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Learning Curves in 204 Robotic-Assisted Total Knee Replacements: Comparing Senior, Intermediate, and Senior-Junior Surgical Teams

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Learning Curves in 204 Robotic-Assisted Total Knee Replacements: Comparing Senior, Intermediate, and Senior-Junior Surgical Teams

Hector Zamorano, MD, CHILE Roberto Yañez, MD,phD,prof, CHILE Sebastian Valdes, student, CHILE Gaston Caracciolo, CHILE Cristobal Yañez, MD, CHILE Sebastian Yanez, MD, CHILE Leonardo Javier Carabajal Vera, MD, ARGENTINA Lars Raymond Strömback, MD, CHILE Magaly Iñiguez, MD, CHILE

Clinica MEDS, Santiago, Metropolitana, CHILE

2025 Congress ePoster Presentation 2025 Congress Not yet rated

Anatomic Location

Knee

Diagnosis / Condition

Osteoarthritis

Treatment / Technique

Total Joint Replacement

Summary: Robotic-assisted total knee arthroplasty using the ROSA® system showed the fastest learning curve and earlier stabilization when performed by a senior-junior surgical team, with significantly shorter ischemia times, low complication rates, and a synergistic effect that supports collaborative integration of new surgical technologies.

Introduction

Robotic Total Knee Arthroplasty (TKA) aims to enhance surgical planning and outcomes. Performing 10–20 TKAs may be sufficient to stabilize surgical times, but it remains unclear whether senior surgeons in traditional TKA, intermediate-senior surgeons, or senior-junior teams learn more efficiently.

Objective

To evaluate the learning curves of senior, intermediate, and senior-junior surgical teams using the ROSA® robotic system, considering complication rates and overall outcomes during the first 25 rTKAs.

Methods

A total of 204 patients scheduled for TKA were prospectively enrolled between 2021 and 2024, following the principles of the Declaration of Helsinki and ethical guidelines. Stability was assessed by slope changes that minimized cumulative error. Ischemia times and complication rates were compared among the senior team (25 years of traditional TKA experience), the intermediate team (15 years), and the senior-junior team (25 and 5 years, respectively). The first 25 rTKAs performed by each team were compared in terms of ischemia time and cumulative error differences using ANOVA and multiple comparisons (α = 0.05).

Results

The senior, intermediate, and senior-junior teams performed 25, 29, and 159 rTKAs, 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-junior team achieved a stable slope (TKA = 88). Among the first 25 rTKAs, the senior-junior team demonstrated significantly shorter ischemia times and lower error differences compared to the intermediate team (p < 0.001, Cohen’s d = 1.2) and the senior team (p < 0.001, Cohen’s d = 1.2). No significant differences were found between the senior and intermediate teams (p = 1.000, Cohen’s d = 0.01). Complication rates were 2.3% (senior), 3.2% (intermediate), and 3.8% (senior-junior).

Discussion

and Conclusions: Robotic TKA using the ROSA® system demonstrated a clear learning curve, with significantly improved efficiency when procedures were performed by a senior-junior team. This team achieved faster ischemia times, earlier stabilization, and comparable complication rates to more experienced groups. The collaboration between a senior and a junior surgeon not only facilitated the adaptation to robotic assistance but also enhanced surgical performance, suggesting a synergistic dynamic that may accelerate the learning process. Importantly, all groups maintained low complication rates, supporting the safety of incorporating robotic assistance into TKA regardless of prior robotic experience. These findings underscore the value of mentorship and teamwork in the successful adoption of new surgical technologies.

