Gordon Max, Rivkin Gurion, Greenberg Alex, Kandel Leonid, Liebergall Meir, Perets Itay
Orthopedic surgery department, Hadassah Medical Organization, Hadassah University Hospital, Israel, Jerusalem.
Arthroplast Today. 2025 Jul 2;34:101746. doi: 10.1016/j.artd.2025.101746. eCollection 2025 Aug.
Previous studies have reported initial and proficiency phases of the learning curve among individual surgeons when robotic-assisted total knee arthroplasty (raTKA) into their practices. The purpose of this study was to assess the number of raTKA cases needed to achieve proficiency in the operative time (OT) across a group of surgeons.
A retrospective analysis comparing raTKA to manual Total Knee Arthroplasty (mTKA) was performed at a single-site comprised of 6 orthopaedic surgeons. The first 90 patients who underwent raTKA at the institution divided chronologically into 3 groups of 30 each and compared to 30 previous mTKA cases. Tourniquet time was used as the measure for OT, range of motion (ROM) was measured preoperatively and at 2 and 6 weeks postoperative.
Average OT was significantly shorter in the mTKA group in comparison with all the raTKA groups. A statistically significant difference was found in OT when comparing the succeeding raTKA groups (mean time of 97.6, 86.6, and 76.7 min value<.001). The change in ROM at 6 weeks postoperative was found to be greater in the first raTKA group in comparison to the second raTKA group (mean of 0.9° vs -17.1°; = .04) and the mTKA group (mean of 0.9° vs -7.9°; = .04). However, when controlling for preoperative ROM and performing surgeon, there was no difference in ROM at 6 weeks postoperative between defined time periods ( = .78). No difference was found when comparing rate of complications ( value>.05).
When evaluating the group learning curve, this study showed average shorter operating time with every 30 cases (mean time of 97.6; 86.6- and 76.7-min value<.001) and no difference in complication rate ( value>.05). These findings suggest continued proficiency over time; however, adoption of the technology is associated with longer OTs.
先前的研究报告了个别外科医生在将机器人辅助全膝关节置换术（raTKA）纳入其手术操作时学习曲线的初始阶段和熟练阶段。本研究的目的是评估一组外科医生在手术时间（OT）方面达到熟练水平所需的raTKA病例数量。
在一个由6名骨科医生组成的单中心进行了一项回顾性分析，比较raTKA与手动全膝关节置换术（mTKA）。该机构首批接受raTKA的90例患者按时间顺序分为3组，每组30例，并与之前的30例mTKA病例进行比较。使用止血带时间作为OT的衡量指标，术前以及术后2周和6周测量活动范围（ROM）。
与所有raTKA组相比，mTKA组的平均OT明显更短。比较后续raTKA组时，OT存在统计学上的显著差异（平均时间分别为97.6、86.6和76.7分钟；P值<.001）。发现术后6周时，第一个raTKA组的ROM变化比第二个raTKA组更大（平均值分别为0.9°对 -17.1°；P = .04）以及比mTKA组更大（平均值分别为0.9°对 -7.9°；P = .04）。然而，在控制术前ROM和执行手术的外科医生后，特定时间段之间术后6周的ROM没有差异（P = .78）。比较并发症发生率时未发现差异（P值>.05）。
在评估团队学习曲线时，本研究表明每30例病例的平均手术时间更短（平均时间分别为97.6、86.6和76.7分钟；P值<.001），且并发症发生率无差异（P值>.05）。这些发现表明随着时间推移持续保持熟练程度；然而，采用该技术与更长的手术时间相关。
