What happens when the worlds of orthopedic trauma and joint replacement overlap?
In Episode 43 of The Joint Replacement Podcast, I sat down with Dr. Alon Antebi, a fellowship trained orthopedic trauma surgeon in Southern California whose practice spans complex fracture care, pelvic and acetabular trauma, primary and revision joint replacement, and outpatient surgery. He is also a co-founder of AVORS Medical Group and serves in orthopedic leadership roles at two Level II trauma centers.
What makes this conversation particularly interesting is Dr. Antebi’s perspective from both sides of the equation. He treats the initial injury, but he also sees what can happen years later when a major fracture leads to arthritis, deformity, retained hardware, or the eventual need for joint replacement.
Why Are Some Hip Fractures Fixed While Others Are Replaced?
One of the most common questions after a hip fracture is deceptively simple: Why does one patient get screws or a rod while another gets a partial or total hip replacement?
As Dr. Antebi explains, “hip fracture” describes several very different injuries. Femoral neck, intertrochanteric, and subtrochanteric fractures may occur within a relatively small area, but their treatment can be very different. Age, fracture pattern, bone quality, activity level, and the likelihood that fixation will heal all influence the decision.
In a younger patient with a femoral neck fracture, preserving the natural hip is often a major priority. In an older patient with a displaced femoral neck fracture and poor bone quality, however, arthroplasty may provide a more predictable path toward mobilization than attempting to repair a fracture with limited healing potential.
The next question becomes whether that replacement should be a hemiarthroplasty, which replaces the femoral side of the joint, or a total hip replacement, which replaces both the ball and socket. Dr. Antebi emphasizes that he does not view this as a one-size-fits-all decision. A highly active 75-year-old who was mountain biking before the injury is a very different patient from someone of the same age with limited mobility living in a nursing facility.
The Other Side of the Hip: Acetabular Fractures
We also discuss an injury many patients have never heard of until it happens to them: an acetabular fracture.
The acetabulum is the socket of the hip joint. These injuries can occur after high-energy trauma, including motor vehicle accidents, falls from height, and motorcycle crashes. A hip dislocation may occur at the same time, creating an orthopedic emergency that requires prompt reduction.
Repairing an acetabular fracture can require plates, screws, and complex surgical approaches. Even after successful reconstruction, damage to the joint surface can contribute to post-traumatic arthritis and may eventually lead to hip replacement.
The treatment can be particularly challenging in older patients. Poor bone quality and complex fracture patterns can make internal fixation less predictable, while prolonged restrictions on weight bearing can be difficult for an elderly patient to tolerate.
For selected older patients, acute total hip replacement, sometimes combined with fracture fixation, has therefore emerged as an alternative strategy. Systematic reviews suggest that factors such as articular comminution, femoral head injury, dome impaction, and pre-existing arthritis may favor acute arthroplasty, although these remain complex procedures with meaningful complication risks.
Dr. Antebi describes using the patient’s own femoral head as bone graft and building a construct designed to provide enough stability to allow earlier mobilization in selected cases.
Hip Replacement After Previous Fracture Surgery
A hip replacement is usually more complicated when the hip has already been operated on.
Previous plates, screws, rods, scar tissue, altered anatomy, bone loss, and deformity can all change the operation. Sometimes hardware can be removed at the same time as the hip replacement. In other cases, Dr. Antebi prefers a staged strategy, removing larger implants first and allowing the bone to recover before returning for the definitive hip replacement.
This is one of the areas where his trauma background becomes particularly relevant. Understanding both fracture fixation and arthroplasty can be valuable when planning a reconstruction in a hip that no longer resembles a routine primary replacement.
Nearly Two Decades of Anterior Hip Replacement
Dr. Antebi was also an early adopter of the direct anterior approach to total hip replacement, beginning approximately 18 years ago after attending a course and learning the technique through cadaveric training. He subsequently helped introduce the approach at hospitals and later incorporated it into outpatient joint replacement.
During our discussion, he makes one of the episode’s strongest statements: in his personal experience, he has not had a prosthetic hip dislocation following an anterior hip replacement over those 18 years. He attributes that experience in part to preservation of the posterior soft tissues and his use of intraoperative fluoroscopy.
