Intended for healthcare professionals

Rapid response to:

Analysis And Comment Surgery

Adoption of new surgical technology

BMJ 2006; 332 doi: (Published 12 January 2006) Cite this as: BMJ 2006;332:112

Rapid Response:

New Surgical Technology : Evolution vs Revolution


We were interested to read in the article by Professor Wilson (Wilson
CB, Adoption of new surgical technology, BMJ 2006;332;112-114on how our
neurosurgical colleagues in the USA have had problems with adopting new
technology. Though orthopaedic surgery may not be regarded by some as a
highly intellectual branch of surgery, in lower limb arthroplasty at
least, the profession has been at the forefront of monitoring the
introduction of new technology. On both a national and international
level, the performance of existing and new joint replacements are now
recorded and extrapolated using survival analysis in well-established
joint registries. This has allowed an industry standard performance to be
set, up to which new implants much achieve. This has allowed the early
failure of several implants (Capital 3M, Isoelastic hips) to be detected
in time to prevent undue hardship to patients. NICE now recommends that
hip replacements should have at least 95% survivorship at 10 years to be
acceptable. Implants are now graded by their length of follow up and the
quality of published clinical series, allowing surgeons to give evidence
to their patients regarding the implant they use.

Our institution has had great innovators who changed the course of
orthopaedic surgery, with the invention of the Charnley Low Friction
Arthroplasty, and has continued to improve implant design maintaining the
biomechanical principles through evolution and not revolution. This is
combined with the ethical policy of introducing new implants on to the
market only after laboratory testing and long-term pilot studies.

Orthopaedic surgery is the specialty probably most susceptible to the
introduction of new technology, and should continue to manage its
implementation in a controlled manner. Our speciality has its share of
‘innovators’ and early ‘promoters’ but needs to be aware of the often
subtle difference between innovation and experimentation.


Amit Shah & Lee Jeys

Competing interests:
None declared

Competing interests: No competing interests

20 January 2006
Lee M Jeys
Lower Limb Arthroplasty Fellow
Amit Shah, Clinical Research Fellow, Wrightington Hospital
Wrightington Hospital; Hall Lane, Appley Bridge, Wigan, WN6 9EP