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2025 Great Debates: Every cup deserves a good screw · AHF Podcast

• 0:00
  Joseph M. Schwab: Hi, this is Joe Schwab and if you recognize my voice, it's probably because you've heard another episode of the AHF podcast, which means you're listening again, and I can't tell you how much I appreciate that.
• 0:15
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• 0:28
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• 0:37
  Joseph M. Schwab: We really appreciate it and it helps us grow.
• 0:40
  Joseph M. Schwab: Anyway, thank you so much for being a listener and a subscriber to the AHF podcast.
• 0:47
  Joseph M. Schwab: Now let's get on with the show.
• 0:48
  Joseph M. Schwab: Hello, and welcome to the AHF podcast.
• 1:07
  Joseph M. Schwab: I'm your host, Joe Schwab.
• 1:10
  Joseph M. Schwab: Well, welcome to our sixth and final great debate where the topics are serious, the arguments are passionate, and the innuendo is well kind of unavoidable.
• 1:23
  Joseph M. Schwab: Today's debate is titled to Screw or Not to Screw, which means two things.
• 1:30
  Joseph M. Schwab: One.
• 1:30
  Joseph M. Schwab: Yes, this is about acetabular fixation and two, no, there was absolutely no chance this was going to stay.
• 1:39
  Joseph M. Schwab: PG 13.
• 1:41
  Joseph M. Schwab: Taking the pro position that every cup deserves a good screw is Dr.
• 1:46
  Joseph M. Schwab: Michael Blankstein, who arrived the morning of this debate.
• 1:50
  Joseph M. Schwab: Absolutely furious.
• 1:52
  Joseph M. Schwab: I took away his AI generated slide deck.
• 1:56
  Joseph M. Schwab: Imagine waking up hungover in Nashville, Tennessee only to discover you can't show the world.
• 2:04
  Joseph M. Schwab: The machine made screw slides.
• 2:06
  Joseph M. Schwab: You were so proud of a tragedy.
• 2:09
  Joseph M. Schwab: Really opposing him is Dr.
• 2:11
  Joseph M. Schwab: Nicholas mast who believes screws in primary total hip arthroplasty are basically the orthopedic equivalent of a rotary phone.
• 2:19
  Joseph M. Schwab: Charming, nostalgic, but unnecessary unless you're reenacting history.
• 2:25
  Joseph M. Schwab: What follows is a debate about fixation stability and bone biology wrapped in the energy of two surgeons who absolutely knew what they were getting into with a title like this.
• 2:39
  Joseph M. Schwab: Well buckle up, or I should say screw in.
• 2:44
  Joseph M. Schwab: We've got Dr.
• 2:47
  Joseph M. Schwab: Michael Blankstein and Dr.
• 2:48
  Joseph M. Schwab: Nicholas Mast talking about every cup deserves a good screw In the pro position.
• 2:56
  Joseph M. Schwab: We've got Michael Blankstein.
• 2:58
  Joseph M. Schwab: You get to go first in the con position.
• 3:00
  Joseph M. Schwab: We've got Dr.
• 3:01
  Joseph M. Schwab: Nicholas Mast.
• 3:02
  Joseph M. Schwab: Gentlemen, keep it clean.
• 3:04
  Joseph M. Schwab: No, don't.
• 3:06
  Michael Blankstein: Just so you guys know, I went out drinking last night and I woke up this morning at 8:00 AM from a text from Joe Schwab who said, you have too many slides and I'm, you only get to use one slide.
• 3:15
  Michael Blankstein: And I woke up angry and all I did is text him why you should be using slides for this.
• 3:19
  Michael Blankstein: 'cause I made this AI generate slides that I was so happy about and I can't use them.
• 3:23
  Michael Blankstein: Well, thanks Joe.
• 3:25
  Michael Blankstein: So, um, so I just wanna let you know, an orthopedic surgeon's best friend is the screw who has taken an AO course here before.
• 3:33
  Michael Blankstein: What's the first lecture you take?
• 3:37
  Michael Blankstein: What's the first thing you learn about in the AO course?
