Surgeon experience, the learning curve, revision rates, and patient safety.

A recent article in Clinical Orthopaedics explored the effects of introducing a new total knee prosthesis design. They found that the first 15 patients having the new prosthesis had a 48% greater risk of needing a revision surgery during the first two years after the procedure.

While knees are not shoulders, a surprisingly similar result was obtained regarding the learning curve for reverse total shoulders.

Other articles have pointed to the importance of surgeon case volume to the result, such as this one and this one.

Interestingly, many shoulder replacements are performed by surgeons with relatively little experience.

These articles serve to point out the importance of recognizing the importance of experience to the result.  While there is much emphasis on suggested advantages of one design of implant over another, the most important variable may be the experience of the surgeon - not only in doing the procedure, but also in selecting and preparing the patients and in guiding the recovery.

As we say, 'the surgeon is the method'.

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