Abstract
IntroductionRobotic-assisted surgery techniques are increasing in total knee arthroplasty (TKA). One crucial point is the prolonged time of surgery. The primary objective of this study was to determine the learning curve necessary to minimize the time of surgery. The secondary objective was to evaluate the accuracy of the implant alignment when using an imageless robotic system for TKA.Materials and methodsIn a case–control study, the first 70 consecutive robotic-assisted TKA procedures performed by a single senior surgeon were analyzed with regard to surgery time and implant alignment by comparing the intraoperative plan with the postoperative alignment. The evaluation of the learning curve with respect to surgery time was conducted using cumulative summation (CUSUM) analysis. The joint line height was measured with a new technique. Surgery time and joint line reconstruction were compared to 70 consecutive conventional TKA procedures.ResultsThe learning curve for robotic TKA was completed after 11 cases. The learning curve did not influence the accuracy of joint line obliquity, joint line height, or limb alignment. The intraoperative plan designed for the robotic system was precisely implemented. The mean skin-to-skin time in the robotic group after the learning curve was completed did not differ from that in the manual group. A significant positive correlation was observed between the preoperative hip–knee–ankle angle and the postoperative distalization of the joint line in the robotic-assisted TKA group.ConclusionAfter completing the initial learning curve of 11 cases, the surgery time required to perform imageless robotic handpiece-assisted TKA was similar to that for the conventional technique. However, no learning curve was observed for the implant positioning when using the imageless robotic system. The implementation of the intraoperative plan was accurate up to < 2°. The precision of the system allows the implementation of different joint balancing approaches between valgus and varus morphotypes.
Highlights
Robotic-assisted surgery techniques are increasing in total knee arthroplasty (TKA)
Approximately 20% of patients remain dissatisfied after Total knee arthroplasty (TKA) [4], typically due to poor alignment, the inaccuracy of implant positioning, changes in the joint line
Robotic-assisted TKA has been associated with a significant reduction in positioning outliers, the more frequent restoration of the natural joint line (JL), the successful achievement of target alignment, and reductions in iatrogenic soft tissue injury [7, 9,10,11,12,13,14,15]
Summary
Robotic-assisted surgery techniques are increasing in total knee arthroplasty (TKA). One crucial point is the prolonged time of surgery. Materials and methods In a case–control study, the first 70 consecutive robotic-assisted TKA procedures performed by a single senior surgeon were analyzed with regard to surgery time and implant alignment by comparing the intraoperative plan with the postoperative alignment. Conclusion After completing the initial learning curve of 11 cases, the surgery time required to perform imageless robotic handpiece-assisted TKA was similar to that for the conventional technique. Approximately 20% of patients remain dissatisfied after TKA [4], typically due to poor alignment, the inaccuracy of implant positioning, changes in the joint line (JL), or soft tissue management during surgery [5,6,7,8]. Several studies have evaluated the potential advantages of implant positioning and soft tissue management of using robotic-assisted TKA versus conventional manual techniques. Robotic-assisted TKA has been associated with a significant reduction in positioning outliers, the more frequent restoration of the natural JL, the successful achievement of target alignment, and reductions in iatrogenic soft tissue injury [7, 9,10,11,12,13,14,15]
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