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Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning
Purpose The primary objective of this study was to determine the surgical team’s learning curve for robotic-arm assisted TKA through assessments of operative times, surgical team comfort levels, accuracy of implant positioning, limb alignment, and postoperative complications. Secondary objectives we...
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| Published in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2019-04, Vol.27 (4), p.1132-1141 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Kayani, Babar Konan, S. Huq, S. S. Tahmassebi, J. Haddad, F. S. |
| description | Purpose
The primary objective of this study was to determine the surgical team’s learning curve for robotic-arm assisted TKA through assessments of operative times, surgical team comfort levels, accuracy of implant positioning, limb alignment, and postoperative complications. Secondary objectives were to compare accuracy of implant positioning and limb alignment in conventional jig-based TKA versus robotic-arm assisted TKA.
Methods
This prospective cohort study included 60 consecutive conventional jig-based TKAs followed by 60 consecutive robotic-arm assisted TKAs performed by a single surgeon. Independent observers recorded surrogate markers of the learning curve including operative times, stress levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy of implant positioning, limb alignment, and complications within 30 days of surgery. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time and STAI scores in robotic TKA.
Results
Robotic-arm assisted TKA was associated with a learning curve of seven cases for operative times (
p
= 0.01) and surgical team anxiety levels (
p
= 0.02). Cumulative robotic experience did not affect accuracy of implant positioning (n.s.) limb alignment (n.s.) posterior condylar offset ratio (n.s.) posterior tibial slope (n.s.) and joint line restoration (n.s.). Robotic TKA improved accuracy of implant positioning (
p
|
| doi_str_mv | 10.1007/s00167-018-5138-5 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6435632</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2108023192</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-4c59e09c9ac85cade34b32a11ae3026fafc91e0cb9a6c1a179f09f931c407d583</originalsourceid><addsrcrecordid>eNp1ks9u1DAQxiMEokvhAbggS1y4BPwnTtYXJFS1gFQJCcHZmnjHWbeJvdjOVvtuPFwdthSoxMUeeb75zYz1VdVLRt8ySrt3iVLWdjVl61oyUY5H1Yo1QtSdaLrH1YqqhtecyvakepbSFaUlbNTT6kRQzqWUzar6-TX0ITtTQ5wIpORSxg3JIcNIrj0igZi3MexGSPlAtpAIkBEheucHYua4RxIsSbhHTwwkTMSGSJzPOETILvglDiRvkaQ5Ds4U7k2I13YMN6SfM_HhIQ-tRZN_ccCUJzCHpYebyhA-k11IbgGXgufVEwtjwhd392n1_eL829mn-vLLx89nHy5r03Q0142RCqkyCsxaGtigaHrBgTHA8hGtBWsUQ2p6Ba1hwDplqbJKMNPQbiPX4rR6f-Tu5n7CjUGfI4x6F90E8aADOP1vxrutHsJet42QreAF8OYOEMOPGVPWk0sGx7IQhjlpzqgSXCmuivT1A-lVmKMv6y2qNeWCqQXIjioTQ0oR7f0wjOrFG_roDV28oRdvaFlqXv29xX3FbzMUAT8KUkn5AeOf1v-n3gJTWMqg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2108023192</pqid></control><display><type>article</type><title>Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning</title><source>EBSCOhost SPORTDiscus with Full Text</source><source>Wiley-Blackwell Read & Publish Collection</source><source>Springer Link</source><creator>Kayani, Babar ; Konan, S. ; Huq, S. S. ; Tahmassebi, J. ; Haddad, F. S.</creator><creatorcontrib>Kayani, Babar ; Konan, S. ; Huq, S. S. ; Tahmassebi, J. ; Haddad, F. S.</creatorcontrib><description>Purpose
The primary objective of this study was to determine the surgical team’s learning curve for robotic-arm assisted TKA through assessments of operative times, surgical team comfort levels, accuracy of implant positioning, limb alignment, and postoperative complications. Secondary objectives were to compare accuracy of implant positioning and limb alignment in conventional jig-based TKA versus robotic-arm assisted TKA.
Methods
This prospective cohort study included 60 consecutive conventional jig-based TKAs followed by 60 consecutive robotic-arm assisted TKAs performed by a single surgeon. Independent observers recorded surrogate markers of the learning curve including operative times, stress levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy of implant positioning, limb alignment, and complications within 30 days of surgery. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time and STAI scores in robotic TKA.
Results
Robotic-arm assisted TKA was associated with a learning curve of seven cases for operative times (
p
= 0.01) and surgical team anxiety levels (
p
= 0.02). Cumulative robotic experience did not affect accuracy of implant positioning (n.s.) limb alignment (n.s.) posterior condylar offset ratio (n.s.) posterior tibial slope (n.s.) and joint line restoration (n.s.). Robotic TKA improved accuracy of implant positioning (
p
< 0.001) and limb alignment (
p
< 0.001) with no additional risk of postoperative complications compared to conventional manual TKA.