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Visible fluid motion on manipulation as the new threshold for intraoperatively-determined knee arthroplasty component loosening – a Delphi study ePoster Presentation George Samuel Buijs, MD, NETHERLANDS Arthur Johan Kievit, MD, NETHERLANDS Alex Bastiaan Walinga, MD, NETHERLANDS Matthias U. Schafroth, MD, NETHERLANDS Michael T. Hirschmann, MD, Prof., SWITZERLAND Leendert Blankevoort, PhD, NETHERLANDS
Longer Hospital Length of Stay After Total Knee Arthroplasty is an Independent Risk Factor for Increased Complication Rates ePoster Presentation Logan Finger, MD, UNITED STATES Kelly A Murphy, BS, UNITED STATES Kenneth Urish, MD, PhD Michael O'Malley, MD, UNITED STATES Brian Klatt, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES
Anxiety And Depression Prior To Total Knee Arthroplasty Are Associated With Worse Pain And Subjective Function: A Prospective Comparative Study ePoster Presentation Margot B. Aalders, MD, NETHERLANDS Jelle P. van der List, MD, PhD, NETHERLANDS Dirk Jan Hofsteee, NETHERLANDS Lucien C.M. Keijser, MD PhD, NETHERLANDS Joyce L. Benner, PhD, NETHERLANDS
Robotic-Assisted Total Knee Arthroplasty Is Associated With Improved Surgical And Post-Operative Outcomes: A Large Single-Centre Study ePoster Presentation Mei Lin Tay, PhD, NEW ZEALAND Kohei Kawaguchi, MD, PhD, JAPAN Scott M Bolam, MBChB, PhD, NEW ZEALAND Ali Bayan, MBChB, FRACS, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
The Use Of Imageless Robotic Assistance Does Not Reduce Early Postoperative Pain In Total Knee Replacement Compared To Conventional Arthroplasty ePoster Presentation Rodrigo Olivieri, MD, CHILE Sebastian Bianchi, MD, CHILE Cristóbal Díaz, MD, CHILE Pablo Albornoz, MD, CHILE Victor Barrientos, PhD, CHILE Jaime Ignacio Ugarte Checura, MD, CHILE Carolina Cardemil, MD, CHILE Pilar Buendia, BSN, CHILE Nicolas Franulic, MD, CHILE Jose Ignacio Laso, MD, CHILE Nicolas Gaggero, MD, CHILE
Investigating Patient And Surgical Factors Affecting Same Day Discharge After Unicompartmental Knee Replacement ePoster Presentation Suleyman Ulla, MBChB, UNITED KINGDOM Patrick Richard Michael Nicholas, MBChB, MRCS(Glasg), UNITED KINGDOM Stuart Wilson Bell, MBChB MRCP FRCS (Orth), UNITED KINGDOM
Novel Algorithm for Gap Balancing and Bone Cuts in Robotic Total Knee Replacements Significantly Improves Accuracy and Surgical Duration ePoster Presentation Glen Liau , MBBS, MRCS, MMed, FRCS, FAMS, MBA, SINGAPORE Matthew Song Peng Ng, MBBS, SINGAPORE Ryan Wai Keong Loke, MBBS candidate, SINGAPORE
Preservation of Pre-Arthritic Coronal Knee Phenotype and Pre-Arthritic Coronal Alignment Yielded Improved Kujala Scores Following Ligament-Guided Medial Unicompartmental Knee Arthroplasty ePoster Presentation Roderick J.M. Vossen, MD, UNITED STATES Joost Burger, MD, PhD, GERMANY Gaby Victoria Ten Noever De Brauw, NETHERLANDS Tarik Bayoumi, MD, NETHERLANDS Jake Fiore, Bsc, UNITED STATES Lindsey Ruderman, BA, UNITED STATES Hendrik Aernout Zuiderbaan, MD PhD, NETHERLANDS Andrew D. Pearle, MD, UNITED STATES
A Different Course Of Recovery For Extension And Flexion Strengths Following Total And Unicompartmental Knee Arthroplasty: A Prospective Cohort Study Of 369 Cases ePoster Presentation Roderick J.M. Vossen, MD, UNITED STATES Joyce L. Benner, PhD, NETHERLANDS Gaby Victoria Ten Noever De Brauw, NETHERLANDS Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS Andrew D. Pearle, MD, UNITED STATES Hendrik Aernout Zuiderbaan, MD PhD, NETHERLANDS Lucien C.M. Keijser, MD PhD, NETHERLANDS
EARLY LOOSENING OF THE FEMORAL STEM IN CEMENTED SEGMENTAL PROSTHESES WITH DISTAL FEMUR REPLACEMENT ePoster Presentation Clara Chimeno Pigrau, MD, SPAIN Marta Sabater Martos, Md, SPAIN Mariano Balaguer-Castro, MD, MSc, PhD, SPAIN Marc Ferrer Banús, MD, SPAIN Montserrat Monfort Mira, MD, SPAIN Dragos Popescu, MD, PhD, SPAIN Salvi Prat, SPAIN Joan Sugrañes, SPAIN Juan C. Martinez-Pastor, MD, SPAIN
