Le Guen Alexandre, Mouton Antoine, Auberger Guillaume, Le Strat Vincent, Marmor Simon, Aubert Thomas
Department of Orthopaedic Surgery Groupe Hospitalier Diaconesses Croix Saint-Simon Paris France.
J Exp Orthop. 2025 Sep 4;12(3):e70401. doi: 10.1002/jeo2.70401. eCollection 2025 Jul.
Robotic-assisted total knee arthroplasty (RA-TKA), which is increasingly used to improve surgical precision, can face adoption difficulties due to a learning curve marked by longer operating times. The aim of this study was to evaluate the learning curve associated with the VELYS™ robot in five surgeons from the same centre with different annual arthroplasty volumes using navigated assistance with personalised alignment. The primary aim was to assess the learning curve for each surgeon. Secondary aims were to identify the factors associated with extended operative times.
In this retrospective comparative study, 367 patients who underwent primary TKA between January and December 2024 were included, comprising 149 with robotic assistance and 218 with navigated assistance. The surgical learning curve, based on skin-to-skin operating time, was assessed using the cumulative summation method. Five surgeons were evaluated: two high-volume surgeons (>150 TKAs per year), a medium-volume surgeon (between 50 and 150) and two low-volume surgeons (<50). Pre- and intra-operative data (age, gender, body mass index, American Society of Anesthesiologists score, pre-operative hip-knee-ankle, range of motion, approach, size and implant constraint and type of assistance) were collected to identify extended operative time factors.
The learning curve was reached after performing between 4 and 11 cases (11 procedures for surgeon no. 1, 4 for surgeon no. 2, 6 for surgeon no. 3, 4 for surgeon no. 4 and 4 for surgeon no. 5). The robotic operating time was 57.1 min compared to 54.1 min ( = 0.017) with navigation. The increase was statistically significant only for one low-volume surgeon ( = 0.008). Use of the robot ( < 0.001), surgeon ( < 0.001), use of a posterior-stabilised implant ( < 0.001) and varus of more than 10° ( = 0.0191) were independent factors associated with extended operative time.
The learning curve associated with VELYS™ was between 4 and 11 procedures. The small increase in operative time compared to navigation should not be a barrier to its adoption.
Level III, case-control retrospective analysis.
机器人辅助全膝关节置换术（RA-TKA）越来越多地用于提高手术精度，但由于存在以手术时间延长为特征的学习曲线，可能面临应用困难。本研究的目的是评估同一中心的五名外科医生使用个性化对齐导航辅助技术与VELYS™机器人相关的学习曲线，这五名医生的年度关节置换手术量不同。主要目的是评估每位外科医生的学习曲线。次要目的是确定与手术时间延长相关的因素。
在这项回顾性比较研究中，纳入了2024年1月至12月期间接受初次全膝关节置换术的367例患者，其中149例接受机器人辅助，218例接受导航辅助。基于皮肤到皮肤的手术时间，使用累积求和法评估手术学习曲线。评估了五名外科医生：两名高手术量医生（每年>150例全膝关节置换术）、一名中等手术量医生（50至150例之间）和两名低手术量医生（<50例）。收集术前和术中数据（年龄、性别、体重指数、美国麻醉医师协会评分、术前髋-膝-踝活动范围、手术入路、假体尺寸和限制以及辅助类型）以确定手术时间延长的因素。
在完成4至11例手术（第1位外科医生11例手术、第2位外科医生4例、第3位外科医生6例、第4位外科医生4例、第5位外科医生4例）后达到学习曲线。机器人手术时间为57.1分钟，而导航辅助手术时间为54.1分钟（=0.017）。仅一名低手术量医生的手术时间增加具有统计学意义（=0.008）。使用机器人（<0.001）、外科医生（<0.001）、使用后稳定型假体（<0.001）以及内翻超过10°（=0.0191）是与手术时间延长相关的独立因素。
与VELYS™相关的学习曲线为4至11例手术。与导航辅助相比，手术时间的小幅增加不应成为其应用的障碍。
III级，病例对照回顾性分析。
