2025 Great Debates: Collared stems are clearly superior to collarless stems

Great Debates Return at 2025 AHF Annual Meeting: Collared vs. Collarless Stems 🏆

Welcome to the AHF podcast, hosted by Joe Schwab. In this episode, we bring back the Great Debates at the 2025 Anterior Hip Foundation (AHF) annual meeting. The episode dives into the spirited debate about 'Collared Stems vs. Collarless Stems' with Gillian Soles advocating for collared stems and Steve Lochow making the case for collarless stems. With a series of timed arguments and rebuttals, both presenters provide evidence and personal insights into the superiority of their respective approaches to the anterior hip replacement. The debate covers topics such as stability, revision rates, and ease of use. It promises to be both informative and entertaining. Tune in to see who comes out on top! Don't forget to like, subscribe, and leave your comments. 🏅

Transcript

Joseph M. Schwab: 1:05

Welcome to the AHF podcast. I'm your host, Joe Schwab. So one of the things we added to the 2025 annual meeting, or I should say, one of the things we brought back at the 2025 AHF annual meeting were the great debates. When the AHF first started, the vision was that it could be a place for open debate about how best to do anterior approach. Often that means disagreeing with each other and debates are a good way to do that in front of your peers so everybody can benefit. I remember that Joel Matta specifically wanted the original debates to be contentious, maybe even a little personal tongue in cheek, of course, but in some of the early debates, the insults thrown around were a bit one sided. Not everybody got the memo, I think so when I brought it back for this meeting, I made sure that all the participants got the same ground rules. The first rule. No fact checking specifically as the moderator. I wasn't gonna do any fact checking. I wanted the participants to know that they didn't have to be right to win. They just had to be persuasive. The second rule was that this is a debate, not a PowerPoint. You should provide arguments for your position and against your opponent's position, not just provide a review on a subject. I allowed them to have notes, but I didn't want any slides to be shown. The third rule was that you didn't actually need to believe or practice the side you were arguing, but you should be genuinely interested in putting forth the best set of arguments for your position. And the last rule, maybe the most important one is that it should be entertaining. If some playful ad hominin attacks against your opponent are added to the fun and no feelings are hurt, well that's all the better from my perspective. So now that you have the ground rules, let's jump in to the first debate. I. 10 minutes are gonna be allocated to each topic, and the way it'll go is that the pro person will get four minutes for their primary position statement, followed by four minutes for the con primary position statement. And then one minute rebuttals back and forth. This is gonna be strictly timed. There will be a buzzer. There you go. You just gotta end what you're saying at that point. So we're gonna start off with collared versus collarless stems, and the position statement is"Collared stems are clearly superior to collarless stems", the pro position will be Gillian Soles, and the con position will be Steve Lochow. Gillian, you get the floor first.

Gillian Soles: 4:08

Okay. So I mean, we're talking about collarless versus collared stems, and I mean, I don't know if my colleague reads any journals, but there was a large study with 48,000 patients out of Australia. And they looked at the difference in revision rate for fracture or loosening over a seven year period, and they found that there were increased revision rates at three months and increased fractures at six months for the collarless stems. Because it resists subsidence. Now, yesterday we all saw how Yerasimides took a simple three pound mallet and pounded on the stem and got it to loosen a little bit so that he could get it out. And I would argue if you take one of Haidukewych's carbohydrate-ly, what did he call it? They had carbohydrate resistance or carbohydrate poisoning disease, and they start stomping around. I'm sure their legs weigh more than three pounds. And so the stem might subside and now the leg length's a little bit off. And the common complaints patients come into the office and they're like, doc, you did my hip replacement. And now one leg is longer than the other or shorter than the other. And you get all these complaints. And if you just simply do the surgery, plane down, put the stem with the collar, it'll sit exactly where you put it. It won't move. Your patients will be happier. They won't loosen the stems. They won't need to be revised. I mean, I have other scientific evidence to back me up too. There was another meta-analysis. They looked at 480 studies, a few of those, 40 of them qualified, and they also noted lower revision rates with equivalent or better radiographic outcomes. Sure, your x-rays look good, but if you have to pay, take the patient back to the or. I mean, that's no fun for anybody. And that was because they had increased axial and rotational stability and less subsidence. And finally, if you don't believe any of those clinical studies, you have to believe biomechanical studies where they did a finite, an element analysis, and they showed that there was more stability even if you had a small gap. So, I mean, you got the collared stem. Even if you have a one millimeter gap, they compared collared sitting on the calcar collared with a one millimeter gap and collarless and both the collared ones outperformed the collarless stem. So I'm saying here, there is no argument the collared is clearly superior.

