Imageless robotic handpiece-assisted total knee arthroplasty: a learning curve analysis of surgical time and alignment accuracy

Abstract

Introduction Robotic-assisted surgery techniques are increasing in total knee arthroplasty (TKA). One crucial point is the prolonged time of surgery. The primary objective of this study was to determine the learning curve necessary to minimize the time of surgery. The secondary objective was to evaluate the accuracy of the implant alignment when using an imageless robotic system for TKA. Materials and methods In a case–control study, the first 70 consecutive robotic-assisted TKA procedures performed by a single senior surgeon were analyzed with regard to surgery time and implant alignment by comparing the intraoperative plan with the postoperative alignment. The evaluation of the learning curve with respect to surgery time was conducted using cumulative summation (CUSUM) analysis. The joint line height was measured with a new technique. Surgery time and joint line reconstruction were compared to 70 consecutive conventional TKA procedures. Results The learning curve for robotic TKA was completed after 11 cases. The learning curve did not influence the accuracy of joint line obliquity, joint line height, or limb alignment. The intraoperative plan designed for the robotic system was precisely implemented. The mean skin-to-skin time in the robotic group after the learning curve was completed did not differ from that in the manual group. A significant positive correlation was observed between the preoperative hip–knee–ankle angle and the postoperative distalization of the joint line in the robotic-assisted TKA group. Conclusion After completing the initial learning curve of 11 cases, the surgery time required to perform imageless robotic handpiece-assisted TKA was similar to that for the conventional technique. However, no learning curve was observed for the implant positioning when using the imageless robotic system. The implementation of the intraoperative plan was accurate up to < 2°. The precision of the system allows the implementation of different joint balancing approaches between valgus and varus morphotypes.

Imageless robotic-assisted revision arthroplasty from UKA to TKA

“…Furthermore, postoperative coronal alignment parameters were all comparable between the groups. In addition to the numerous published studies on improved alignment accuracy in primary robotic-assisted knee arthroplasty in comparison to conventional TKA [ 12 , 19 , 23 , 26 , 31 ], this case series was able to demonstrate a comparable accuracy and outcome to robotic-assisted primary knee arthroplasty. Intraoperative control of component alignment and joint line restoration in revision arthroplasty is often a challenge due to further bone loss or loss of bony reference points after implant removal.…”

“…Robotic-assisted UKA conversion to TKA and primary RA-TKA were both done with the image-less robotic system NAVIO TM (Smith & Nephew, London, UK) using the Journey II BCS prothesis. Primary RA-TKA was performed as described before [ 7 , 23 ]. In the following, the technique of robotic-assisted UKA conversion to TKA is described:…”

“…Robotic-assisted primary TKA (RA-TKA) is increasingly gaining popularity in the orthopaedic domain [ 9 ]. The main advantages of RA-TKA include improved component alignment and real-time control of soft tissue balance [ 12 , 19 , 23 , 26 , 31 ]. The use of RA-TKA in the context of UKA revision is a promising approach to improve the results of these revision procedures.…”

Where are We Now and What are We Hoping to Achieve with Robotic Total Knee Arthroplasty? A Critical Analysis of the Current Knowledge and Future Perspectives

“…Similarly, Liow et al 11 reported that rTKAs were associated with a more accurate restoration of the joint line with only 3.2% of outliers (defined as >5 mm deviation) compared to a 20.6% in the conventional group. Savov et al 30 reported an overall incidence of 11% outliers (8 cases out of 70; p = 0.002) when comparing NAVIO assisted TKA with conventional technique with a mean error from planned of 2±1.2° regarding HKA (p < 0.001), 1±0.8° regarding medial…”

“…However, their analysis revealed an inflection point after the initial seven cases, identifying an initial learning stage with mean 100 min per case and a proficiency stage with mean 67 min per case (p < 0.001). The learning curve associated with the same robotic system (NAVIO) was analyzed by Savov et al, 30 on two groups of 70 consecutive patients operated with robotic and conventional technique, respectively.…”