:

One minute. Rebuttal.

Atul Kamath:

You can start signing that certificate for me for the award, but, uh,

Joseph M. Schwab:

please go and vote.

Atul Kamath:

I I preface it. I use both, right? I also do hip arthroscopy. We do a lot of other things, but I, I think we should not be beholden to saying the table is the best way to do surgery. It's the surgeon. Don't, you know, sell yourself short Surgeon anatomy principles, adjunctive technology can both be done. Table, no table. Uh, you know, uh, it doesn't matter. So I think, uh, from that standpoint, I'm glad I convinced you all that, uh, off table is, uh, easy and facile and the way to go. So thank you.

Joseph M. Schwab:

That was just great. I'll put links to the different slides that each of them used in the show notes so that you can see exactly what they were referencing in each of those slides. So, what do you use in your practice? Do you use a Hana table? Do you use some other sort of orthopedic table that helps facilitate mobility of the leg, or do you use. A standard operating table and why is it cost? Is it just the way you were trained? Is it something else? Does it have something to do with the other technology that you are using? I really like the way they have this debate, but I'm interested to hear what you have to think too. Go ahead and drop a comment below. Thank you for joining me for this episode of the AHF Podcast. As always, please take a moment to like and subscribe so we can keep the lights on and keep sharing great content just like this. Please also drop any topic ideas or feedback in the comments below. You can find the AHF podcast on Apple Podcasts, Spotify, or in any of your favorite podcast apps, as well as in video form on YouTube slash at anterior hip foundation. All one word. Episodes of the AHF Podcast come out on Fridays. I'm your host, Joe Schwab, asking you to keep those hips happy and healthy regardless of whether they're on table or off table.

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Joseph M. Schwab

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