Steve Lochow: 6:23

Alright. Right. So, great. So it made you, uh, quoting those articles made me think of something. Uh, Joel Matta likes to tell us. That sometimes you don't need a study to try to disprove common sense, right? So sometimes common sense tells you all you need to know. So for this, all I did is went to chat GPT and said, Hey, who's superior? And it's pretty amazing. I thought there was no chance chat GPT would be able to talk about collared versus collarless stems. And by gosh it does. So that's something interesting to go check out. So I have multiple points that I can make why collarless is better. Um, first collarless is easier to put in, right? You don't have to worry about, you know, if you put a collar on a stem and you undersize it and it sits on the calcar, that's sometimes hard to judge. And if your stem's too small, I don't care if there's a collar there or not, it can still subside. It can go into retroversion. They talk about rotational stability. I don't buy it, you know, um, collarless is more forgiving to different anatomies, right? So you can put that in about anybody. I even read an article, they talked about the collar can impinge on the iliopsoas. So there's something else I hadn't even ever thought of. There's another problem with collared stems. They talk about biomechanically. Um, a collarless stem has less stress shielding, right? So it's more, um, anatomy friendly, more physiologically friendly. And so the last point that I'm gonna make that I think is actually the most important one about a collarless stem. So we're doing anterior hips. Everybody in this room's here interested in anterior hips and. That kind of makes our patients a little bit younger, right? Um, that's just me thinking about our practices. You know, it's very common. I have a 55-year-old with good bone. Our patients have good bone, so I use a collarless stem in all those younger patients because there's a chance. And we've learned this week, this weekend. That each year the revision rate creeps up a little bit as people get older. And we all know it is so much easier to take out a collarless stem than a collared stem. You know, collarless stem you can have out in just minutes. If you've got a collared stem, that's a whole different animal. So hopefully that proves my point. collarless stems is way to go.

Gillian Soles: 8:35

Steve, you ignorant slut. As a final point. Please show the founder of the Anterior Hip Foundation's remarks on this.

Joel Matta: 8:47

Why would anyone use a non collared stem?

Steve Lochow: 8:56

My simple rebuttal is the instructions were no PowerPoint, no videos, so if you had to resort to that, that's cheating.

Joseph M. Schwab: 9:04

All right. Very good. I'd like to thank Gillian Soles and Steve Lochow for starting us off. Right. You'll be awarded the winner at the end when we give out all the prizes at the moment, and this is good. We're keeping things going.

Steve Lochow: 9:19

I never thought I'd be called a slut on the stage.

Joseph M. Schwab: 9:23

It's about time everyone's too intimidated by your size to call you that. Even though Gillian clearly violated my rules by showing a video clip, as somebody who grew up on the old Saturday Night Live, I couldn't help but appreciate how she brought back Dan Aykroyd versus Jane Curtin, but she took the Dan Aykroyd perspective. Man, that was great. So who do you think won the debate? Is it collared or collarless stems that's better for patients? Or maybe better yet, tell me what you're doing in your practice. Do you try and use the same stem in every case, or maybe you like to mix it up, or maybe you try and match a stem to a patient's anatomy? Either way leave 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.