Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing
Purpose The application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2022-02, Vol.30 (2), p.593-602 |
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| creator | Vermue, Hannes Luyckx, Thomas Winnock de Grave, Philip Ryckaert, Alexander Cools, Anne-Sophie Himpe, Nicolas Victor, Jan |
| description | Purpose
The application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study is to identify and predict the learning curve of robot-assisted (RA) TKA.
Methods
A RA TKA system (MAKO) was introduced in April 2018 in our service. A retrospective analysis was performed of all patients receiving a TKA with this system by six surgeons. Operative times, implant and limb alignment, intraoperative joint balance and robot-related complications were evaluated. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time, implant alignment and joint balance in RA TKA. Linear regression was performed to predict the learning curve of each surgeon.
Results
RA TKA was associated with a learning curve of 11–43 cases for operative time (
p
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| doi_str_mv | 10.1007/s00167-020-06341-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2457277246</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2457277246</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-8eff9202c81cafa52e6b0f7ef735df0114b9b9aa9772005fe0a461ff79ccc2a53</originalsourceid><addsrcrecordid>eNp9kcuKFTEQhoMoznH0BVxIwI0Lo7l1Z3opgzcYEETXoTqn0pOxO2mTtDIv47OaM2d0wIWrVKivvhT5CXkq-CvBuXldOBe9YVxyxnulBevvkZ3QSjGjtLlPdnzQkkne9SfkUSlXnLdSDw_JiVJCC6n7Hfn1OY2pMigllIp7WlOFmX6LiBRyvcxpnaHUaxoKbUxyAQ7Uz1AvKdAZIccQJ-q2_AOpT5mWLU_BNUUNC9JxqzSmetNxaVlTxFgpzGGKS6te0jks492dQtzTCVY6wgzRNfNj8sDDXPDJ7XlKvr57--X8A7v49P7j-ZsL5pTpKjtD7wfJpTsTDjx0EvuRe4PeqG7vuRB6HMYBYDBGtk_wyEH3wnszOOckdOqUvDh615y-b1iqXUJxOLc1MG3FSt0Z2YZ139Dn_6BXacuxbWdlr9oSRsuDUB4pl1MpGb1dc1ggX1vB7SE9e0zPtvTsTXr2oH52q97GBfd_R_7E1QB1BEprxQnz3dv_0f4GTjWoPg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2632027425</pqid></control><display><type>article</type><title>Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Springer Nature - Complete Springer Journals</source><creator>Vermue, Hannes ; Luyckx, Thomas ; Winnock de Grave, Philip ; Ryckaert, Alexander ; Cools, Anne-Sophie ; Himpe, Nicolas ; Victor, Jan</creator><creatorcontrib>Vermue, Hannes ; Luyckx, Thomas ; Winnock de Grave, Philip ; Ryckaert, Alexander ; Cools, Anne-Sophie ; Himpe, Nicolas ; Victor, Jan</creatorcontrib><description>Purpose
The application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study is to identify and predict the learning curve of robot-assisted (RA) TKA.
Methods
A RA TKA system (MAKO) was introduced in April 2018 in our service. A retrospective analysis was performed of all patients receiving a TKA with this system by six surgeons. Operative times, implant and limb alignment, intraoperative joint balance and robot-related complications were evaluated. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time, implant alignment and joint balance in RA TKA. Linear regression was performed to predict the learning curve of each surgeon.
Results
RA TKA was associated with a learning curve of 11–43 cases for operative time (
p
< 0.001). This learning curve was significantly affected by the surgical profile (high vs. medium vs. low volume). A complete normalisation of operative times was seen in four out of five surgeons. The precision of implant positioning and gap balancing showed no learning curve. An average deviation of 0.2° (SD 1.4), 0.7° (SD 1.1), 1.2 (SD 2.1), 0.2° (SD 2.9) and 0.3 (SD 2.4) for the mLDFA, MPTA, HKA, PDFA and PPTA from the preoperative plan was observed. Limb alignment showed a mean deviation of 1.2° (SD 2.1) towards valgus postoperatively compared to the intraoperative plan. One tibial stress fracture was seen as a complication due to suboptimal positioning of the registration pins.
Conclusion
RA TKA is associated with a learning curve for surgical time, which might be longer than reported in current literature and dependent on the profile of the surgeon. There is no learning curve for component alignment, limb alignment and gap balancing.
