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This study compared surgeon cervical (C) spine postures and repetitive motions when performing traditional manual total knee arthroplasty (MTKA) versus robotic-assisted TKA (RATKA). Surgeons wore motion trackers on T3 vertebra and the occiput anatomical landmarks to obtain postural and repetitive motion data during MTKA and RATKA performed on cadavers. We assessed (1) flexion–extension at T3 and the occiput anatomical landmarks, (2) range of motion (ROM) as the percentage of time in the flexion–extension angle, (3) repetition rate, defined as the number of the times T3 and the occiput flexion-extension angle exceeded ±10°; and (4) static posture, where T3 or occiput postures exceed 10° for more than 30 seconds. The average T3 flexion–extension angle for MTKA cases was 5-degree larger than for RATKA cases (19 ± 8 vs. 14 ± 8 degrees). The surgeons who performed MTKA cases spent 15% more time in nonneutral C-spine ROM than those who performed RATKA cases (78 ± 25 vs. 63 ± 36%, p < 0.01). The repetition rate at T3 was 4% greater for MTKA than RATKA (14 ± 5 vs. 10 ± 6 reps/min). The percentage of time spent in static T3 posture was 5% greater for overall MTKA cases than for RATKA cases (15 ± 3 vs. 10 ± 3%). In this cadaveric study, we found differences in cervical and thoracic ergonomics between manual and robotic–assisted TKA. Specifically, we found that RATKA may reduce a surgeon's ergonomic strain at both the T3 and occiput locations by reducing the time the surgeon spends in a nonneutral position.

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Surgeon physical stress in the operating room is a known potential cause of musculoskeletal overuse injuries, specifically in surgeons who perform total knee arthroplasty (TKA). Injuries have been attributed to ergonomically challenging postures. This study compared surgeon lower back and shoulder posture between manual TKA (MTKA) and robotic assisted TKA (RATKA).Two surgeons performed a total six MTKA and six RATKA on a set of cadaveric knees. Movement and EMG sensors were secured to each surgeon to monitor lower back and shoulder movements, as well as muscle activities. Data was analyzed and activities were assessed as low, medium, or high risk, providing a score between 0-lowest and 16-highest. Risk data was compared between MTKA and RATKA for three separate surgical tasks: 1-bone cut preparation &amp; cutting (MTKA = placement of cutting jigs, bone cutting, RATKA = array placement, bone registration, bone cutting), 2-knee balancing and 3-trialing.Overall, there were more high-risk shoulder than lower back activities in MTKA and RATKA. More high-risk movement and EMG stimulation were measured in the dominant shoulder than the non-dominant. When lower back and shoulder data were combined, highest risk task was bone cut preparation &amp; cutting (MTKA: 13 vs. 6 vs. 6 and RATKA: 11 vs. 8 vs. 6), with a higher risk for MTKA than RATKA.Poor posture can be a potential cause for surgeon work-related injuries. This study evaluated which tasks presented highest risk to surgeon ergonomic safety while performing TKA, and found lower overall ergonomics risk for performing RATKA vs. MTKA. Although this study provides data indicating reduced ergonomic risk with RATKA, additional studies in the operating room need to be performed.

The purposes of this study were to assess 1) number of bone recuts with manual TKA (MTKA) vs RATKA and 2) influence of robotics on surgeon’s posture and workload during recutting.Two surgeons each performed three MTKAs and three RATKAs. Occurrence, time and type of post-resection recuts were recorded. Movement sensors were placed on surgeons to measure lower back, shoulder, and cervical movements. Data was analyzed for average angle, percent of time in high-risk range of motion (ROM), number of times in high-risk sustained positions, and repetitions per minute. Surgeons were surveyed to assess physical and mental effort on a 1-10 scale (1 as lowest effort).Six TKAs required recuts, five MTKA and one RATKA. 5 were on tibia and 1 (MTKA) was on femur. Compared to RATKA, MTKA had: increased time to perform recut (4.8-minutes vs. 3.7-minutes), increased occiput and T3 (38.9 vs 17.0° and 16.0 vs 3.0°) average angles, increased lower back ROM, sustained positions, and repetitions (14 vs 0%, 1 vs 0, and 1.9 vs 0), increased non-dominant shoulder ROM and repetitions (22 vs 0% and 2 vs 1), reduced dominant shoulder ROM (56 vs 19%), increased mental (4.2 vs 2.8) efforts and increased physical (3.3 vs 1.7) efforts.Results indicate RATKA may reduce incidence of post-resection bone recuts. Increased time and required efforts for MTKA may be due to setting up surgical cutting instruments. Whereas, for RATKA, recut changes are made on the robotic surgical screen and the robotic-arm is used to help perform the recut.

Orthopaedic surgery is a mentally and physically demanding procedure for surgeons. Studies reported 44-66% of surgeons surveyed have had a work-related injury attributed to poor surgeon posture. The purpose of this study was to understand how surgical variables may affect a surgeon’s posture and workload when performing TKA. Variables included: influence of level of surgical experience, type of surgical procedure, and specific surgical tasks.Two experienced surgeons, with a median 22-years surgical experience, and 2 surgeons, currently in their fellowship training, each performed 3 manual TKAs (MTKA) and 3 robotic assisted TKAs (RATKA) using a cadaveric setup. Kinematic sensors were placed on the occiput and T3 to measure flexion of the head and neck. Surgeons were surveyed to assess their physical and mental effort using a 1-10 scale (1 being least effort).Compared to the fellows, experienced surgeons had reduced occiput and T3 angles for MTKA (28.0 vs. 38.7°, 4.2 vs. 15.7°) and RATKA (18.0 vs. 29.2°, 4.8 vs. 13.2°) as well as reduced mental and physical effort. Considering surgical procedure, all surgeons had reduced occiput angles for RATKA compared to MTKA. Considering surgical task, surgical application (MTKA vs. RATKA) had greater influence on cervical angles for the fellows group.All three factors influenced the surgeon’s posture and workload. Occiput angle was reduced by approximately 10° during RATKA, which is attributed to the surgeon standing in a more upright position, to visualize the robotic screen during cutting and trialing. Robotics may help newer surgeons better visualize knee balancing during TKA, easing the process of balancing and trialing.