Conclusion
Implementation of robotic-arm assisted TKA led to increased operative times and heightened levels of anxiety amongst the surgical team for the initial seven cases but there was no learning curve for achieving the planned implant positioning. Robotic-arm assisted TKA improved accuracy of implant positioning and limb alignment compared to conventional jig-based TKA. The findings of this study will enable clinicians and healthcare professionals to better understand the impact of implementing robotic TKA on the surgical workflow, assist the safe integration of this procedure into surgical practice, and facilitate theatre planning and scheduling of operative cases during the learning phase.
Level of evidence
II.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-018-5138-5</identifier><identifier>PMID: 30225554</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Accuracy ; Alignment ; Anxiety ; Arm ; Arthroplasty (knee) ; Biomedical materials ; Complications ; Health care ; Integration ; Jigs ; Joint surgery ; Knee ; Learning ; Learning curves ; Medical personnel ; Medicine ; Medicine & Public Health ; Orthopedics ; Restoration ; Robotic surgery ; Robotics ; Surgical implants ; Transplants & implants ; Workflow</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-04, Vol.27 (4), p.1132-1141</ispartof><rights>The Author(s) 2018</rights><rights>Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, (2018). All Rights Reserved. © 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-4c59e09c9ac85cade34b32a11ae3026fafc91e0cb9a6c1a179f09f931c407d583</citedby><cites>FETCH-LOGICAL-c470t-4c59e09c9ac85cade34b32a11ae3026fafc91e0cb9a6c1a179f09f931c407d583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30225554$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kayani, Babar</creatorcontrib><creatorcontrib>Konan, S.</creatorcontrib><creatorcontrib>Huq, S. S.</creatorcontrib><creatorcontrib>Tahmassebi, J.</creatorcontrib><creatorcontrib>Haddad, F. S.</creatorcontrib><title>Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
The primary objective of this study was to determine the surgical team’s learning curve for robotic-arm assisted TKA through assessments of operative times, surgical team comfort levels, accuracy of implant positioning, limb alignment, and postoperative complications. Secondary objectives were to compare accuracy of implant positioning and limb alignment in conventional jig-based TKA versus robotic-arm assisted TKA.
Methods
This prospective cohort study included 60 consecutive conventional jig-based TKAs followed by 60 consecutive robotic-arm assisted TKAs performed by a single surgeon. Independent observers recorded surrogate markers of the learning curve including operative times, stress levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy of implant positioning, limb alignment, and complications within 30 days of surgery. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time and STAI scores in robotic TKA.
Results
Robotic-arm assisted TKA was associated with a learning curve of seven cases for operative times (
p
= 0.01) and surgical team anxiety levels (
p
= 0.02). Cumulative robotic experience did not affect accuracy of implant positioning (n.s.) limb alignment (n.s.) posterior condylar offset ratio (n.s.) posterior tibial slope (n.s.) and joint line restoration (n.s.). Robotic TKA improved accuracy of implant positioning (
p
< 0.001) and limb alignment (
p
< 0.001) with no additional risk of postoperative complications compared to conventional manual TKA.
Conclusion
Implementation of robotic-arm assisted TKA led to increased operative times and heightened levels of anxiety amongst the surgical team for the initial seven cases but there was no learning curve for achieving the planned implant positioning. Robotic-arm assisted TKA improved accuracy of implant positioning and limb alignment compared to conventional jig-based TKA. The findings of this study will enable clinicians and healthcare professionals to better understand the impact of implementing robotic TKA on the surgical workflow, assist the safe integration of this procedure into surgical practice, and facilitate theatre planning and scheduling of operative cases during the learning phase.
