The learning curve associated with robotic-arm assisted unicompartmental knee arthroplasty

2018 ◽  
Vol 100-B (8) ◽  
pp. 1033-1042 ◽  
Author(s):  
B. Kayani ◽  
S. Konan ◽  
J. R. T. Pietrzak ◽  
S. S. Huq ◽  
J. Tahmassebi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Learning Curve ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Operating Time ◽  
Robotic Arm ◽  
Surgical Team ◽  
Limb Alignment ◽  
Confidence Levels ◽  
Implant Positioning

Aims The primary aim of this study was to determine the surgical team’s learning curve for introducing robotic-arm assisted unicompartmental knee arthroplasty (UKA) into routine surgical practice. The secondary objective was to compare accuracy of implant positioning in conventional jig-based UKA versus robotic-arm assisted UKA. Patients and Methods This prospective single-surgeon cohort study included 60 consecutive conventional jig-based UKAs compared with 60 consecutive robotic-arm assisted UKAs for medial compartment knee osteoarthritis. Patients undergoing conventional UKA and robotic-arm assisted UKA were well-matched for baseline characteristics including a mean age of 65.5 years (sd 6.8) vs 64.1 years (sd 8.7), (p = 0.31); a mean body mass index of 27.2 kg.m2 (sd 2.7) vs 28.1 kg.m2 (sd 4.5), (p = 0.25); and gender (27 males: 33 females vs 26 males: 34 females, p = 0.85). Surrogate measures of the learning curve were prospectively collected. These included operative times, the Spielberger State-Trait Anxiety Inventory (STAI) questionnaire to assess preoperative stress levels amongst the surgical team, accuracy of implant positioning, limb alignment, and postoperative complications. Results Robotic-arm assisted UKA was associated with a learning curve of six cases for operating time (p < 0.001) and surgical team confidence levels (p < 0.001). Cumulative robotic experience did not affect accuracy of implant positioning (p = 0.52), posterior condylar offset ratio (p = 0.71), posterior tibial slope (p = 0.68), native joint line preservation (p = 0.55), and postoperative limb alignment (p = 0.65). Robotic-arm assisted UKA improved accuracy of femoral (p < 0.001) and tibial (p < 0.001) implant positioning with no additional risk of postoperative complications compared to conventional jig-based UKA. Conclusion Robotic-arm assisted UKA was associated with a learning curve of six cases for operating time and surgical team confidence levels but no learning curve for accuracy of implant positioning. Cite this article: Bone Joint J 2018;100-B:1033–42.

The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty

2019 ◽  
pp. 112070001988933 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Sumon S Huq ◽  
Mazin S Ibrahim ◽  
Atif Ayuob ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Robotic Arm ◽  
Surgical Team ◽  
Leg Length ◽  
Acetabular Cup ◽  
Confidence Levels ◽  
Length Discrepancy ◽  
Cup Positioning

Background: Robotic-arm assisted surgery aims to reduce manual errors and improve the accuracy of implant positioning and orientation during total hip arthroplasty (THA). The objective of this study was to assess the surgical team’s learning curve for robotic-arm assisted acetabular cup positioning during THA. Methods: This prospective cohort study included 100 patients with symptomatic hip osteoarthritis undergoing primary total THA performed by a single surgeon. This included 50 patients receiving conventional manual THA and 50 patients undergoing robotic-arm assisted acetabular cup positioning during THA. Independent observers recorded surrogate markers of the learning curve including operative times, confidence levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy in restoring native hip biomechanics, acetabular cup positioning, leg-length discrepancy, and complications within 90 days of surgery. Results: Cumulative summation (CUSUM) analysis revealed robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for achieving operative times ( p < 0.001) and surgical team confidence levels ( p < 0.001) comparable to conventional manual THA. There was no learning curve of robotic-arm assisted THA for accuracy of achieving the planned horizontal ( p = 0.83) and vertical ( p = 0.71) centres of rotation, combined offset ( p = 0.67), cup inclination ( p = 0.68), cup anteversion ( p = 0.72), and correction of leg-length discrepancy ( p = 0.61). There was no difference in postoperative complications between the two treatment groups. Conclusions: Integration of robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for operative times and surgical team confidence levels but there was no learning curve effect for accuracy in restoring native hip biomechanics or achieving planned acetabular cup positioning and orientation.

