New orthopaedic technology is constantly being developed to help improve patient care. New technology may lead to a waste of resources or lead to harm for the patient if it is not properly evaluated before it is accepted as a standard of care. The purpose of this article is to assess how new technology can be implemented safely while maintaining an environment that allows for surgical innovation through an evidence-based approach. Although randomized controlled trials (Level-I evidence) are typically seen as the so-called gold standard with regard to treatment efficacy, randomized trials may not be the most effective form of evaluating a new technology. In many circumstances, a prospective cohort series or large registry that documents outcomes and adverse events may be more effective and practical for the evaluation of a new surgical technology.