Level of evidence
IV.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-020-06341-6</identifier><identifier>PMID: 33141246</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Alignment ; Arthroplasty (knee) ; Arthroplasty, Replacement, Knee ; Balancing ; Complications ; Deviation ; Humans ; Joint replacement surgery ; Joint surgery ; Joints (anatomy) ; Knee ; Knee Joint - surgery ; Learning ; Learning Curve ; Learning curves ; Medicine ; Medicine & Public Health ; New technology ; Operative Time ; Orthopaedic implants ; Orthopedics ; Osteoarthritis, Knee - surgery ; Retrospective Studies ; Robotic surgery ; Robotic Surgical Procedures ; Robotics ; Robots ; Sports Medicine ; Surgeons</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022-02, Vol.30 (2), p.593-602</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020</rights><rights>2020. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-8eff9202c81cafa52e6b0f7ef735df0114b9b9aa9772005fe0a461ff79ccc2a53</citedby><cites>FETCH-LOGICAL-c375t-8eff9202c81cafa52e6b0f7ef735df0114b9b9aa9772005fe0a461ff79ccc2a53</cites><orcidid>0000-0003-2072-4375</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-020-06341-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-020-06341-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33141246$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vermue, Hannes</creatorcontrib><creatorcontrib>Luyckx, Thomas</creatorcontrib><creatorcontrib>Winnock de Grave, Philip</creatorcontrib><creatorcontrib>Ryckaert, Alexander</creatorcontrib><creatorcontrib>Cools, Anne-Sophie</creatorcontrib><creatorcontrib>Himpe, Nicolas</creatorcontrib><creatorcontrib>Victor, Jan</creatorcontrib><title>Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing</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 application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study is to identify and predict the learning curve of robot-assisted (RA) TKA.
Methods
A RA TKA system (MAKO) was introduced in April 2018 in our service. A retrospective analysis was performed of all patients receiving a TKA with this system by six surgeons. Operative times, implant and limb alignment, intraoperative joint balance and robot-related complications were evaluated. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time, implant alignment and joint balance in RA TKA. Linear regression was performed to predict the learning curve of each surgeon.
Results
RA TKA was associated with a learning curve of 11–43 cases for operative time (
p
< 0.001). This learning curve was significantly affected by the surgical profile (high vs. medium vs. low volume). A complete normalisation of operative times was seen in four out of five surgeons. The precision of implant positioning and gap balancing showed no learning curve. An average deviation of 0.2° (SD 1.4), 0.7° (SD 1.1), 1.2 (SD 2.1), 0.2° (SD 2.9) and 0.3 (SD 2.4) for the mLDFA, MPTA, HKA, PDFA and PPTA from the preoperative plan was observed. Limb alignment showed a mean deviation of 1.2° (SD 2.1) towards valgus postoperatively compared to the intraoperative plan. One tibial stress fracture was seen as a complication due to suboptimal positioning of the registration pins.
Conclusion
RA TKA is associated with a learning curve for surgical time, which might be longer than reported in current literature and dependent on the profile of the surgeon. There is no learning curve for component alignment, limb alignment and gap balancing.
Level of evidence
IV.</description><subject>Alignment</subject><subject>Arthroplasty (knee)</subject><subject>Arthroplasty, Replacement, Knee</subject><subject>Balancing</subject><subject>Complications</subject><subject>Deviation</subject><subject>Humans</subject><subject>Joint replacement surgery</subject><subject>Joint surgery</subject><subject>Joints (anatomy)</subject><subject>Knee</subject><subject>Knee Joint - surgery</subject><subject>Learning</subject><subject>Learning Curve</subject><subject>Learning curves</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>New technology</subject><subject>Operative Time</subject><subject>Orthopaedic implants</subject><subject>Orthopedics</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Retrospective Studies</subject><subject>Robotic surgery</subject><subject>Robotic Surgical Procedures</subject><subject>Robotics</subject><subject>Robots</subject><subject>Sports Medicine</subject><subject>Surgeons</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kcuKFTEQhoMoznH0BVxIwI0Lo7l1Z3opgzcYEETXoTqn0pOxO2mTtDIv47OaM2d0wIWrVKivvhT5CXkq-CvBuXldOBe9YVxyxnulBevvkZ3QSjGjtLlPdnzQkkne9SfkUSlXnLdSDw_JiVJCC6n7Hfn1OY2pMigllIp7WlOFmX6LiBRyvcxpnaHUaxoKbUxyAQ7Uz1AvKdAZIccQJ-q2_AOpT5mWLU_BNUUNC9JxqzSmetNxaVlTxFgpzGGKS6te0jks492dQtzTCVY6wgzRNfNj8sDDXPDJ7XlKvr57--X8A7v49P7j-ZsL5pTpKjtD7wfJpTsTDjx0EvuRe4PeqG7vuRB6HMYBYDBGtk_wyEH3wnszOOckdOqUvDh615y-b1iqXUJxOLc1MG3FSt0Z2YZ139Dn_6BXacuxbWdlr9oSRsuDUB4pl1MpGb1dc1ggX1vB7SE9e0zPtvTsTXr2oH52q97GBfd_R_7E1QB1BEprxQnz3dv_0f4GTjWoPg</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Vermue, Hannes</creator><creator>Luyckx, Thomas</creator><creator>Winnock de