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

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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. 🏅

Episode Transcript

Joseph M. Schwab (01:05):
Welcome to the AHF podcast.
I'm your host, Joe Schwab.
So one of the things we added tothe 2025 annual meeting, or I
should say, one of the things webrought back at the 2025 AHF
annual meeting were the greatdebates.
When the AHF first started, thevision was that it could be a

(01:26):
place for open debate about howbest to do anterior approach.
Often that means disagreeingwith each other and debates are
a good way to do that in frontof your peers so everybody can
benefit.
I remember that Joel Mattaspecifically wanted the original
debates to be contentious, maybeeven a little personal tongue in

(01:50):
cheek, of course, but in some ofthe early debates, the insults
thrown around were a bit onesided.
Not everybody got the memo, Ithink so when I brought it back
for this meeting, I made surethat all the participants got
the same ground rules.
The first rule.
No fact checking specifically asthe moderator.

(02:13):
I wasn't gonna do any factchecking.
I wanted the participants toknow that they didn't have to be
right to win.
They just had to be persuasive.
The second rule was that this isa debate, not a PowerPoint.
You should provide arguments foryour position and against your

(02:34):
opponent's position, not justprovide 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 youdidn't actually need to believe
or practice the side you werearguing, but you should be
genuinely interested in puttingforth the best set of arguments

(02:57):
for your position.
And the last rule, maybe themost important one is that it
should be entertaining.
If some playful ad homininattacks against your opponent
are added to the fun and nofeelings are hurt, well that's
all the better from myperspective.
So now that you have the groundrules, let's jump in to the

(03:19):
first debate.
I.
10 minutes are gonna beallocated to each topic, and the
way it'll go is that the properson will get four minutes for
their primary positionstatement, followed by four
minutes for the con primaryposition statement.
And then one minute rebuttalsback and forth.
This is gonna be strictly timed.
There will be a buzzer.

(03:40):
There you go.
You just gotta end what you'resaying at that point.
So we're gonna start off withcollared versus collarless
stems, and the positionstatement is"Collared stems are
clearly superior to collarlessstems", the pro position will be
Gillian Soles, and the conposition will be Steve Lochow.

(04:02):
Gillian, you get the floorfirst.

Gillian Soles (04:08):
Okay.
So I mean, we're talking aboutcollarless versus collared
stems, and I mean, I don't knowif my colleague reads any
journals, but there was a largestudy with 48,000 patients out
of Australia.
And they looked at thedifference in revision rate for
fracture or loosening over aseven year period, and they

(04:29):
found that there were increasedrevision rates at three months
and increased fractures at sixmonths for the collarless stems.
Because it resists subsidence.
Now, yesterday we all saw howYerasimides took a simple three
pound mallet and pounded on thestem and got it to loosen a
little bit so that he could getit out.
And I would argue if you takeone of Haidukewych's

(04:50):
carbohydrate-ly, what did hecall it?
They had carbohydrate resistanceor carbohydrate poisoning
disease, and they start stompingaround.
I'm sure their legs weigh morethan three pounds.
And so the stem might subsideand now the leg length's a
little bit off.
And the common complaintspatients come into the office
and they're like, doc, you didmy hip replacement.
And now one leg is longer thanthe other or shorter than the

(05:13):
other.
And you get all thesecomplaints.
And if you just simply do thesurgery, plane down, put the
stem with the collar, it'll sitexactly 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 scientificevidence to back me up too.
There was another meta-analysis.
They looked at 480 studies, afew of those, 40 of them

(05:37):
qualified, and they also notedlower revision rates with
equivalent or betterradiographic outcomes.
Sure, your x-rays look good, butif you have to pay, take the
patient back to the or.
I mean, that's no fun foranybody.
And that was because they hadincreased axial and rotational
stability and less subsidence.
And finally, if you don'tbelieve any of those clinical
studies, you have to believebiomechanical studies where they

(05:58):
did a finite, an elementanalysis, and they showed that
there was more stability even ifyou had a small gap.
So, I mean, you got the collaredstem.
Even if you have a onemillimeter gap, they compared
collared sitting on the calcarcollared with a one millimeter
gap and collarless and both thecollared ones outperformed the
collarless stem.
So I'm saying here, there is noargument the collared is clearly

(06:21):
superior.

