Department of Orthopaedics, Lokmanya Hospital, Pune, India.
J Robot Surg. 2023 Apr;17(2):393-403. doi: 10.1007/s11701-022-01423-8. Epub 2022 Jun 22.
The main purpose of this study was to determine the learning curve of Robotic assisted Total Knee Arthroplasty surgery through assessment of operative time and comparison with that of conventional jig based Total Knee Arthroplasty. The study included our first 75 Robotic assisted Total Knee Arthroplasty and 25 randomly selected conventional jig-based Total knee arthroplasty from June 2017 to December 2017. The 75 cases were divided into 3 groups of 25 consecutive cases. The mean of operative time for each phase and total time was compared between the 3 groups and with the mean of total time for conventional jig based group. In our experience, Robotic assisted Total Knee arthroplasty was associated with a learning curve of approximately 25 cases. The mean for Registration phase of Group A (1st set of 25 cases) was 6.12 min (SD 1.8 min), group B (2nd set of 25 cases) was 4.46 min (SD 0.79 min) and group C (3rd set of 25 cases) was 4.17 min (SD 0.59 min). The mean for Planning phase of group A was 5.08 min (SD 1.01 min), group B was 4.04 min (SD 0.37 min) and group C was 4.01 min (SD 0.35 min). The mean for Cutting Phase of group A was 28.22 min (SD 6.24 min), group B was 22.49 min (SD 0.79 min) and group C was 22.36 min (SD 0.88 min). The mean for total time of group A was 39.42 min (SD 8.02), group B was 31 min (SD 1.22 min), group C was 30.53 min (SD 1.14 min) and conventional group was 30.54 min (SD 1.14 min). On comparing the Registration phase (Group A vs B, p < 0.001; Group B vs C, p 0.14; Group A vs C, p < 0.001), Planning phase (Group A vs B, p < 0.001; Group B vs C, p 0.75; Group A vs C, p < 0.001), Cutting phase (Group A vs B, p < 0.001; Group B vs C, p 0.58; Group A vs C, p < 0.001) and Total time (Group A vs B, p < 0.001; Group B vs C, p 0.74; Group A vs C, p < 0.001; Group A vs Conventional, p < 0.001; Group B vs Conventional, p 0.17, Group C vs Conventional, p 0.99), the results showed that the inflection point for learning curve in our hands was 25 cases. The learning curve and increased operation theatre time are likely to be major barrier in widespread acceptance of robotic technology amongst arthroplasty surgeons. We, in our experience can say that the learning curve was approximately 25 cases. The results of this study will help the arthroplasty surgeons in accepting this technology and achieve better outcomes.
本研究的主要目的是通过评估手术时间并与传统截骨导向架全膝关节置换术进行比较，来确定机器人辅助全膝关节置换术的学习曲线。本研究纳入了我们 2017 年 6 月至 2017 年 12 月期间的前 75 例机器人辅助全膝关节置换术和 25 例随机选择的传统截骨导向架全膝关节置换术。这 75 例患者分为 3 组，每组 25 例连续病例。比较了 3 组之间每个阶段和总时间的手术时间平均值，并与传统截骨导向架组的总时间平均值进行了比较。在我们的经验中，机器人辅助全膝关节置换术的学习曲线约为 25 例。组 A（第 1 组 25 例）的注册阶段平均时间为 6.12 分钟（SD 1.8 分钟），组 B（第 2 组 25 例）为 4.46 分钟（SD 0.79 分钟），组 C（第 3 组 25 例）为 4.17 分钟（SD 0.59 分钟）。组 A 的规划阶段平均时间为 5.08 分钟（SD 1.01 分钟），组 B 为 4.04 分钟（SD 0.37 分钟），组 C 为 4.01 分钟（SD 0.35 分钟）。组 A 的切割阶段平均时间为 28.22 分钟（SD 6.24 分钟），组 B 为 22.49 分钟（SD 0.79 分钟），组 C 为 22.36 分钟（SD 0.88 分钟）。组 A 的总时间平均为 39.42 分钟（SD 8.02），组 B 为 31 分钟（SD 1.22 分钟），组 C 为 30.53 分钟（SD 1.14 分钟），传统组为 30.54 分钟（SD 1.14 分钟）。在比较注册阶段（组 A 与 B，p<0.001；组 B 与 C，p 0.14；组 A 与 C，p<0.001）、规划阶段（组 A 与 B，p<0.001；组 B 与 C，p 0.75；组 A 与 C，p<0.001）、切割阶段（组 A 与 B，p<0.001；组 B 与 C，p 0.58；组 A 与 C，p<0.001）和总时间（组 A 与 B，p<0.001；组 B 与 C，p 0.74；组 A 与 C，p<0.001；组 A 与传统，p<0.001；组 B 与传统，p 0.17，组 C 与传统，p 0.99）时，结果表明我们手中的学习曲线转折点为 25 例。学习曲线和增加的手术室时间可能是关节置换术医生广泛接受机器人技术的主要障碍。根据我们的经验，我们可以说学习曲线大约是 25 例。本研究的结果将帮助关节置换术医生接受这项技术并获得更好的结果。