That observation is worth distinguishing from population-level evidence. Individual surgeon experience does not establish that one approach universally has a lower dislocation risk. A 2025 systematic review and meta-analysis of 27 studies and more than 44,000 patients found no statistically significant difference in dislocation risk between direct anterior and posterior total hip arthroplasty, although the anterior approach was associated with a shorter average hospital stay and smaller incision.
That distinction is important throughout joint replacement: the surgical approach matters, but so do surgeon experience, technique, implant positioning, patient factors, and the entire perioperative pathway.
Outpatient Joint Replacement Before It Was Routine
Today, going home the same day after hip or knee replacement is increasingly familiar. That was far from the norm when Dr. Antebi began performing outpatient joint replacements approximately 15 years ago.
He describes watching patients undergoing anterior hip replacement get up and walk within hours of surgery and questioning why appropriately selected patients needed to remain in the hospital. Building an outpatient program required much more than simply moving the same operation into a surgery center. It required appropriate equipment, anesthesia protocols, regional blocks, patient selection, postoperative support, and a system capable of recognizing when a patient was not ready to go home.
The literature similarly emphasizes that outpatient arthroplasty depends heavily on patient selection and risk assessment. Significant cardiac or pulmonary disease, poorly controlled medical conditions, limited functional independence, and inadequate support at home can make same-day discharge inappropriate.
Dr. Antebi makes a similar point clinically. Chronologic age alone does not determine whether he will operate in a surgery center. Medical comorbidities and the patient’s home situation may be far more important. A patient with significant cardiopulmonary disease or someone who truly lives alone may be better served in the hospital.
How Long Does Recovery Take?
Another recurring theme is that recovery after joint replacement is highly individual.
For one patient, recovery means being able to walk around the house independently. For another, it means returning to golf, cycling, or another demanding activity. Dr. Antebi generally tells patients to think in terms of approximately six weeks for meaningful recovery after either hip or knee replacement, while emphasizing that knees often take longer and that patients progress at very different rates.
We also discuss an evolving concept in knee replacement rehabilitation: more rehabilitation is not necessarily better rehabilitation. Excessive activity or overly aggressive therapy early in recovery can contribute to swelling and pain, potentially making patients feel as though they have moved backward rather than forward.
“My Hip Is Too Complicated to Fix”
Perhaps the most important message of the episode comes near the end.
What should a patient do after a major fracture, several operations, retained hardware, deformity, or post-traumatic arthritis if they are told that their hip or knee is simply too complicated to reconstruct?
Get another opinion.
Not every orthopedic surgeon performs complex revision or post-traumatic reconstruction. That does not necessarily mean that no solution exists.
Dr. Antebi encourages these patients to seek surgeons who routinely perform high-volume complex reconstruction. In some cases, finding the right surgeon may require several consultations.
That is an important distinction for patients to understand: “I don’t perform this operation” and “this operation cannot be performed” are not always the same thing.
The Bigger Picture
This episode also ventures beyond surgical technique into how orthopedic practice has changed over the past two decades.
We discuss declining physician reimbursement, the economics of outpatient surgery, private practice, increasing clinical volume, insurance authorization requirements, and the tension between improving efficiency and preserving the physician-patient relationship.
But the central theme remains the patient.
Whether the problem is a straightforward arthritic hip, a displaced hip fracture, a shattered acetabulum, or a joint that has already undergone multiple operations, the goal is the same: choose the right treatment for the right patient and create a pathway that safely restores function.
Episode 43 of The Joint Replacement Podcast with Dr. Alon Antebi is available now on YouTube, Spotify, and major podcast platforms.
This article is for educational purposes only and is not a substitute for individualized medical advice. Treatment decisions after fractures or joint replacement should be made with a qualified healthcare professional familiar with the individual patient.
References
- Antebi A, Sloan M. The Joint Replacement Podcast, Episode 43. Interview transcript, 2026.
- Zhang Z, et al. Current indications for acute total hip arthroplasty in older patients with acetabular fracture: Evidence in 601 patients from 2002 to 2021. Front Surg. 2023.
- Capone A, et al. Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: a systematic review. Eur J Orthop Surg Traumatol.
- Kort NP, et al. Patient selection criteria for outpatient joint arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017;25:2668-2675.
- Outpatient Total Joint Arthroplasty. Curr Rev Musculoskelet Med. 2017.
- Direct anterior approach versus posterior approach in total hip arthroplasty: a systematic review and meta-analysis. 2025.