Steve Lochow (06:23):
Alright.
Right.
So, great.
So it made you, uh, quotingthose articles made me think of
something.
Uh, Joel Matta likes to tell us.
That sometimes you don't need astudy to try to disprove common
sense, right?
So sometimes common sense tellsyou all you need to know.
So for this, all I did is wentto chat GPT and said, Hey, who's
superior?

(06:44):
And it's pretty amazing.
I thought there was no chancechat GPT would be able to talk
about collared versus collarlessstems.
And by gosh it does.
So that's something interestingto go check out.
So I have multiple points that Ican make why collarless is
better.
Um, first collarless is easierto put in, right?
You don't have to worry about,you know, if you put a collar on

(07:04):
a stem and you undersize it andit sits on the calcar, that's
sometimes hard to judge.
And if your stem's too small, Idon't care if there's a collar
there or not, it can stillsubside.
It can go into retroversion.
They talk about rotationalstability.
I don't buy it, you know, um,collarless is more forgiving to
different anatomies, right?
So you can put that in aboutanybody.

(07:26):
I even read an article, theytalked about the collar can
impinge on the iliopsoas.
So there's something else Ihadn't even ever thought of.
There's another problem withcollared stems.
They talk about biomechanically.
Um, a collarless stem has lessstress shielding, right?
So it's more, um, anatomyfriendly, more physiologically
friendly.
And so the last point that I'mgonna make that I think is

(07:49):
actually the most important oneabout a collarless stem.
So we're doing anterior hips.
Everybody in this room's hereinterested in anterior hips and.
That kind of makes our patientsa little bit younger, right?
Um, that's just me thinkingabout our practices.
You know, it's very common.
I have a 55-year-old with goodbone.
Our patients have good bone, soI use a collarless stem in all

(08:12):
those younger patients becausethere's a chance.
And we've learned this week,this weekend.
That each year the revision ratecreeps up a little bit as people
get older.
And we all know it is so mucheasier to take out a collarless
stem than a collared stem.
You know, collarless stem youcan have out in just minutes.
If you've got a collared stem,that's a whole different animal.
So hopefully that proves mypoint.

(08:33):
collarless stems is way to go.

Gillian Soles (08:35):
Steve, you ignorant slut.
As a final point.
Please show the founder of theAnterior Hip Foundation's
remarks on this.

Joel Matta (08:47):
Why would anyone use a non collared stem?

Steve Lochow (08:56):
My simple rebuttal is the instructions were no
PowerPoint, no videos, so if youhad to resort to that, that's
cheating.

Joseph M. Schwab (09:04):
All right.
Very good.
I'd like to thank Gillian Solesand Steve Lochow for starting us
off.
Right.
You'll be awarded the winner atthe end when we give out all the
prizes at the moment, and thisis good.
We're keeping things going.

Steve Lochow (09:19):
I never thought I'd be called a slut on the
stage.

Joseph M. Schwab (09:23):
It's about time everyone's too intimidated
by your size to call you that.
Even though Gillian clearlyviolated my rules by showing a
video clip, as somebody who grewup on the old Saturday Night
Live, I couldn't help butappreciate how she brought back
Dan Aykroyd versus Jane Curtin,but she took the Dan Aykroyd

(09:44):
perspective.
Man, that was great.
So who do you think won thedebate?
Is it collared or collarlessstems that's better for
patients?
Or maybe better yet, tell mewhat you're doing in your
practice.
Do you try and use the same stemin every case, or maybe you like
to mix it up, or maybe you tryand match a stem to a patient's

(10:10):
anatomy?
Either way leave a commentbelow.
Thank you for joining me forthis episode of the AHF podcast.
As always, please take a momentto like and subscribe so we can
keep the lights on and keepsharing great content just like
this.
Please also drop any topic ideasor feedback in the comments

(10:30):
below.
You can find the AHF podcast onApple Podcasts, Spotify, or in
any of your favorite podcastapps, as well as in video form
on YouTube slash at anterior hipfoundation.
All one word, episodes of theAHF podcast come out on Fridays.

(10:51):
I'm your host, Joe Schwab,asking you to keep those hips
happy and healthy.