• 3:40
  Michael Blankstein: You learn about the screw.
• 3:42
  Michael Blankstein: The Screw is our best friend.
• 3:44
  Michael Blankstein: Neil, what's the best feeling you get during the case when you do a revision case?
• 3:48
  Michael Blankstein: Can you just show me, show me, get up that you know that, that feeling, the best feeling that we experience as surgeons right there.
• 3:57
  Michael Blankstein: How often can one stand up here and say, guys, what I promote is safe?
• 4:02
  Michael Blankstein: Easy, cheap and quick.
• 4:07
  Michael Blankstein: How often, what's exactly what it is, what's happening here?
• 4:10
  Michael Blankstein: When you put a screw in, it literally takes a couple minutes For Charlie DeCook, it means 12 by 1230 maybe instead of 12 by 12, but literally it's easy.
• 4:20
  Michael Blankstein: It's safe.
• 4:21
  Michael Blankstein: The anatomy it just so easy.
• 4:23
  Michael Blankstein: Now here's the, here's the kicker here.
• 4:26
  Michael Blankstein: If you're worried about the safety of this screw trajectory, then you should definitely practice putting in these screws so you know the anatomy.
• 4:35
  Michael Blankstein: So when you need it for your tough cases, post-traumatic, dysplastic, osteoporotic, et cetera.
• 4:40
  Michael Blankstein: Um, who doesn't like additional stability?
• 4:44
  Michael Blankstein: Now let's talk about the pressfit cup that doesn't get the screw.
• 4:47
  Michael Blankstein: What do you have to do?
• 4:48
  Michael Blankstein: You need to rely on good bone.
• 4:50
  Michael Blankstein: You need to under ream and head harder.
• 4:52
  Michael Blankstein: These are things that you only get once in a while.
• 4:56
  Michael Blankstein: Who does complex hip surgeries here?
• 4:59
  Michael Blankstein: Most of us, right?
• 5:00
  Michael Blankstein: We need those screws.
• 5:01
  Michael Blankstein: 'cause many of us will do these complex cases.
• 5:04
  Michael Blankstein: If you guys wanna quote me, I wanna be quoted for this for the rest of my life.
• 5:08
  Michael Blankstein: Every screw matters.
• 5:09
  Michael Blankstein: It's an opportunity to master, refine, sharpen, and perfect the technique that is critical for every hip surgeon.
• 5:17
  Michael Blankstein: So my last slide here.
• 5:20
  Michael Blankstein: I got one.
• 5:27
  Michael Blankstein: You guys.
• 5:28
  Michael Blankstein: I would say that you don't always need a screw, but when you do, it can save the case.
• 5:31
  Michael Blankstein: So you should definitely stay sharp, my friends,
• 5:37
  Nicholas Mast: well to my, uh, esteemed colleague.
• 5:40
  Nicholas Mast: Um, I as a man enjoy a good screw as much as anybody, but, um.
• 5:46
  Nicholas Mast: The acetabular screw for routine primaries, the orthopedic equivalent of a, of a rotary phone in the age of smartphones, um, well considered a necessary crutch in the days of old, uh, Harris-Galante cups, it was important for stability of the total hip.
• 6:06
  Nicholas Mast: Um, the unquestioned used is less about sound biomechanics, and more about nostalgia.
• 6:11
  Nicholas Mast: It is the orthopedic equivalent of reinforcing a sturdy bridge with duct tape If the engineering is sound, why do you need to do that?
• 6:21
  Nicholas Mast: Implant designs have advanced, we have high friction coatings.
• 6:27
  Nicholas Mast: There's no need for additional supplemental fixation.
• 6:31
  Nicholas Mast: Uh, it's kind of like clinging to the same decade old scrubs.
• 6:37
  Nicholas Mast: A closer look at clinical outcomes and surgical risk makes it clear.
• 6:43
  Nicholas Mast: Screws add unnecessary complexity, potential complications.
• 6:48
  Nicholas Mast: They make the revision harder and they do not add any additional longevity to the prosthesis.
