Robotic‐arm assisted total knee arthroplasty has a learning curve of 16 cases and increased operative time of 12 min

Abstract

Background: Robotic-arm assisted systems are increasingly used for knee arthroplasty, however introduction of new systems can involve a learning curve. We aimed to define the learning curve in terms of operative time and component placement/sizing of a robotic system for total knee arthroplasty (TKA) in a team of experienced surgeons, and to investigate mid-term patient outcomes. Methods: A total of 101 consecutive patients underwent primary robotic-arm assisted TKA by three surgeons (mean 2 year follow-up). Operative times, component placement, implant sizing and reoperations were recorded. Cumulative Summation (CUSUM) was used to analyse learning curves. Patient outcomes were compared between learning and proficiency phases. Results: The learning curve was 16 cases, with a 12-min increase in operative time (P < 0.01). Once proficiency was achieved, the greatest time reductions were seen for navigation registration (P = 0.003) and bone preparation (P < 0.0001). A learning curve was found with polyethylene (PE) insert sizing (P = 0.01). No differences were found between learning and proficiency groups in terms of implant survival (100% and 97%, respectively, NS) or patient-reported outcome measures at 2 years (NS). Conclusion: Introduction of a robotic-arm assisted system for TKA led to increased operative times for navigation registration and bone preparation, and a learning curve with PE insert sizing. No difference in patient outcomes between learning and proficiency groups at 2 years was found. These findings can inform surgeons' expectations when starting to use robotic-assisted systems. Patients and methodsEthical approval for this study was obtained from national and local committees. This study included prospectively-collected data from surgeons who completed at least 20 robotic-arm assisted TKA

The learning curve for a novel, fluoroscopy‐based robotic‐assisted total hip arthroplasty system

“…Similarly, the learning curve of robotically-assisted TKA (RA-TKA) systems determined by LC-CUSUM analysis of operative times has been reported between 7 and 43 cases. [23][24][25][26] The range of reported learning curves for these RA-TKA systems is similar to both that CT-based RA-THA and of this present study, illustrating the comparable adoption characteristics of robotic technologies into orthopaedic surgery workflows across techniques.…”

“…The similarity of our results to that in the current literature suggests that the adoption of fluoroscopy‐based RA‐THA is no more complex or difficult than that of CT‐based robotic systems. Similarly, the learning curve of robotically‐assisted TKA (RA‐TKA) systems determined by LC‐CUSUM analysis of operative times has been reported between 7 and 43 cases 23–26 . The range of reported learning curves for these RA‐TKA systems is similar to both that CT‐based RA‐THA and of this present study, illustrating the comparable adoption characteristics of robotic technologies into orthopaedic surgery workflows across techniques.…”

Robotic‐assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta‐analysis of randomized controlled trials

“…The infection risk has been also documented with respect to the operative time [49], another debated aspect in the comparison of R‐TKA and C‐TKA. Most studies suggest longer operative time in R‐TKA, mainly due to registration and bone preparation stages of the R‐TKA surgical procedure [55, 60]. The present meta‐analysis confirmed a statistically significant difference in terms of operative time in favour of C‐TKA.…”

Transition to Robotic Total Knee Arthroplasty With Kinematic Alignment is Associated With a Short Learning Curve and Similar Acute-Period Functional Recoveries

“…Additionally, a recent analysis of high-volume arthroplasty surgeons has found that the transition to robotic instrumentation substantially increased surgery times, even over the long term [ 8 ]. Studies on the transition to other robotic TKA solutions found learning curves of anywhere between six and 16 surgeries [ 6 , 7 ]. In our study, robotic surgery times were equal to traditional instrumentation after just two robotic surgeries (Figure 1 and Table 5 ); unlike the studies previously mentioned, we did not see a gradual reduction in robotic surgery times with an eventual plateau.…”

“…An analysis of surgeons transitioning to robotic approaches showed that surgeons took 6-11 surgeries to learn the new techniques and stabilize surgery times [ 6 ]. Additionally, a study evaluating the learning curve of a popular image-based robotic solution found a learning curve of 16 surgeries across three different mediums for high-volume surgeons [ 7 ]. Previous research has shown that among high-volume arthroplasty surgeons, robotics significantly increase a surgeon’s time in the operating room [ 8 ].…”