The Learning Curve of Reaching the Planned Limb Alignment in Robotic-Arm-Assisted Total Knee Arthroplasty

2021 ◽  
Author(s):  
Tejbir S. Pannu ◽  
Jesus M. Villa ◽  
Isaac Schultz ◽  
Wael K. Barsoum ◽  
Carlos A. Higuera ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Robotic Arm ◽  
Perioperative Outcomes ◽  
Second Phase ◽  
Consecutive Series ◽  
Limb Alignment ◽  
Total Knee

AbstractEvidence on the learning curve associated with robotic-arm-assisted total knee arthroplasty (ra-TKA) is scarce and mostly based on operative time. Thus, the objective of this study was to assess a surgeon's learning experience based on accuracy to reach planned limb alignment and its impact on surgical-characteristics, limb-alignment, and perioperative-outcomes. A retrospective chart review was conducted on a consecutive series of 204 primary ra-TKAs (patients), performed by a single surgeon in a single institution (3/7/2018-to-6/18/2019). Cumulative summation control sequential analysis was used for the assessment of the learning curve using accuracy of reaching the planned limb alignment establishing that surgeries had an initial-learning-phase, followed by a second-consolidation-phase. Baseline demographics, operative/tourniquet times, prosthesis type, and limb alignment were compared between these two phases. Length of stay, discharge disposition, complications, reoperation/readmission (90 days), and total morphine equivalents (TMEs) prescribed were compared between phases. Independent sample t-tests, and chi-squared analyses were performed. ra-TKA demonstrated a learning curve of 110 cases for reaching planned limb alignment (p = 0.012). Robotic experience resulted in significantly more proportion of knees in neutral-axis postoperatively (p = 0.035) and significant reduction in TMEs prescribed (p = 0.04). The mean operative and tourniquet time were found to be significantly lower in second-phase versus the first-phase (p for both < 0.0001). ra-TKA has a significant learning curve in clinical practice. A surgeon can reach the planned limb alignment with increased accuracy over time (110-cases). Progressive robotic learning and associated operative time efficiency can lead to significantly lower opioid consumption in patients undergoing TKA.

Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis

2021 ◽  
Author(s):  
Linsen T. Samuel ◽  
Jaret M. Karnuta ◽  
Aditya Banerjee ◽  
Isaac Briskin ◽  
William A. Cantrell ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Robotic Arm ◽  
Pain Scores ◽  
Randomized Controlled Studies ◽  
Patient Reported ◽  
Total Knee ◽  
Ed Visits

AbstractThe purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional database, patients who underwent RA- and manual TKA were the nearest neighbor propensity score matched 3:1 (255 manual TKA:85 RA-TKA), accounting for various preoperative characteristics. Data were compared using analysis of variance (ANOVA), Kruskal–Wallis, Pearson's Chi-squared, and Fisher's exact tests, when appropriate. Postoperative pain scores, opioid use, ED visits, readmissions, and 1-year PROMs were similar between the cohorts. Manual TKA patients achieved higher maximum flexion ROM (120.3 ± 9.9 versus 117.8 ± 10.2, p = 0.043) with no statistical differences in other ROM parameters. Manual TKA had shorter operative time (105 vs.113 minutes, p < 0.001), and fewer PT visits (median [interquartile range] = 10.0 [8.0–13.0] vs. 11.5 [9.5–15.5] visits, p = 0.014). RA-TKA had shorter LOS (0.48 ± 0.59 vs.1.2 ± 0.59 days, p < 0.001) and higher proportion of home discharges (p < 0.001). RA-TKA and manual TKA had similar postoperative complications and 1-year PROMs. Although RA-TKA patients had longer operative times, they had shorter LOS and higher propensity for home discharge. In an era of value-based care models and the steady shift to outpatient TKA, these trends need to be explored further. Long-term and randomized controlled studies may help determine potential added value of RA-TKA versus manual TKA. This study reflects level of evidence III.

The Learning Curve by Operative Time for Soft Tissue Balancing in Total Knee Arthroplasty Using Electronic Sensor Technology

2019 ◽  
Vol 34 (3) ◽  
pp. 483-487 ◽  
Author(s):  
Akshay Lakra ◽  
Nana O. Sarpong ◽  
Emma L. Jennings ◽  
Matthew J. Grosso ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Sensor Technology ◽  
Soft Tissue Balancing ◽  
Electronic Sensor ◽  
Total Knee

scholarly journals “Standard” Versus “Challenging” Patients - Early Outcomes using Computer-Assisted Total Knee Arthroplasty

10.29007/3vpn ◽  
2018 ◽  
Author(s):  
Yifei Dai ◽  
Michael Bolognesi ◽  
Samuel Wellman ◽  
Thorsten Seyler ◽  
Quanjun Cui ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Outcome Data ◽  
Perioperative Outcomes ◽  
Computer Assisted ◽  
Consecutive Series ◽  
Standard Case ◽  
Early Outcome ◽  
Early Results ◽  
Total Knee

This study investigated if CAOS TKA cases complicated by challenging patient conditions would negatively impact the perioperative outcomes of surgery. Early outcome data on 51 TKA’s from a multicenter, consecutive series were analyzed. The patients were separated into challenging and standard case groups according to the criteria of age, BMI, and severity of deformity. The two groups did not exhibit significant differences in any of the early outcomes. Our study demonstrates consistent early results using CAOS TKA irrespective of patient conditions.

Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon

2020 ◽  
Author(s):  
Kevin B. Marchand ◽  
Joseph Ehiorobo ◽  
Kevin K. Mathew ◽  
Robert C. Marchand ◽  
Michael A. Mont
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
High Volume ◽  
Study Groups ◽  
P Value ◽  
Robotic Assisted ◽  
Total Knee ◽  
The Mean

AbstractThe learning curve has been established for robotic-assisted total knee arthroplasty (RATKA) during the first month of use; however, there have been no studies evaluating this on a longer term. Therefore, the purpose of this study was to compare operative times for three cohorts during the first year following adoption of RATKA (initial, 6 months, and 1 year) and a prior cohort of manual TKA. We investigated both mean operative times and the variability of operative time in each cohort. This is a learning curve study comparing a single surgeon's experience using RAKTA. The study groups were made up of two cohorts of 60 cementless RATKAs performed at ∼6 months and 1 year of use. A learning curve was created based on the mean operative times and individual operative times were stratified into different cohorts for comparison. Study groups were compared with the surgeon's initial group of 20 cemented RATKAs and 60 cementless manual cases. Descriptive numbers were compiled and mean operative times were compared using Student's t-tests for significant differences with a p-value of < 0.05. The mean surgical times continued to decrease after 6 months of RATKA. In 1 year, the surgeon was performing 88% of the RATKA between 50 and 69 minutes. The initial cohort and 1-year robotic-assisted mean operative times were 81 and 62 minutes, respectively (p < 0.00001). Mean 6-month robotic-assisted operative times were similar to manual times (p = 0.12). A significant lower time was found between the mean operative times for the 1-year robotic-assisted and manual (p = 0.008) TKAs. The data show continued improvement of operative times at 6 months and 1 year when using this new technology. The results of this study are important because they demonstrate how the complexity of a technology which initially increases operative time can be overcome and become more time-effective than conventional techniques.

scholarly journals Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve

2019 ◽  
Vol 5 (4) ◽  
pp. 465-470 ◽  
Author(s):  
Luis Grau ◽  
Max Lingamfelter ◽  
Danielle Ponzio ◽  
Zachary Post ◽  
Alvin Ong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Robotic Arm ◽  
Workflow Optimization ◽  
Total Knee

scholarly journals The initial learning curve for the ROSA® Knee System can be achieved in 6-11 cases for operative time and has similar 90-day complication rates with improved implant alignment compared to manual instrumentation in total knee arthroplasty

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Luc Vanlommel ◽  
Enrico Neven ◽  
Mike B. Anderson ◽  
Liesbeth Bruckers ◽  
Jan Truijen
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Postoperative Complications ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Complication Rates ◽  
Total Operative Time ◽  
Initial Learning ◽  
Total Knee

Abstract Purpose The purpose of this study was to determine the learning curve for total operative time using a novel cutting guide positioning robotic assistant for total knee arthroplasty (raTKA). Additionally, we compared complications and final limb alignment between raTKA and manual TKA (mTKA), as well as accuracy to plan for raTKA cases. Methods We performed a retrospective cohort study on a series of patients (n = 180) that underwent raTKA (n = 90) using the ROSA Total Knee System or mTKA (n = 90) by one of three high-volume (> 200 cases per year) orthopaedic surgeons between December 2019 and September 2020, with minimum three-month follow-up. To evaluate the learning curve surgical times and postoperative complications were reviewed. Results The cumulative summation analysis for total operative time revealed a change point of 10, 6, and 11 cases for each of three surgeons, suggesting a rapid learning curve. There was a significant difference in total operative times between the learning raTKA and both the mastered raTKA and mTKA groups (p = 0.001) for all three surgeons combined. Postoperative complications were minimal in all groups. The proportion of outliers for the final hip-knee-ankle angle compared to planned was 5.2% (3/58) for the mastered raTKA compared to 24.1% (19/79) for mTKA (p = 0.003). The absolute mean difference between the validated and planned resections for all angles evaluated was < 1 degree for the mastered raTKA cases. Conclusion As the digital age of medicine continues to develop, advanced technologies may disrupt the industry, but should not disrupt the care provided. This cutting guide positioning robotic system can be integrated relatively quickly with a rapid initial learning curve (6-11 cases) for operative times, similar 90-day complication rates, and improved component positioning compared to mTKA. Proficiency of the system requires additional analysis, but it can be expected to improve over time. Level of evidence Level III Retrospective Therapeutic Cohort Study.

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