Grave, Philip</creator><creator>Ryckaert, Alexander</creator><creator>Cools, Anne-Sophie</creator><creator>Himpe, Nicolas</creator><creator>Victor, Jan</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</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><orcidid>https://orcid.org/0000-0003-2072-4375</orcidid></search><sort><creationdate>20220201</creationdate><title>Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing</title><author>Vermue, Hannes ; Luyckx, Thomas ; Winnock de Grave, Philip ; Ryckaert, Alexander ; Cools, Anne-Sophie ; Himpe, Nicolas ; Victor, Jan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-8eff9202c81cafa52e6b0f7ef735df0114b9b9aa9772005fe0a461ff79ccc2a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Alignment</topic><topic>Arthroplasty (knee)</topic><topic>Arthroplasty, Replacement, Knee</topic><topic>Balancing</topic><topic>Complications</topic><topic>Deviation</topic><topic>Humans</topic><topic>Joint replacement surgery</topic><topic>Joint surgery</topic><topic>Joints (anatomy)</topic><topic>Knee</topic><topic>Knee Joint - surgery</topic><topic>Learning</topic><topic>Learning Curve</topic><topic>Learning curves</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>New technology</topic><topic>Operative Time</topic><topic>Orthopaedic implants</topic><topic>Orthopedics</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Retrospective Studies</topic><topic>Robotic surgery</topic><topic>Robotic Surgical Procedures</topic><topic>Robotics</topic><topic>Robots</topic><topic>Sports Medicine</topic><topic>Surgeons</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vermue, Hannes</creatorcontrib><creatorcontrib>Luyckx, Thomas</creatorcontrib><creatorcontrib>Winnock de Grave, Philip</creatorcontrib><creatorcontrib>Ryckaert, Alexander</creatorcontrib><creatorcontrib>Cools, Anne-Sophie</creatorcontrib><creatorcontrib>Himpe, Nicolas</creatorcontrib><creatorcontrib>Victor, Jan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vermue, Hannes</au><au>Luyckx, Thomas</au><au>Winnock de Grave, Philip</au><au>Ryckaert, Alexander</au><au>Cools, Anne-Sophie</au><au>Himpe, Nicolas</au><au>Victor, Jan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing</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>2022-02-01</date><risdate>2022</risdate><volume>30</volume><issue>2</issue><spage>593</spage><epage>602</epage><pages>593-602</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
The application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study is to identify and predict the learning curve of robot-assisted (RA) TKA.
Methods
A RA TKA system (MAKO) was introduced in April 2018 in our service. A retrospective analysis was performed of all patients receiving a TKA with this system by six surgeons. Operative times, implant and limb alignment, intraoperative joint balance and robot-related complications were evaluated. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time, implant alignment and joint balance in RA TKA. Linear regression was performed to predict the learning curve of each surgeon.
Results
RA TKA was associated with a learning curve of 11–43 cases for operative time (
p
< 0.001). This learning curve was significantly affected by the surgical profile (high vs. medium vs. low volume). A complete normalisation of operative times was seen in four out of five surgeons. The precision of implant positioning and gap balancing showed no learning curve. An average deviation of 0.2° (SD 1.4), 0.7° (SD 1.1), 1.2 (SD 2.1), 0.2° (SD 2.9) and 0.3 (SD 2.4) for the mLDFA, MPTA, HKA, PDFA and PPTA from the preoperative plan was observed. Limb alignment showed a mean deviation of 1.2° (SD 2.1) towards valgus postoperatively compared to the intraoperative plan. One tibial stress fracture was seen as a complication due to suboptimal positioning of the registration pins.
Conclusion
RA TKA is associated with a learning curve for surgical time, which might be longer than reported in current literature and dependent on the profile of the surgeon. There is no learning curve for component alignment, limb alignment and gap balancing.
Level of evidence
IV.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33141246</pmid><doi>10.1007/s00167-020-06341-6</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-2072-4375</orcidid></addata></record> |
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| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022-02, Vol.30 (2), p.593-602 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2457277246 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Springer Nature - Complete Springer Journals |
| subjects | Alignment Arthroplasty (knee) Arthroplasty, Replacement, Knee Balancing Complications Deviation Humans Joint replacement surgery Joint surgery Joints (anatomy) Knee Knee Joint - surgery Learning Learning Curve Learning curves Medicine Medicine & Public Health New technology Operative Time Orthopaedic implants Orthopedics Osteoarthritis, Knee - surgery Retrospective Studies Robotic surgery Robotic Surgical Procedures Robotics Robots Sports Medicine Surgeons |
| title | Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing |
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