1Ali M, 1Phillips D, 1Kamson A, 1Nivar I, 2Dahl R
1UPMC Pinnacle, Harrisburg, PA, United States; 2Orthopedic Institute of Pennsylvania, Camp Hill, PA, United States
Introduction/Objective: Robotic-assisted total knee arthroplasty (raTKA) may improve patient satisfaction and functional outcomes. Prior studies examining its learning curve have only been conducted by fellowship-trained arthroplasty surgeons. The goal of this study is to investigate the learning curve for non-fellowship-trained orthopaedic surgeons.
Methods: A total of 120 raTKAs performed by two non-fellowship-trained orthopaedic surgeons were analyzed. For each surgeon, mean operative times for three consecutive cohorts of 20 raTKA cases were compared with 20 randomly selected manual cases. Each of the surgeons raTKA cases were then combined to create 3 cohorts of 40 cases for analysis which were then compared to their combined 40 manual cases. Mean operative times were compared using ANOVA for three group comparisons and Student t-tests for between group comparisons.
Results: Patient demographics were not statistically significant between groups. Surgeon 1: Mean operative times for the first 20 raTKA cases were increased compared to the last 20 raTKA (59.1 vs 53.3 minutes, p < 0.05). Mean operative times for the first 20 raTKA cases and last 20 raTKA cases were increased compared to manual cases (59.1 and 53.3 vs 47.0 minutes, p < 0.05). Surgeon 2: Mean operative times for the first 20 raTKA were increased compared to the last 20 raTKA (74.8 vs 58.1 minutes, p < 0.05). Mean operative times for the first 20 raTKA cases were increased compared to manual cases (74.8 vs 61 minutes, p < 0.05). Mean operative times for the last 20 raTKA cases were similar to manual cases (58.1 vs 61 minutes, p > 0.05). A similar trend followed when the times of two surgeons were combined.
Conclusions: Despite the potential advantages of robotic-assisted technology, its implementation by a non-fellowship trained surgeons is challenging given the potential for increased operative times. Our study demonstrates that the use of robotics for the general orthopedist is achievable and attainable. With a learning curve of approximately 40 cases, operative times for robotic-assisted TKA can become time neutral compared to a surgeon’s manual TKA. Outside of the learning curve for surgeons, patients benefit from improved implant positioning accuracy and consistency with the assistance of robotics. Robotic-arm assisted TKA should not be looked at as a daunting task for the general orthopedist, but should be seen as an asset in those looking to implement robotic assistance in their practice. Despite the challenge of adopting new technology, general orthopedic surgeons in a community hospital may perform raTKA in less than an hour within their first 40 cases.