Changing amount of posterior tibial slope during unicompartmental knee arthroplasty does not affect short-term postoperative patients reported outcome measurement ePoster Presentation Ryo Tomita, MD, JAPAN Eiji Sasaki, MD, PhD, JAPAN Hikaru Kristi Ishibashi, MD, JAPAN Hitoshi Kudo, PhD, JAPAN Hironori Otsuka, MD, JAPAN Takahiro Tsushima, MD, PhD, JAPAN Yukiko Sakamoto, MD, PhD, JAPAN Yuka Kimura, MD, PhD, JAPAN Yasuyuki Ishibashi, MD, JAPAN
Tourniquet use Does not Affect Bleeding and Surgical Time in Robotic Assisted Total Knee Arthroplasty ePoster Presentation João P.F. Guerreiro, MD, PhD, BRAZIL JOAO BALAN, MD, BRAZIL MARSAL VILHENA, MD, BRAZIL SERGIO MERÇON, MD, BRAZIL Paulo Roberto Bignardi, PhD, BRAZIL Marcus Vinicius Danieli, MD, PhD, BRAZIL
Gait Analysis Focusing On The Relationship Between Knee Biomechanics And Patient Outcome In Unilateral Total Knee Arthroplasty And Nonoperative Residual Osteoarthritis Knee ePoster Presentation Shinichi Kuriyama, MD, PhD, JAPAN Sayako Sakai, MD, JAPAN Yugo Morita, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Shinichiro Nakamura, MD, PhD, JAPAN Shuichi Matsuda, MD, PhD, JAPAN
The Effects Of The Flexion Gap Setting On Postoperative Outcomes Of Tka Using The Mako Robotic Arm ePoster Presentation Shuhei Sugioka, MD, JAPAN Masayoshi Okuda, MD, PhD, JAPAN Yuki Kawaguchi, PT, JAPAN Yasuhito Tanaka, Prof., JAPAN
Increasing Coronal Deformity, Tibiofemoral Subluxation And More Severe Bone Defects Are Risk Factors For To The Use Of A Higher-Constrained Total Knee Arthroplasty ePoster Presentation Sandro Hodel, MD, SWITZERLAND Patrick Pflüger, MD, SWITZERLAND Lukas Jud, MD, SWITZERLAND Juliette Wälchli, SWITZERLAND Francesca Napoli, MD, SWITZERLAND Lazaros Vlachopoulos, MD, PhD, SWITZERLAND Sandro Fucentese, Prof MD, SWITZERLAND
Joint Line Convergence Angle After Total Knee Arthroplasty: Comparison Between Mechanical V/S Patient-Specific Alignment With Robotic Assisted Surgery: Retrospective Data Of 98 Patients ePoster Presentation David H. Figueroa, MD, CHILE Waldo Gonzalez Duque, MD, CHILE Loreto Figueroa, MD, CHILE Francisco Figueroa, MD, CHILE Rodrigo Guiloff, MD, Prof, CHILE
Cementless Total Knee Arthroplasty is Performed in Younger Patients ePoster Presentation Logan Finger, MD, UNITED STATES Nicole Don, MA, UNITED STATES Noah Feder, BA, UNITED STATES Kenneth Urish, MD, PhD Michael O'Malley, MD, UNITED STATES Brian Klatt, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES
Knees With Lateral Compartment Osteoarthritis Show A Substantial Variability In Functional Knee Phenotypes With Gender-Specific And Age-Related Differences: Phenotypic Analysis Of 305 Knees ePoster Presentation Gaby Victoria Ten Noever De Brauw, NETHERLANDS Tarik Bayoumi, MD, NETHERLANDS Lindsey Ruderman, BA, UNITED STATES Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS Hendrik Aernout Zuiderbaan, MD PhD, NETHERLANDS Andrew D. Pearle, MD, UNITED STATES
The Effect Of Excessive Alignment Correction And Limb Length Discrepancy After Total Knee Arthroplasty On Contralateral Lower Extremity Alignment And Knee Condition ePoster Presentation Seung Hoon Lee, MD, KOREA, REPUBLIC OF
Integrating Elongation Patterns with AR-Based Navigation in Kinematic Alignment TKA. ePoster Presentation Atsushi Sato, MD, PhD, JAPAN Marika Mukunoki, MD, JAPAN Masataka Ota, MD, JAPAN Misako Takizawa, MD, JAPAN Kanako Izukashi, MD, JAPAN Jun Oike, MD, PhD, JAPAN Takayuki Okumo, MD, PhD, JAPAN Takayuki Koya, MD, PhD, JAPAN Koji Kanzaki, Prof., JAPAN
Is Bi-Cruciate Stabilized Total Knee Arthroplasty Better Than Conventional Knee Arthroplasty In Knee Biomechanics During Gait? ePoster Presentation Kengo Harato, MD, PhD, JAPAN Kohei Nishizawa, PhD, JAPAN Shu Kobayashi, MD, PhD, JAPAN Kazuya Kaneda, MD, PhD, JAPAN Tatsuaki Matsumoto, MD, PhD, JAPAN Takeo Nagura, MD, JAPAN
