EC Orthopaedics

Background: As more robotic technologies are introduced into orthopedics, it is important for surgeons to understand the learning curve for switching robotic systems. Thus, adoption time was investigated for a robot-trained surgeon conducting robotic-assisted total knee arthroplasty (raTKA).

Materials and Methods: Data were collected retrospectively from twenty patients undergoing robotic-assisted primary TKA (raTKA). Operating Room (OR) time, robot time, and implant size difference were investigated. Cumulative sum analysis was performed in order to determine the inflection point at which efficiency was reached.

Results: The study found that prior robotic experience shortened the transition time to a new robotic TKA system. Additionally, while efficiency was reached for each parameter, the time to do so varied. For robot time, efficiency was reached after 4 cases, 6 cases for implant size difference, and 12 cases for overall OR time.

Conclusion: In the study, it was found that for a high-volume arthroplasty surgeon with prior robotic experience, the learning curve for a new robotic TKA system was relatively small. It was also found that efficiency was reached with fewer cases for robot-specific time compared to general OR time.

Keywords: Robotic Adoption; raTKA; Transition Time; Learning Curve; OR Time

Abbreviations: raTKA: Robotic-Assisted Total Knee Arthroplasty; CUSUM: Cumulative Sum

1. Ali M., et al. "Learning curve of robotic-assisted total knee arthroplasty for non-fellowship-trained orthopedic surgeons”. Arthroplasty Today 13 (2022): 194-198.
2. Brinkman JC., et al. "Patient interest in robotic total joint arthroplasty is exponential: a 10-year google trends analysis”. Arthroplasty Today 15 (2022): 13-18.
3. Choi YJ and HJ Ra. "Patient satisfaction after total knee arthroplasty”. Knee Surgery and Related Research 1 (2016): 1-15.
4. Emara AK., et al. "Robotic-arm-assisted knee arthroplasty associated with favorable in-hospital metrics and exponentially rising adoption compared with manual knee arthroplasty”. Journal of the American Academy of Orthopaedic Surgeons 24 (2021): e1328-e1342.
5. Hampp EL., et al. "Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques”. Journal of Knee Surgery 3 (2019): 239-250.
6. Hua Y and J Salcedo. "Cost-effectiveness analysis of robotic-arm assisted total knee arthroplasty”. PLoS One11 (2022): e0277980.
7. Kahlenberg CA., et al. "Patient satisfaction after total knee replacement: a systematic review”. HSS Journal 2 (2018): 192-201.
8. Kayani B., et al. "Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning”. Knee Surgery, Sports Traumatology, Arthroscopy4 (2019): 1132-1141.
9. King CA., et al. "Transitioning a practice to robotic total knee arthroplasty is correlated with favorable short-term clinical outcomes-a single surgeon experience”. Journal of Knee Surgery 1 (2022): 78-82.
10. Marchand KB., et al. "Learning curve of robotic-assisted total knee arthroplasty for a high-volume surgeon”. Journal of Knee Surgery4 (2022): 409-415.
11. Registry, American Joint Replacement. "The Ajrr Annual Report”. American Academy of Orthopaedic Surgeons (2024).
12. Saber AY., et al. "Robotic-assisted total knee arthroplasty”. Statpearls. Treasure Island (FL): StatPearls Publishing (2024).
13. Schopper C., et al. "The learning curve in robotic assisted knee arthroplasty is flattened by the presence of a surgeon experienced with robotic assisted surgery”. Knee Surgery, Sports Traumatology, Arthroscopy 3 (2023): 760-767.
14. Walgrave S and S Oussedik. "Comparative assessment of current robotic-assisted systems in primary total knee arthroplasty”. Bone and Joint Open 1 (2023): 13-18.
15. Zhang J., et al. "Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis”. Knee Surgery, Sports Traumatology, Arthroscopy 8 (2022): 2677-2695.