Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing

Abstract

Purpose The application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study is to identify and predict the learning curve of robot-assisted (RA) TKA. Methods A RA TKA system (MAKO) was introduced in April 2018 in our service. A retrospective analysis was performed of all patients receiving a TKA with this system by six surgeons. Operative times, implant and limb alignment, intraoperative joint balance and robot-related complications were evaluated. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time, implant alignment and joint balance in RA TKA. Linear regression was performed to predict the learning curve of each surgeon. Results RA TKA was associated with a learning curve of 11-43 cases for operative time (p < 0.001). This learning curve was significantly affected by the surgical profile (high vs. medium vs. low volume). A complete normalisation of operative times was seen in four out of five surgeons. The precision of implant positioning and gap balancing showed no learning curve. An average deviation of 0.2° (SD 1.4), 0.7° (SD 1.1), 1.2 (SD 2.1), 0.2° (SD 2.9) and 0.3 (SD 2.4) for the mLDFA, MPTA, HKA, PDFA and PPTA from the preoperative plan was observed. Limb alignment showed a mean deviation of 1.2° (SD 2.1) towards valgus postoperatively compared to the intraoperative plan. One tibial stress fracture was seen as a complication due to suboptimal positioning of the registration pins. Conclusion RA TKA is associated with a learning curve for surgical time, which might be longer than reported in current literature and dependent on the profile of the surgeon. There is no learning curve for component alignment, limb alignment and gap balancing. Level of evidence IV.

A new robotically assisted system for total knee arthroplasty: A sheep model study

“…The first robotic system in orthopedic surgery is Robodoc, which has been used for TKA and total hip arthroplasty since 1992 20 . However, the application of this robotic system was limited because of increased operative time, insufficient versatility and technical complexity 21–23 . The objective of the robotic‐assisted TKA system is to provide a tool for surgeons to accurately resect bone and accurately select and balance implant and soft tissue placement 24–26 .…”

“…The objective of the robotic‐assisted TKA system is to provide a tool for surgeons to accurately resect bone and accurately select and balance implant and soft tissue placement 24–26 . To date, multiple robotic‐assisted TKA systems, such as Mako (Stryker), Navio PFS (Plymouth) and Robodoc (CurexoTechnology), have been clinically used 22,27,28 . Until now, however, there have not been any robot‐assisted TKA systems approved by the National Medical Products Administration of China.…”

“…20 However, the application of this robotic system was limited because of increased operative time, insufficient versatility and technical complexity. [21][22][23] The objective of the robotic-assisted TKA system is to provide a tool for surgeons to accurately resect bone and accurately select and balance implant and soft tissue placement. [24][25][26] To date, multiple robotic-assisted TKA systems, such as Mako (Stryker), Navio PFS (Plymouth) and Robodoc (CurexoTechnology), have been clinically used.…”

“…[24][25][26] To date, multiple robotic-assisted TKA systems, such as Mako (Stryker), Navio PFS (Plymouth) and Robodoc (CurexoTechnology), have been clinically used. 22,27,28 Until now, however, there have not been any robot-assisted TKA systems approved by the National Medical Products Administration of China. Thus, more robotic-assisted TKA systems need to be designed and improved, particularly in China.…”

Deep learning approach for guiding three‐dimensional computed tomography reconstruction of lower limbs for robotically‐assisted total knee arthroplasty

“…[3][4][5][6] Robotically assisted TKA was thus developed to promote mechanical alignment, accuracy of bone resection, soft tissue protection, and implant survivorship and implant stability. [7][8][9][10] In this connection, our previous studies showed that a novel HURWA robotic-assisted TKA system (BEIJING HURWA-ROBOT Technology Co. Ltd) could enhance the accuracy of bone resection in terms of resection angles and levels in the sawbone and the sheep models. 11,12 The procedures of robotic-assisted TKA system consists of the following steps: preoperative computed tomography (CT) scanning of lower limbs, three-dimensional (3D) reconstruction of CT data of lower limbs, CT-based planning, surgical planning depending on the 3D CT model, and the act of performing robotic-assisted TKA.…”