Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand.
Department of Orthopaedic Surgery, North Shore Hospital, Waitematā DHB, Auckland, New Zealand.
ANZ J Surg. 2022 Nov;92(11):2974-2979. doi: 10.1111/ans.17975. Epub 2022 Aug 12.
Robotic-arm assisted systems are increasingly used for knee arthroplasty, however introduction of new systems can involve a learning curve. We aimed to define the learning curve in terms of operative time and component placement/sizing of a robotic system for total knee arthroplasty (TKA) in a team of experienced surgeons, and to investigate mid-term patient outcomes.
A total of 101 consecutive patients underwent primary robotic-arm assisted TKA by three surgeons (mean 2 year follow-up). Operative times, component placement, implant sizing and reoperations were recorded. Cumulative Summation (CUSUM) was used to analyse learning curves. Patient outcomes were compared between learning and proficiency phases.
The learning curve was 16 cases, with a 12-min increase in operative time (P < 0.01). Once proficiency was achieved, the greatest time reductions were seen for navigation registration (P = 0.003) and bone preparation (P < 0.0001). A learning curve was found with polyethylene (PE) insert sizing (P = 0.01). No differences were found between learning and proficiency groups in terms of implant survival (100% and 97%, respectively, NS) or patient-reported outcome measures at 2 years (NS).
Introduction of a robotic-arm assisted system for TKA led to increased operative times for navigation registration and bone preparation, and a learning curve with PE insert sizing. No difference in patient outcomes between learning and proficiency groups at 2 years was found. These findings can inform surgeons' expectations when starting to use robotic-assisted systems.
机器人辅助系统越来越多地用于膝关节置换术，但新系统的引入可能涉及学习曲线。我们旨在定义一个经验丰富的外科医生团队使用机器人系统进行全膝关节置换术（TKA）的手术时间和组件放置/尺寸的学习曲线，并研究中期患者结果。
共有 101 例连续患者由 3 名外科医生接受了机器人辅助 TKA（平均 2 年随访）。记录手术时间、组件放置、植入物尺寸和再手术。累积总和（CUSUM）用于分析学习曲线。在学习和熟练阶段比较患者的结果。
学习曲线为 16 例，手术时间增加 12 分钟（P < 0.01）。一旦达到熟练程度，导航注册（P = 0.003）和骨准备（P < 0.0001）的时间减少最大。发现聚乙烯（PE）插入物尺寸存在学习曲线（P = 0.01）。在植入物存活率方面，学习组和熟练组之间没有差异（分别为 100%和 97%，NS）或 2 年时患者报告的结果测量值（NS）。
引入机器人辅助 TKA 系统导致导航注册和骨准备的手术时间增加，并且存在 PE 插入物尺寸的学习曲线。在 2 年时，学习组和熟练组之间的患者结果没有差异。这些发现可以为外科医生在开始使用机器人辅助系统时提供预期。