Level of evidence
II.</description><subject>Accuracy</subject><subject>Alignment</subject><subject>Anxiety</subject><subject>Arm</subject><subject>Arthroplasty (knee)</subject><subject>Biomedical materials</subject><subject>Complications</subject><subject>Health care</subject><subject>Integration</subject><subject>Jigs</subject><subject>Joint surgery</subject><subject>Knee</subject><subject>Learning</subject><subject>Learning curves</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Restoration</subject><subject>Robotic surgery</subject><subject>Robotics</subject><subject>Surgical implants</subject><subject>Transplants & implants</subject><subject>Workflow</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1ks9u1DAQxiMEokvhAbggS1y4BPwnTtYXJFS1gFQJCcHZmnjHWbeJvdjOVvtuPFwdthSoxMUeeb75zYz1VdVLRt8ySrt3iVLWdjVl61oyUY5H1Yo1QtSdaLrH1YqqhtecyvakepbSFaUlbNTT6kRQzqWUzar6-TX0ITtTQ5wIpORSxg3JIcNIrj0igZi3MexGSPlAtpAIkBEheucHYua4RxIsSbhHTwwkTMSGSJzPOETILvglDiRvkaQ5Ds4U7k2I13YMN6SfM_HhIQ-tRZN_ccCUJzCHpYebyhA-k11IbgGXgufVEwtjwhd392n1_eL829mn-vLLx89nHy5r03Q0142RCqkyCsxaGtigaHrBgTHA8hGtBWsUQ2p6Ba1hwDplqbJKMNPQbiPX4rR6f-Tu5n7CjUGfI4x6F90E8aADOP1vxrutHsJet42QreAF8OYOEMOPGVPWk0sGx7IQhjlpzqgSXCmuivT1A-lVmKMv6y2qNeWCqQXIjioTQ0oR7f0wjOrFG_roDV28oRdvaFlqXv29xX3FbzMUAT8KUkn5AeOf1v-n3gJTWMqg</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Kayani, Babar</creator><creator>Konan, S.</creator><creator>Huq, S. S.</creator><creator>Tahmassebi, J.</creator><creator>Haddad, F. S.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190401</creationdate><title>Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning</title><author>Kayani, Babar ; Konan, S. ; Huq, S. S. ; Tahmassebi, J. ; Haddad, F. S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-4c59e09c9ac85cade34b32a11ae3026fafc91e0cb9a6c1a179f09f931c407d583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Accuracy</topic><topic>Alignment</topic><topic>Anxiety</topic><topic>Arm</topic><topic>Arthroplasty (knee)</topic><topic>Biomedical materials</topic><topic>Complications</topic><topic>Health care</topic><topic>Integration</topic><topic>Jigs</topic><topic>Joint surgery</topic><topic>Knee</topic><topic>Learning</topic><topic>Learning curves</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Restoration</topic><topic>Robotic surgery</topic><topic>Robotics</topic><topic>Surgical implants</topic><topic>Transplants & implants</topic><topic>Workflow</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kayani, Babar</creatorcontrib><creatorcontrib>Konan, S.</creatorcontrib><creatorcontrib>Huq, S. S.</creatorcontrib><creatorcontrib>Tahmassebi, J.</creatorcontrib><creatorcontrib>Haddad, F. 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S.</au><au>Tahmassebi, J.</au><au>Haddad, F. S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>27</volume><issue>4</issue><spage>1132</spage><epage>1141</epage><pages>1132-1141</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
The primary objective of this study was to determine the surgical team’s learning curve for robotic-arm assisted TKA through assessments of operative times, surgical team comfort levels, accuracy of implant positioning, limb alignment, and postoperative complications. Secondary objectives were to compare accuracy of implant positioning and limb alignment in conventional jig-based TKA versus robotic-arm assisted TKA.
Methods
This prospective cohort study included 60 consecutive conventional jig-based TKAs followed by 60 consecutive robotic-arm assisted TKAs performed by a single surgeon. Independent observers recorded surrogate markers of the learning curve including operative times, stress levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy of implant positioning, limb alignment, and complications within 30 days of surgery. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time and STAI scores in robotic TKA.
Results
Robotic-arm assisted TKA was associated with a learning curve of seven cases for operative times (
p
= 0.01) and surgical team anxiety levels (
p
= 0.02). Cumulative robotic experience did not affect accuracy of implant positioning (n.s.) limb alignment (n.s.) posterior condylar offset ratio (n.s.) posterior tibial slope (n.s.) and joint line restoration (n.s.). Robotic TKA improved accuracy of implant positioning (
p
< 0.001) and limb alignment (
p
< 0.001) with no additional risk of postoperative complications compared to conventional manual TKA.
Conclusion
Implementation of robotic-arm assisted TKA led to increased operative times and heightened levels of anxiety amongst the surgical team for the initial seven cases but there was no learning curve for achieving the planned implant positioning. Robotic-arm assisted TKA improved accuracy of implant positioning and limb alignment compared to conventional jig-based TKA. The findings of this study will enable clinicians and healthcare professionals to better understand the impact of implementing robotic TKA on the surgical workflow, assist the safe integration of this procedure into surgical practice, and facilitate theatre planning and scheduling of operative cases during the learning phase.
Level of evidence
II.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30225554</pmid><doi>10.1007/s00167-018-5138-5</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019-04, Vol.27 (4), p.1132-1141 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6435632 |
| source | EBSCOhost SPORTDiscus with Full Text; Wiley-Blackwell Read & Publish Collection; Springer Link |
| subjects | Accuracy Alignment Anxiety Arm Arthroplasty (knee) Biomedical materials Complications Health care Integration Jigs Joint surgery Knee Learning Learning curves Medical personnel Medicine Medicine & Public Health Orthopedics Restoration Robotic surgery Robotics Surgical implants Transplants & implants Workflow |
| title | Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning |
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