Abstract
Introduction
Semi-active robots can improve the accuracy and precision of total knee arthroplasty (TKA). The surgical efficiency of the recently introduced NAVIO robotic-assisted (RA-TKA) surgery was assessed in this study to define: (1) the time commitment for RA-TKA; (2) the learning curve for RA-TKA; and (3) to compare RA-TKA surgical time commitment to conventional, instrumented TKA (CI-TKA).
Materials and Methods
Beginning in May 2017, the first 100 patients undergoing NAVIO RA-TKA were registered pre-operatively. Operative time, defined as the time from surgical skin incision to capsular closure, was recorded.
Exclusion criteria were cases in which surgical time was not recorded.
During the same study period, surgical case times for fifty cases of CI-TKA procedures were also assessed.
Baseline data, including age, gender, BMI, range of motion, was recorded for all subjects.
Surgical and anesthetic technique, multi-modality pain management protocol, and post-operative mobilization was consistent for all patients enrolled in the study.
Results
No cases were excluded due to missing data. Demographics were similar in the study groups.
Average surgical time for the first 100 RA-TKA cases was 68.2 minutes (range 48–100 minutes).
The learning curve, as defined by both absolute (added surgical time) and relative measures (percentage of added time) was forty cases. Significant further surgical efficiency was achieved after 80 cases.
In comparison to CI-TKA (average surgical time 51.7 minutes), the first ten RA-TKA cases required an average of 80 minutes, or over 50% increase in surgical time. After case #40, RA-TKA took only 10 minutes longer (18% greater) than CI-TKA. After case #80, RA-TKA required less than 5% more time than RA-TKA.
Discussion/Conclusions
The initial experience with the NAVIO RA-TKA produced predictable surgical efficiency as measured by surgical time commitment. The learning curve for this user was forty cases. After eighty cases, RA-TKA was time neutral (<5% added time).
This study demonstrates that implementation of robotic-assisted technology in TKA can achieve a high level of surgical efficiency within an acceptable learning curve.
