What about the stem?

A bunch of papers last year explained the shift towards collared stems...

The collar is that expanded flange at the top of the stem (blue arrow)

And a lot of surgeon are using them now.

A quick whizz through 4 papers explains why..

59,518 Australian patients showed a 4x lower risk of fracture with a collar
333,144 German patients showed the collar as a ‘safety belt’, particularly in woman over 80 years old
11,278 patients, again in Australia, had a 22% lower risk of revision if they had a collar, compared to 47,835 cemented stems (the supposed gold standard)
And changing to a collared stem in a smaller study, form the States, dropped the fracture rate from 1.42% to 0.13%.

These BIG numbers add up to..

Big News!

Leading to a broad change in practice for many surgeons.

It reflects how big datasets and registries and tightening up our knowledge.

Our knowledge of what works... or rather what works very slightly better than the next thing..

Collared stems are harder to get out (if you need to revise them). Picture getting a long thin chisel around that chunky collar- it’s hard to do!

So, the classic argument was to keep it simple.

This data has flipped that argument..

We now take the lower chance of failure + revision.. Over a more challenging- perhaps less safe- revision. If indeed it's ever needed..

And it’s these big datasets- great feats of measurement- that have changed minds.

That has changed my mind and changed my practice.

..BUT these papers also hint at a problem.

We are only measuring revisions, i.e. when things go badly wrong.

We are often failing to capture real-life patient experience.

We are missing what really matter sto people..

Pain + how well we function.