scholarly journals Comparison of Robotic and Conventional Unicompartmental Knee Arthroplasty Outcomes in Patients with Osteoarthritis: A Retrospective Cohort Study

2021 ◽  
Vol 11 (1) ◽  
pp. 220
Author(s):  
Christopher Wu ◽  
Nobuei Fukui ◽  
Yen-Kuang Lin ◽  
Ching-Yu Lee ◽  
Shih-Hsiang Chou ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Robotic Arm ◽  
Surgical Time ◽  
Implant Positioning ◽  
Implant Placement ◽  
Unicompartmental Knee ◽  
One Year ◽  
Anatomical Alignment

Robotic-arm-assisted unicompartmental knee arthroplasty (RUKA) was developed to increase the accuracy of bone alignment and implant positioning. This retrospective study explored whether RUKA has more favorable overall outcomes than conventional unicompartmental knee arthroplasty (CUKA). A total of 158 patients with medial compartment osteoarthritis were recruited, of which 85 had undergone RUKA with the Mako system and 73 had undergone CUKA. The accuracy of component positioning and bone anatomical alignment was compared using preoperative and postoperative radiograph. Clinical outcomes were evaluated using questionnaires, which the patients completed preoperatively and then postoperatively at six months, one year, and two years. In total, 52 patients from the RUKA group and 61 from the CUKA group were eligible for analysis. The preoperative health scores and Kellgren–Lawrence scores were higher in the RUKA group. RUKA exhibited higher implant positioning accuracy, thus providing a superior femoral implant angle, properly aligned implant placement, and a low rate of overhang. RUKA also achieved higher accuracy in bone anatomical alignment (tibial axis angle and anatomical axis angle) than CUKA, but surgical time was longer, and blood loss was greater. No significant differences were observed in the clinical outcomes of the two procedures.

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.

Navigated lateral unicompartmental knee arthroplasty — Technique and case report

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 382-387
Author(s):  
Daniel Kendoff ◽  
Paolo Benedetto ◽  
Asheesh Bedi ◽  
Mustafa Citak ◽  
Lucien Olivier ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Mechanical Axis ◽  
Computer Assisted ◽  
Limb Alignment ◽  
Technical Errors ◽  
Implant Positioning ◽  
Unicompartmental Knee ◽  
Lateral Unicompartmental Knee Arthroplasty ◽  
Lateral Uka

AbstractLateral unicompartmental knee arthroplasty (UKA) outcomes have been inferior to those described after medial UKA. Inaccurate implant positioning and mechanical axis malalignment appear to be the most common technical errors. Rare studies or failure identification on lateral UKA are currently presented in the literature. We describe the utilization of computer-assisted lateral UKA placement for lateral knee osteoarthritis with a valgus malalignment of 10°. Navigation allows for a dynamic intraoperative visualisation of the mechanical axis, as well as for accurate component positioning and overall postoperative limb alignment. The systems allow the knee position to be captured with appropriate tension in extension and flexion prior to making definite cuts. Postoperatively, no instabilities occurred with a precise component placement. Navigation can be used in rare cases for lateral UKA.

