The learning curve associated with imageless navigation in total knee arthroplasty

Abstract

Introduction Computer-assisted navigation systems (CAS) are increasingly being integrated into total knee arthroplasty (TKA) procedures, but perceptions of associated learning curve and increased operative time continue to curtail uptake. Newer-generation navigational systems aim to streamline integration into surgical workflow to mitigate increases in operative time. Here, we assess the impact of a novel imageless CAS on operative time for TKA. Methods A retrospective analysis of prospectively collected data of a cohort of patients undergoing primary unilateral TKA with one of three surgeons between October 2019 and March 2020 was conducted. Consecutive cases using a novel imageless CAS were included in analysis. For each surgeon, average operative time was recorded and compared in sequential five-case cohorts to average operative time for the same procedure performed conventionally using a two-tailed t test. Results Average conventional operative times were 95.9 ± 15.0, 86.6 ± 13.7, and 116.9 ± 25.1 min for the three surgeons. Initial CAS-assisted operative times increased to 107.0 ± 9.8 ( p = 0.07) and 102.4 ± 13.2 ( p = 0.06) min for Surgeons 1 and 2 and decreased to 113.2 ± 9.8 min ( p = 0.52) for Surgeon 3. Most recent CAS-assisted operative times were 94.8 ± 13.9 ( p = 0.88), 88.7 ± 15.3 ( p = 0.84), and 104.8 ± 13.2 ( p = 0.12) min as compared to pre-CAS. Absolute differences for the most recent navigated procedures ranged from 12.1 min faster to 2.0 min slower. Conclusion The learning curve for TKA navigation may be as few as 10 cases, and any associated increases in operative time may be transient and non-significant. Moreover, navigation may ultimately speed operative time, perhaps as the result of enhanced intraoperative assessment of alignment.

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty

“…37 Similarly, the use of imageless navigation in total knee arthroplasty has been demonstrated to have a learning curve of approximately 10 cases. 38 To our knowledge, there is no study that has conducted a thorough cost-analysis on the use of imageless navigation in THA. Although cost-analyses are multifactorial, surgical time is one component that has been studied in imageless navigation.…”

A Retrospective Study to Compare Patient Outcomes from Standard Total Knee Arthroplasty (TKA) versus Navigation-Guided Arthroplasty Using the Brainlab Software-Guided Surgical System at a Center in Hebei Province January 2021 to July 2023

“…Navigation-assisted TKA has been reported to prolong the service life of the prosthesis by achieving more accurate prosthesis position, more accurate alignment control at 1 degree error, and no need for femoral intramedullary localization during surgery, with less intraoperative bleeding and bone destruction due to an accurate positioning system [ 6 ]. Navigation systems are currently divided into accelerometer-based navigation (ABN) systems, conventional instrumentation (CONI) systems, and computer navigation (CN) systems.…”