What Is the Learning Curve for New Technologies in Total Joint Arthroplasty? A 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.

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. 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.