Khan Shujaa T, Jevnikar Benjamin E, Emara Ahmed K, Delaney Peter G, Elmenawi Khaled A, Surace Peter A, Piuzzi Nicolas S, Deren Matthew
Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, 9500 Euclid Ave, A41, Cleveland, OH, 44195, USA.
J Robot Surg. 2025 Aug 8;19(1):463. doi: 10.1007/s11701-025-02642-5.
Robotic-assisted total joint arthroplasty (RA-TJA) has experienced rapid growth in adoption and is reshaping orthopedic surgical practice. Despite offering potential for improved precision, reproducibility, and intraoperative feedback, its integration into orthopedic training has raised questions about educational equity and quality, manual skill development, and trainee autonomy. This review examines the educational implications of RA-TJA on orthopedic residency and fellowship training. The goal is to synthesize existing literature on RA-TJA impact on technical skill acquisition, surgical exposure, operative autonomy, and cognitive engagement, with attention to global disparities and the role of simulation in modern training models. A narrative literature review was conducted, focusing on empirical studies, trainee surveys, and expert opinion related to robotic systems in arthroplasty education. Specific attention was given to competency-based medical education (CBME) frameworks, intraoperative performance metrics, simulation-based learning, and institutional variability. Robotic systems facilitate early technical proficiency by offering structured intraoperative workflows and objective metrics, aligning well with CBME. These platforms enhance resident involvement in preoperative planning and spatial understanding but may inadvertently reduce manual versatility and intraoperative decision-making without complementary training in conventional techniques. Trainee autonomy varies significantly by institution, and access to RA-TJA during post-graduate medical education remains inconsistent. Simulation technologies, particularly virtual reality, represent scalable solutions to bridge training gaps but require standardized integration, assessment models, and certification pathways. RA-TJA presents both opportunities and challenges for orthopedic education. Its successful implementation requires deliberate curricular design, hybrid exposure to both robotic and manual techniques, and equitable access to simulation-based resources. Moving forward, training standardization, integration of performance-based progression metrics, and global cooperation will be essential to preparing orthopedic surgeons for the evolving digital surgical landscape.
机器人辅助全关节置换术（RA-TJA）的应用增长迅速，正在重塑骨科手术实践。尽管它具有提高精准度、可重复性和术中反馈的潜力，但其融入骨科培训引发了有关教育公平与质量、手动技能发展以及学员自主性的问题。本综述探讨了RA-TJA对骨科住院医师和专科培训的教育影响。目标是综合现有关于RA-TJA对技术技能获取、手术暴露、手术自主性和认知参与影响的文献，关注全球差异以及模拟在现代培训模式中的作用。进行了一项叙述性文献综述，重点关注与关节置换术教育中机器人系统相关的实证研究、学员调查和专家意见。特别关注基于胜任力的医学教育（CBME）框架、术中性能指标、基于模拟的学习以及机构差异。机器人系统通过提供结构化的术中工作流程和客观指标促进早期技术熟练程度，与CBME非常契合。这些平台增强了住院医师在术前规划和空间理解方面的参与度，但如果没有传统技术的补充培训，可能会无意中降低手动灵活性和术中决策能力。学员的自主性因机构而异，并且在研究生医学教育期间获得RA-TJA的机会仍然不一致。模拟技术，特别是虚拟现实，是弥合培训差距的可扩展解决方案，但需要标准化的整合、评估模型和认证途径。RA-TJA给骨科教育带来了机遇和挑战。其成功实施需要精心的课程设计、机器人技术和手动技术的混合接触，以及公平获取基于模拟的资源。展望未来，培训标准化、基于性能的进阶指标的整合以及全球合作对于让骨科外科医生为不断发展的数字手术环境做好准备至关重要。