• 6:54
  Nicholas Mast: But it's understandable that my opponent here continues to cling to the idea that screws are necessary.
• 7:01
  Nicholas Mast: 'cause remember, I believe he trained in a place where I think the mullet is still the men's.
• 7:05
  Nicholas Mast: Premier fashion.
• 7:07
  Nicholas Mast: So I posit to you that the same thing in that AO course that they teach about putting that first screw in.
• 7:16
  Nicholas Mast: You learn that from the plate, that every screw hole is an opportunity, not an obligation.
• 7:23
  Nicholas Mast: So thank you.
• 7:26
  Joseph M. Schwab: One minute rebuttal.
• 7:29
  Michael Blankstein: I do love that.
• 7:29
  Michael Blankstein: Last point.
• 7:30
  Michael Blankstein: Good for you again, guys.
• 7:31
  Michael Blankstein: Two options.
• 7:32
  Michael Blankstein: Get in the cup.
• 7:33
  Michael Blankstein: Two minutes put on a screw.
• 7:35
  Michael Blankstein: Perfect.
• 7:36
  Michael Blankstein: It know what you're doing when you need it.
• 7:38
  Michael Blankstein: You have that trajectory in the back of your mind.
• 7:40
  Michael Blankstein: You know you're three dimensionally oriented.
• 7:42
  Michael Blankstein: It's a no brainer.
• 7:44
  Michael Blankstein: The alternative is one day you're gonna under ream.
• 7:46
  Michael Blankstein: One day you're gonna hit too hard.
• 7:48
  Michael Blankstein: One day you're gonna have a cup inside the pelvis, and gonna think I should have listened to Dr.
• 7:52
  Michael Blankstein: Blankstein.
• 7:54
  Joseph M. Schwab: One minute rebuttal.
• 7:57
  Nicholas Mast: Alright, so we're scientists here.
• 7:59
  Nicholas Mast: Please show my slide.
• 8:00
  Nicholas Mast: So after Joe assigned us our topic, a timely paper came out.
• 8:05
  Nicholas Mast: And in this paper, the conclusion on a very large retrospective series showed that actually in this cohort, the largest, the longevity, the least risk of aseptic loosening, least risk of complications of the implant failing were those without screws.
• 8:22
  Nicholas Mast: Thank you.
• 8:24
  Joseph M. Schwab: Go to your Hova app and vote, and we need your votes in because we're gonna hand out the awards.
• 8:29
  Joseph M. Schwab: Well, there you have it.
• 8:32
  Joseph M. Schwab: Two seasoned surgeons passionately debating an issue that has divided orthopedics since the dawn of press.
• 8:38
  Joseph M. Schwab: Fitt, whether the humble acetabular screw is the anchor of stability or the mullet of arthroplasty.
• 8:47
  Joseph M. Schwab: Dr.
• 8:48
  Joseph M. Schwab: Blankstein reminded us that screws are quick, they're cheap, they're safe, and bring unparalleled joy, especially if you learn the craft at an AO course where screws are practically a love language.
• 9:01
  Joseph M. Schwab: Dr.
• 9:03
  Joseph M. Schwab: Mass reminded us that modern day cup designs don't really need screws, and that adding one is kind of like putting duct tape on a well engineered bridge technically possible, but.
• 9:15
  Joseph M. Schwab: A bit eyebrow raising and somewhere in the middle is the truth.
• 9:19
  Joseph M. Schwab: We all know some cases need them, some don't, and all of us have one revision nightmare burned into our memory where the screw absolutely saved the case or made the revision twice as hard.
• 9:33
  Joseph M. Schwab: Thank you for listening to this final episode of the AHF Great debates.
• 9:40
  Joseph M. Schwab: 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.
• 9:49
  Joseph M. Schwab: Please also drop any topic ideas or feedback in the comments below.
• 9:54
  Joseph M. Schwab: 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.
• 10:10
  Joseph M. Schwab: All one word episodes of the AHF Podcast come out on Fridays.
• 10:16
  Joseph M. Schwab: I'm your host, Joe Schwab, asking you to keep those hips and screws happy and healthy.