Comparison of surgical times of various total knee replacement techniques and assessment of learning curve of robotic total knee replacement: a retrospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241112Keywords:
Total knee arthroplasty, Robotic total knee arthroplasty, Learning curveAbstract
Background: This study aims to compare the operating times of manual, computer-assisted and robotic- assisted TKA and to calculate the learning curve for image-less robotic-assisted TKA (RATKA).
Methods: This retrospective observational study, conducted at the Centre of Excellence, Bone, Joint and Spine, Meitra Hospital, Kozhikode, Kerala, India, focused on patients aged 60 and above undergoing total knee replacement for stage 4 osteoarthritis. The study included 75 consecutive cases of manual, computer- assisted, and robotic-assisted unilateral total knee arthroplasties performed between May 2021 and September 2022 (18 months). Data was collected from the hospital records.
Results: The surgeon transitioned from learning to proficiency phase of RATKA after 14 cases. In the robotic learning phase, the overall operative time was 113.14 minutes (±8.96), significantly longer than the robotic proficiency phase's average of 98.24 minutes (±2.98) and that of CATKA (99.57±10.700 minutes) and manual TKAs (97.01±7.17 minutes). No statistically significant difference was observed in the global operative time between the proficiency phase RATKAs and the CATKA and manual groups (p=0.139).
Conclusions: By optimizing techniques and modifying workflow, one can swiftly overcome the initial learning curve of RATKA and achieve operating times comparable to manual TKA. To enhance efficiency and productivity, the study proposes a revised workflow modifying various rate limiting surgical steps.
References
Pavone V, Boettner F, Fickert S, Sculco TP. Total condylar knee arthroplasty: a long-term followup. Clin Orthop Relat Res. 2001;(388):18-25.
Gill GS, Joshi AB, Mills DM. Total condylar knee arthroplasty. 16- to 21-year results. Clin Orthop Relat Res. 1999;(367):210-5.
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007;89(7):893- 900.
Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res. 1994;299:153-6.
Khlopas A, Chughtai M, Hampp EL, Scholl LY, Prieto M, Chang TC, et al. Robotic-Arm Assisted Total Knee Arthroplasty Demonstrated Soft Tissue Protection. Surg Technol Int. 2017;30:441- 6.
Peersman G, Laskin R, Davis J, Peterson MGE, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J. 2006; 2(1):70-2.
Coon TM. Integrating robotic technology into the operating room. Am J Orthop. 2009;38(2):7-9.
Marchand RC, Sodhi N, Bhowmik-Stoker M, Scholl L, Condrey C, Khlopas A, et al. Does the Robotic Arm and Preoperative CT Planning Help with 3D Intraoperative Total Knee Arthroplasty Planning? J Knee Surg. 2019; 32(8):742-9.
Lonner JH. Robotically Assisted Unicompartmental Knee Arthroplasty with a Handheld Image-Free Sculpting Tool. Orthop Clin North Am. 2016;47(1):29-40.
Pastides P, Nathwani D. The role of newer technologies in knee arthroplasty. Orthop Trauma. 2017;31(1):47-52.
Mont MA, Cool C, Gregory D, Coppolecchia A, Sodhi N, Jacofsky DJ. Health Care Utilization and Payer Cost Analysis of Robotic Arm Assisted Total Knee Arthroplasty at 30, 60, and 90 Days. J Knee Surg. 2021; 34(3):328-37.
Li C, Zhang Z, Wang G, Rong C, Zhu W, Lu X, et al. Accuracies of bone resection, implant position, and limb alignment in robotic-arm-assisted total knee arthroplasty: a prospective single-centre study. J Orthop Surg Res. 2022;17(1):61.
Moon YW, Ha CW, Do KH, Kim CY, Han JH, Na SE, et al. Comparison of robot-assisted and conventional total knee arthroplasty: a controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. Comput Aided Surg. 2012; 17(2):86- 95.
Casper M, Mitra R, Khare R, Jaramaz B, Hamlin B, McGinley B, et al. Accuracy assessment of a novel image-free handheld robot for Total Knee Arthroplasty in a cadaveric study. Comput Assist Surg. 2018;23(1): 14-20.
Schrednitzki D, Horn CE, Lampe UA, Halder AM. Imageless robotic-assisted total knee arthroplasty is accurate in vivo: a retrospective study to measure the postoperative bone resection and alignment. Arch Orthop Trauma Surg. 2023;143(6):3471-9.
Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. 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 Surg Sports Traumatol Arthrosc. 2019;27(4):1132-41.
Nogalo C, Meena A, Abermann E, Fink C. Complications and downsides of the robotic total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2023;31(3):736-50.
Kim SM, Park YS, Ha CW, Lim SJ, Moon YW. Robot-assisted implantation improves the precision of component position in minimally invasive TKA. Orthopedics. 2012;35(9):e1334- 9.
Siebert W, Mai S, Kober R, Heeckt PF. Technique and first clinical results of robot-assisted total knee replacement. Knee. 2002;9(3):173-80.
Grau L, Lingamfelter M, Ponzio D, Post Z, Ong A, Le D, et al. Robotic arm assisted total knee arthroplasty workflow optimization, operative times and learning curve. Arthroplast Today. 2019;5(4):465-70.
Savov P, Tuecking LR, Windhagen H, Ehmig J, Ettinger M. Imageless robotic handpiece-assisted total knee arthroplasty: a learning curve analysis of surgical time and alignment accuracy. Arch Orthop Trauma Surg. 2021;141(12):2119-28.
Dragosloveanu S, Petre MA, Capitanu BS, Dragosloveanu CDM, Cergan R, Scheau C. Initial learning curve for robot-assisted total knee arthroplasty in a dedicated orthopedics center. J Clin Med. 2023; 12(21):123-9.
