Surgeon-driven variability emerged as a central theme in this discussion of a large Cleveland Clinic cohort examining over 5,400 total knee arthroplasties. The hosts reflect on how surgeon-related factors—spanning technical execution, communication, patient selection, and rehabilitation guidance—exert a greater influence on one-year PROMs and length of stay than traditionally emphasized patient characteristics. They explore the implications for surgical trials, noting how randomization cannot fully correct for imbalances in surgeon expertise, and consider whether expertise-based designs or surgeon-level adjustment should become standard. The conversation broadens to issues of transparency, patient choice, and the need for systematic tracking of individual outcomes. Ultimately, they argue that acknowledging the substantial effect of surgeon factors is essential for interpreting past studies, designing future trials, and improving patient care.