Learning curve for robot-assisted total knee arthroplasty in mixed robot-assisted and conventional practice

AbstractAs with most new surgical technologies, there is an associated learning curve with robotic-assisted total knee arthroplasty (TKA) before surgeons can expect ease of use to be similar to that of manual cases. Therefore, the purpose of this study was to (1) assess robotic-assisted versus manual operative times of two joint reconstructive surgeons separately as well as (2) find an overall learning curve. A total of 240 robotic-assisted TKAs performed by two board-certified surgeons were analyzed. The cases were sequentially grouped into 20 cases and a learning curve was created based on mean operative times. For each surgeon, mean operative times for their first 20 and last 20 robotic-assisted cases were compared with 20 randomly selected manual cases performed by that surgeon as controls prior to the initiation of the robotic-assisted cases. Each of the surgeons first 20 robotic assisted, last 20 robotic assisted, and 20 controls were then combined to create 3 cohorts of 40 cases for analysis. Surgeon 1: First and last robotic cohort operative times were 81 and 70 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 81 versus 68 minutes (p < 0.05). Mean operative times for the last 20 robotic-assisted cases and manual cases were 70 versus 68 minutes (p > 0.05). Surgeon 2: First and last robotic cohort operative times were 117 and 98 minutes (p < 0.05). Mean operative times for the first 20 robotic-assisted cases and manual cases were 117 versus 95 (p < 0.05). Mean operative times for the last 20 robotic-cohort cases and manual cases were 98 versus 95 (p > 0.05). A similar trend occurred when the times of two surgeons were combined. The data from this study effectively create a learning curve for the use of robotic-assisted TKA. As both surgeons completed their total cases numbers within similar time frames, these data imply that within a few months, a board-certified orthopaedic joint arthroplasty surgeon should be able to adequately perform robotic TKA without adding any operative times.

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Letter to the Editor on Robot-Assisted Total Knee Arthroplasty Does Not Improve Long-Term Clinical and Radiologic Outcomes

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.04.002 ◽

2020 ◽

Vol 35 (8) ◽

pp. 2303-2304

Author(s):

Albert T. Anastasio ◽

Preet S. Patel ◽

John R. Wickman ◽

William A. Jiranek

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Robot Assisted ◽

Letter To The Editor ◽

Total Knee

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Robot-Assisted Navigation versus Computer-Assisted Navigation in Primary Total Knee Arthroplasty: Efficiency and Accuracy

ISRN Orthopedics ◽

10.1155/2013/794827 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Tanner C. Clark ◽

Frank H. Schmidt

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Secondary Outcome ◽

Computer Assisted ◽

Robot Assisted ◽

Tourniquet Time ◽

Assisted Navigation ◽

Total Knee ◽

Primary Total Knee

Background. Since the introduction of robot-assisted navigation in primary total knee arthroplasty (TKA), there has been little research conducted examining the efficiency and accuracy of the system compared to computer-assisted navigation systems. Objective. To compare the efficiency and accuracy of Praxim robot-assisted navigation (RAN) and Stryker computer-assisted navigation (CAN) in primary TKA. Methods. This was a retrospective study consisting of 52 patients who underwent primary TKA utilizing RAN and 29 patients utilizing CAN. The primary outcome measure was navigation time. Secondary outcome measures included intraoperative final mechanical axis alignment, intraoperative robot-assisted bone cut accuracy, tourniquet time, and hospitalization length. Results. RAN navigation times were, on average, 9.0 minutes shorter compared to CAN after adjustment. The average absolute intraoperative malalignment was 0.5° less in the RAN procedures compared to the CAN procedures after adjustment. Patients in the RAN group tended to be discharged 0.6 days earlier compared to patients in the CAN group after adjustment. Conclusions. Among patients undergoing TKA, there was decreased navigation time, decreased final malalignment, and decreased hospitalization length associated with the use of RAN when compared to CAN independent of age, BMI, and pre-replacement alignment.

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