These authors observe that the risk of early revision is increased for the first patients operatively treated with a newly introduced prosthesis. They explored the learning curves associated with ten knee implant models in 46,363 total knees done with 10 different implant systems in 75 different hospitals to determine the effect of the rank order of the case on early revision risk. Most revisions were in the first two years.
They found large differences among knee implants. The hazard ratios were in general higher for the first 15 cases than for cases done after the first 100.
They concluded that implants have model-specific learning curves and early revision risks. Some models are more difficult to implement than others. They place responsibility on the vendors: "The manufacturers should consider the learning effect when designing implants and instrumentation."
Of note is that this study did not study the effect of individual surgeon experience on the risk of revision rate, rather they studied the effect of rank order of case in the hospital.
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