Operative Time Learning Curve for an Image-Free Robotic Arm Assisted Total Knee Arthroplasty: A Cumulative Sum Analysis

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2025 Jan 15

PMID 39811772

Authors

Cale A Pagan

Theofilos Karasavvidis

Breana Siljander

Eytan M Debbi

Charles A DeCook

Jonathan Vigdorchik

Affiliations

Soon will be listed here.

Abstract

Background: Robotic arm assisted total knee arthroplasty (RA-TKA) aims to improve accuracy in bone resection, implant positioning, and joint alignment compared to manual TKA (M-TKA). However, the learning curve of RA-TKA can disrupt operating room efficiency, increase complications, and raise costs. This study examines the operative time learning curve of RA-TKA using a single robotic system.

Methods: The study analyzed the first 80 RA-TKA and the last 80 M-TKA cases performed by a single surgeon using the VELYS robotic system after transitioning from M-TKA. Cases were subdivided into groups of 20 and compared to M-TKA cases. A cumulative summation analysis identified the learning curve phases.

Results: Three phases were identified: Phase 1 (initial learning, cases 1-9), Phase 2 (increased competence, plateau from cases 10-52), and Phase 3 (post-learning, optimized performance from cases 53-80). Mean surgical time for RA-TKA was 42.4 ± 8.7 minutes, compared to 35.3 ± 7.0 minutes for M-TKA ( < .001). Early RA-TKA cases (1-20) had significantly longer times than late RA-TKA cases (61-80) and M-TKA cases ( < .05). Late RA-TKA times were comparable to M-TKA ( = .06).

Conclusions: RA-TKA is an enabling surgical tool that can be integrated efficiently into a surgical workflow with a rapid learning curve of 9 cases.

References

Marchand K, Ehiorobo J, Mathew K, Marchand R, Mont M . Learning Curve of Robotic-Assisted Total Knee Arthroplasty for a High-Volume Surgeon. J Knee Surg. 2020; 35(4):409-415. DOI: 10.1055/s-0040-1715126. View

Boonen B, Schotanus M, Kerens B, van der Weegen W, Hoekstra H, Kort N . No difference in clinical outcome between patient-matched positioning guides and conventional instrumented total knee arthroplasty two years post-operatively: a multicentre, double-blind, randomised controlled trial. Bone Joint J. 2016; 98-B(7):939-44. DOI: 10.1302/0301-620X.98B7.37274. View

Nam D, Nunley R, Barrack R . Patient dissatisfaction following total knee replacement: a growing concern?. Bone Joint J. 2014; 96-B(11 Supple A):96-100. DOI: 10.1302/0301-620X.96B11.34152. View

Bolam S, Tay M, Zaidi F, Sidaginamale R, Hanlon M, Munro J . Introduction of ROSA robotic-arm system for total knee arthroplasty is associated with a minimal learning curve for operative time. J Exp Orthop. 2022; 9(1):86. PMC: 9427173. DOI: 10.1186/s40634-022-00524-5. View

Vermue H, Luyckx T, de Grave P, Ryckaert A, Cools A, Himpe N . Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing. Knee Surg Sports Traumatol Arthrosc. 2020; 30(2):593-602. DOI: 10.1007/s00167-020-06341-6. View

Scott C, Oliver W, MacDonald D, Wade F, Moran M, Breusch S . Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age. Bone Joint J. 2016; 98-B(12):1625-1634. DOI: 10.1302/0301-620X.98B12.BJJ-2016-0375.R1. View

Savov P, Tuecking L, 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):2119-2128. PMC: 8595234. DOI: 10.1007/s00402-021-04036-2. View

George J, Mahmood B, Sultan A, Sodhi N, Mont M, Higuera C . How Fast Should a Total Knee Arthroplasty Be Performed? An Analysis of 140,199 Surgeries. J Arthroplasty. 2018; 33(8):2616-2622. DOI: 10.1016/j.arth.2018.03.012. View

Marchand K, Moody R, Scholl L, Bhowmik-Stoker M, Taylor K, Mont M . Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up. J Knee Surg. 2021; 36(2):159-166. DOI: 10.1055/s-0041-1731349. View

10.

Namba R, Inacio M, Paxton E . Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013; 95(9):775-82. DOI: 10.2106/JBJS.L.00211. View

11.

Chaput de Saintonge D, Vere D . Why don't doctors use cusums?. Lancet. 1974; 1(7848):120-1. DOI: 10.1016/s0140-6736(74)92345-9. View

12.

Stern N, Li Y, Wang P, Dave S . A cumulative sum (CUSUM) analysis studying operative times and complications for a surgeon transitioning from laparoscopic to robot-assisted pediatric pyeloplasty: Defining proficiency and competency. J Pediatr Urol. 2022; 18(6):822-829. DOI: 10.1016/j.jpurol.2022.07.021. View

13.

Cregar W, Goodloe J, Lu Y, Gerlinger T . Increased Operative Time Impacts Rates of Short-Term Complications After Unicompartmental Knee Arthroplasty. J Arthroplasty. 2020; 36(2):488-494. DOI: 10.1016/j.arth.2020.08.032. View

14.

Chen Z, Bhowmik-Stoker M, Palmer M, Coppolecchia A, Harder B, Mont M . Time-Based Learning Curve for Robotic-Assisted Total Knee Arthroplasty: A Multicenter Study. J Knee Surg. 2022; 36(8):873-877. DOI: 10.1055/s-0042-1744193. View

15.

Chawla H, Nwachukwu B, van der List J, Eggman A, Pearle A, Ghomrawi H . Cost effectiveness of patellofemoral total knee arthroplasty in younger patients. Bone Joint J. 2017; 99-B(8):1028-1036. DOI: 10.1302/0301-620X.99B8.BJJ-2016-1032.R1. View

16.

Clatworthy M . Patient-Specific TKA with the VELYS™ Robotic-Assisted Solution. Surg Technol Int. 2022; 40:315-320. DOI: 10.52198/22.STI.40.OS1561. View

17.

Vince K . Mid-flexion instability after total knee arthroplasty: woolly thinking or a real concern?. Bone Joint J. 2016; 98-B(1 Suppl A):84-8. DOI: 10.1302/0301-620X.98B1.36445. View

18.

Bell C, Grau L, Orozco F, Ponzio D, Post Z, Czymek M . The successful implementation of the Navio robotic technology required 29 cases. J Robot Surg. 2021; 16(3):495-499. DOI: 10.1007/s11701-021-01254-z. View

19.

Kim Y, Yoon S, Park J . Does Robotic-assisted TKA Result in Better Outcome Scores or Long-Term Survivorship Than Conventional TKA? A Randomized, Controlled Trial. Clin Orthop Relat Res. 2019; 478(2):266-275. PMC: 7438149. DOI: 10.1097/CORR.0000000000000916. View

20.

Naziri Q, Cusson B, Chaudhri M, Shah N, Sastry A . Making the transition from traditional to robotic-arm assisted TKA: What to expect? A single-surgeon comparative-analysis of the first-40 consecutive cases. J Orthop. 2019; 16(4):364-368. PMC: 6487301. DOI: 10.1016/j.jor.2019.03.010. View