What Is the Learning Curve for New Technologies in Total Joint Arthroplasty? A Review
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THE USE OF TECHNOLOGY IN ORTHOPAEDIC SURGERY—INTRAOPERATIVE AND POST-OPERATIVE MANAGEMENT (C KRUEGER AND S BINI, SECTION EDITORS)
What Is the Learning Curve for New Technologies in Total Joint Arthroplasty? A Review Nana O. Sarpong 1 & Carl L. Herndon 1 & Michael B. Held 1 & Alexander L. Neuwirth 1 & Thomas R. Hickernell 1 & Jeffrey A. Geller 1 & H. John Cooper 1 & Roshan P. Shah 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The adaptation of new technology in joint replacement surgery is often associated with a learning curve, as performance tends to improve with experience. The purpose of this review is to define the learning curve and its relevance to joint replacement surgery in the setting of new technological advances, and to draw analogies with the learning curve of basic surgical training. Recent Findings Assessing a surgeon’s learning curve for a new technology is complicated and difficult. With every learning curve, the first patients subjected to the novel technology may be at higher risk for adverse events until the learning curve is overcome and a steady state is reached. While measures of performance can be clear and direct in some professions, learning curves with new technology in total joint arthroplasty have been difficult to quantify. Most attempts measure surgical learning curves via an evaluation of the surgical process or patient outcomes. There are published results of both process (i.e., operative time, accuracy of implant position) and outcome measures (i.e., complication rate, revision rate) utilized as proxy for performance during learning curves. Summary We review the concept of the learning curve in joint replacement surgery, highlighting examples of learning curves with adaptation of new technologies, and conclude with a discussion of dilemmas and challenges. Keywords Learning curve . Technology . Arthroplasty . Orthopedic devices . Operating room . Training
Introduction When learning to use a new technology, performance often improves with experience. This concept of a learning curve with
new technology was introduced in 1936 by T.P. Wright, an aeronautical engineer who reported that an increase in the experience and skill of the workforce correlated with increased efficiency of aircraft component production and decreased costs
This work was performed in the Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA This article is part of the Topical Collection on The Use of Technology in Orthopaedic Surgery—Intraoperative and Post-Operative Management * Roshan P. Shah [email protected]; [email protected]
Thomas R. Hickernell [email protected]
Nana O. Sarpong [email protected]
Jeffrey A. Geller [email protected]
Carl L. Herndon [email protected] Michael B. Held [email protected] Alexander L. Neuwirth [email protected]
H. John Cooper [email protected] 1
Department of Orthopedic Surgery, Columbia University Irving Medical
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