An assessment of early functional rehabilitation and hospital discharge in conventional versus robotic-arm assisted unicompartmental knee arthroplasty

2019 ◽  
Vol 101-B (1) ◽  
pp. 24-33 ◽  
Author(s):  
B. Kayani ◽  
S. Konan ◽  
J. Tahmassebi ◽  
F. E. Rowan ◽  
F. S. Haddad
Keyword(s):  
Postoperative Pain ◽  
Postoperative Complications ◽  
Hospital Discharge ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Robotic Arm ◽  
Functional Rehabilitation ◽  
Unicompartmental Knee

Aims The objectives of this study were to compare postoperative pain, analgesia requirements, inpatient functional rehabilitation, time to hospital discharge, and complications in patients undergoing conventional jig-based unicompartmental knee arthroplasty (UKA) versus robotic-arm assisted UKA. Patients and Methods This prospective cohort study included 146 patients with symptomatic medial compartment knee osteoarthritis undergoing primary UKA performed by a single surgeon. This included 73 consecutive patients undergoing conventional jig-based mobile bearing UKA, followed by 73 consecutive patients receiving robotic-arm assisted fixed bearing UKA. All surgical procedures were performed using the standard medial parapatellar approach for UKA, and all patients underwent the same postoperative rehabilitation programme. Postoperative pain scores on the numerical rating scale and opiate analgesia consumption were recorded until discharge. Time to attainment of predefined functional rehabilitation outcomes, hospital discharge, and postoperative complications were recorded by independent observers. Results Robotic-arm assisted UKA was associated with reduced postoperative pain (p < 0.001), decreased opiate analgesia requirements (p < 0.001), shorter time to straight leg raise (p < 0.001), decreased number of physiotherapy sessions (p < 0.001), and increased maximum knee flexion at discharge (p < 0.001) compared with conventional jig-based UKA. Mean time to hospital discharge was reduced in robotic UKA compared with conventional UKA (42.5 hours (sd 5.9) vs 71.1 hours (sd 14.6), respectively; p < 0.001). There was no difference in postoperative complications between the two groups within 90 days’ follow-up. Conclusion Robotic-arm assisted UKA was associated with decreased postoperative pain, reduced opiate analgesia requirements, improved early functional rehabilitation, and shorter time to hospital discharge compared with conventional jig-based UKA.

How should we evaluate robotics in the operating theatre?

2020 ◽  
Vol 102-B (4) ◽  
pp. 407-413 ◽  
Author(s):  
Hannes Vermue ◽  
Jasper Lambrechts ◽  
Thomas Tampere ◽  
Nele Arnout ◽  
Edouard Auvinet ◽  
...  
Keyword(s):  
Learning Curve ◽  
Knee Arthroplasty ◽  
Preoperative Planning ◽  
Operating Time ◽  
Operating Theatre ◽  
Current Evidence ◽  
Cochrane Library ◽  
Surgical Team ◽  
Robot Assisted ◽  
Stress Levels

The application of robotics in the operating theatre for knee arthroplasty remains controversial. As with all new technology, the introduction of new systems might be associated with a learning curve. However, guidelines on how to assess the introduction of robotics in the operating theatre are lacking. This systematic review aims to evaluate the current evidence on the learning curve of robot-assisted knee arthroplasty. An extensive literature search of PubMed, Medline, Embase, Web of Science, and Cochrane Library was conducted. Randomized controlled trials, comparative studies, and cohort studies were included. Outcomes assessed included: time required for surgery, stress levels of the surgical team, complications in regard to surgical experience level or time needed for surgery, size prediction of preoperative templating, and alignment according to the number of knee arthroplasties performed. A total of 11 studies met the inclusion criteria. Most were of medium to low quality. The operating time of robot-assisted total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is associated with a learning curve of between six to 20 cases and six to 36 cases respectively. Surgical team stress levels show a learning curve of seven cases in TKA and six cases for UKA. Experience with the robotic systems did not influence implant positioning, preoperative planning, and postoperative complications. Robot-assisted TKA and UKA is associated with a learning curve regarding operating time and surgical team stress levels. Future evaluation of robotics in the operating theatre should include detailed measurement of the various aspects of the total operating time, including total robotic time and time needed for preoperative planning. The prior experience of the surgical team should also be evaluated and reported. Cite this article: Bone Joint J 2020;102-B(4):407–413.

Sign in / Sign up

Export Citation Format

Share Document