When Should We Adopt New Technologies into our Practices?

Dear CSS Colleagues:

If you fancy yourself an entrepreneur or innovator, you should read this post from Rick Matsen. He has a wonderful blog on LinkedIn and the link to it is provided in the document which I am enclosing here. I am also enclosing the publication to which he is responding, as it is also a provocative and succinct consideration of new technology and its adoption.

First of all, I will disclose that I have not only a Conflict of Interest (COI) but a Conflict of Ego (COE). Many of our colleagues have both, even if they believe it to be otherwise. In the last case, we all believe we can re-engineer an approach or implant to improve patient outcomes or solve an existing unsolved problem; however, we fail to discount our inherent bias and unfortunately this is the lens through which we see these problems. Moreover, many of us have a true COI through the Royalty or Equity that such innovations promise. While I don’t 100% agree with the opinion and views of Dr. Matsen or Dr. Leopold, the author of the enclosed article, I can’t deny their point of view. That said, value is measured in many different ways and it is temporal. As Dr. Leopold notes, he did not adopt cross-linked polyethylene initially for his joint replacements and clearly the data supports this as a more durable outcome for joint replacement patients vs conventional polyethylene. Moreover, we can create value by reducing cost or improving outcomes. Then it becomes a tug-of-war to deliver that value to the patient when the hospital or the surgeon lose value in the process due to added cost or time. Finally, there are many examples of harmful effects of innovation. To name a few, remember Thermal Capsulorrhaphy for shoulder instability, or intraarticular pain pumps for postoperative pain control, or metal-on-metal hip replacement.

You should decide yourself what innovation means to you and how you create value for your patients. I know that I’ll always look for a better way to help my patients but keep these points in mind as I try to create value.

One final note, on the topic of Innovation vs Cost vs Value, Professor Robert Kaplan of Harvard Business School has agreed to do a 30-minute Zoom call with us on this topic and in the context of the posts by Rick Matsen. I’ll be sure to invite you all once we have a date set up. We will also record this and post it to Vumedi and link it to the Codman Shoulder Society.

Kind Regards,

“JP” Warner, MD

Founder, CSS