Summary

To evaluate learning curves among senior and senior-young teams using the ROSA® robot (Zimmer Biomet), during the first 25 TKAs. 204 patients were included. Stability was determined by changes in slopes that minimized accumulated error. the senior-young team had shorter times and demonstrates that collaboration generates a synergistic effect in the implementation of robotic technology.

Abstract

Introduction

Robotic Total Knee Arthroplasty (TKA) aims to enhance surgical designs and procedures. Performing 10-20 TKAs might be sufficient to stabilize surgical times, but it is unknown whether senior surgeons in traditional TKA, senior-intermediate surgeons, or senior-young surgeons learn more quickly.

Objective

To evaluate learning curves among senior, senior-intermediate, and senior-young teams using the ROSA® robot, considering complication rates, overall results, during the first 25 TKAs.

Methods

204 patients scheduled for TKA were prospectively included (2021-2024), adhering to Helsinki and ethical principles. Stability was determined by changes in slopes that minimized accumulated error. Ischemia times and complication rates for the senior team (25 years of traditional TKA), senior-intermediate team (15 years of traditional TKA), and senior-young team (25 years of traditional TKA and 5 years of traditional TKA) were compared. The first 25 TKAs were compared for ischemia times and accumulated error differences (ANOVA and multiple comparisons (α=5%).

Results

The senior, senior-intermediate, and senior-young teams performed 25, 29, and 159 TKAs, respectively, with ischemia times of 105 minutes [95% CI: 95.0–107.6], 98 minutes [95% CI: 91.1–104.6], and 65 minutes [95% CI: 62.1–67.9]. Only the senior-young team achieved a stable slope (TKA=88). Among the first 25 TKAs, the senior-young team had shorter ischemia times and lower error differences compared to the senior-intermediate team (p<0.001, d-Cohen: 1.2) and the senior team (p<0.001, d-Cohen: 1.2). No differences were found between the senior and senior-intermediate teams (p<1.000, d-Cohen: 0.01). The complication rates were 2.3% (senior), 3.2% (senior-intermediate), and 3.8% (senior-young).

Discussion

and Conclusions: Robotic TKA with the ROSA® robot resulted in ischemia times 30 minutes shorter than the recommended 90 minutes to reduce the risk of tissue, neurological damage, and infections. Learning was achieved. Furthermore, this study demonstrates that collaboration between a senior surgeon and a junior surgeon generates a synergistic effect in the implementation of robotic technology in total knee arthroplasty.