An observational study on the functional outcomes of 100 robotic total knee replacements performed by an Indian surgeon: Early experiences

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Abstract Background: We aim to share our preliminary encounter with robotic knee replacements in Indian patients, focusing on the initial 100 cases. This report will delve into our observations regarding the learning curve and provide insights from a short-term follow-up at 6 months. Materials and Methods: Following institutional ethical clearance, we conducted an observational study involving 100 robotic-assisted total knee replacement cases performed from March 2022 to November 2022. These patients underwent a 6-month follow-up to evaluate functional outcomes. Our primary objective was to investigate the learning curve associated with robotic-assisted total knee arthroplasty (RATKA), specifically emphasizing operative time. Furthermore, we examined preoperative and postoperative alignment parameters as part of our analysis. Results: In our investigation, participants had a mean age of 64.68 years, with a female-to-male ratio of 43:22 and an average body mass index of 30.71 ± 4.88. Intraoperative blood loss was recorded at an average of 91.81 ± 21.63 mL. The mean surgical duration for the initial 25 cases was 102.5 ± 11.08 min, which improved to 65.65 ± 13.07 min for the subsequent 75 cases. The average hospital stay length was 2.88 ± 0.88 days. Notably, there was a significant enhancement in the Knee Society Score (KSS), with a preoperative mean of 38.90 ± 12.72 improving to a postoperative mean of 84.89 ± 4.10 (P = 0.001), as well as in the Oxford Knee Score (OKS), which saw a rise from 16.62 ± 16.42 preoperatively to 45.58 ± 4.97 postoperatively (P = 0.001). The accuracy of preoperative determination for femoral component sizes was 100%, while for tibial component sizing, it was 97%. Conclusion: The key finding from this observational study suggests that around 25 procedures are required to reach a learning plateau. During this process, an average decrease of 36.1 min in surgical time was observed from the initial to proficient stages. Notably, no learning curve was observed for lower limb alignment and implant placement, and no significant complication rates were documented.