Female Patients Depend More On Postoperative Outcomes In Assessing Satisfaction Than Male Patients After Total Knee Arthroplasty ePoster Presentation Yun Seong Choi, MD, KOREA, REPUBLIC OF Seung Hoon Lee, MD, KOREA, REPUBLIC OF
Anatomical investigation of the popliteal artery in unicompartmental knee arthroplasty cases ePoster Presentation Naoto Date, MD, JAPAN Masaki Mori, MD, PhD, JAPAN Kengo Kaji, MD, JAPAN Masakazu Ishikawa, MD, PhD, JAPAN
Robotic-Assisted Total Knee Arthroplasty Improves Accuracy and Reproducibility Compared to Manual Instrumentation or Navigation. ePoster Presentation Yoan Bourgeault-Gagnon, MD, FRCSC, CANADA Lucy J. Salmon, PhD, AUSTRALIA Matt Lyons, FRACS, AUSTRALIA
Mid To Long-Term Results Of Medial Unicompartmental Knee Arthroplasty : Mobile Versus Fixed-Bearing ePoster Presentation Sumin Lim, MD, PhD, KOREA, REPUBLIC OF Jun-Young Chung, MD, KOREA, REPUBLIC OF Tae Hun Kim, MD, KOREA, REPUBLIC OF Jeong-Hyun Koh, MD, KOREA, REPUBLIC OF Jeong Sunwoo, MD, KOREA, REPUBLIC OF Myung-Sub Lee, MD, KOREA, REPUBLIC OF
Primary Followed by Revision Total Knee Arthroplasty at Non-Tertiary Centers Have Higher Risk of Complications ePoster Presentation Logan Finger, MD, UNITED STATES Yunseo Linda Park, BS, UNITED STATES Matthew Como, BS, UNITED STATES Nicolas Aycardi, BS, UNITED STATES Kenneth Urish, MD, PhD Michael O'Malley, MD, UNITED STATES Brian Klatt, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES
Single-Shot Femoral Nerve Block Versus Local Infiltration Analgesia For Patients Undergoing Total Knee Arthroplasty: A Systematic Review And Meta-Analysis ePoster Presentation André Richard Da Silva Oliveira Filho, Student, BRAZIL Elcio Machinski, md, BRAZIL Vinícius Furtado, Student, BRAZIL Rodrigo Conde, MS, ARGENTINA Bruno Butturi Varone, MD, BRAZIL Riccardo Gomes Gobbi, MD, PhD, BRAZIL Camilo P. Helito, MD, PhD, Prof, BRAZIL Daniel Leal, MD, BRAZIL
Differences In Coronal Plane Alignment Of The Knee (CPAK) Measured On Long-Leg Radiographs Compared To Computed Tomography For The Patients Undergoing Total Knee Arthroplasty ePoster Presentation Kohei Kawaguchi, MD, PhD, JAPAN Mei Lin Tay, PhD, NEW ZEALAND Bill Farrington, FRCS, NEW ZEALAND Rupert S Van Rooyen, MBChB, FRACS, NEW ZEALAND Matthew Walker, MBChB, FRACS, NEW ZEALAND Ali Bayan, MBChB, FRACS, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
Evaluating The Accuracy Of Imageless Robotic Assistance In Total Knee Replacement: A Study Of Mechanical Axis Correlation With Postoperative Radiographs ePoster Presentation Rodrigo Olivieri, MD, CHILE Piero Innocenti, MD, CHILE Jaime Ignacio Ugarte Checura, MD, CHILE Jose Ignacio Laso, Md, CHILE Marco Koch, MD, CHILE Jose Tomas Muñoz, MD, CHILE Sebastian Bianchi, MD, CHILE Nicolas Gaggero, MD, CHILE
Large Variance in a Lateral Osteoarthritic Population Prior to and Following Lateral Unicompartmental Arthroplasty: An Analysis of Knee Phenotypes ePoster Presentation Hendrik Aernout Zuiderbaan, MD PhD, NETHERLANDS Roderick J.M. Vossen, MD, UNITED STATES Gaby Victoria Ten Noever De Brauw, NETHERLANDS Lindsey Ruderman, BA, UNITED STATES Tarik Bayoumi, MD, NETHERLANDS Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS Andrew D. Pearle, MD, UNITED STATES
Local Soft Tissue Thickness in Unicompartimental Knee Arthroplasty: Strong Inter-Parameter Correlation, Moderate Correlation with BMI, and no Impact on Implant Positioning ePoster Presentation Lorenz Pichler, MD, AUSTRIA Moses Kamal Dieter El Kayali, MD, GERMANY Rosa Berndt, MD, GERMANY Carsten Perka, MD, PhD, GERMANY Clemens Gwinner, MD, GERMANY Danko Dan Milinkovic, MD, GERMANY
Changes in the Posterior Tibial Slope among Patients undergoing Medial Unicompartmental Knee Arthroplasty do not affect the Medial Proximal Tibial Angle ePoster Presentation Lorenz Pichler, MD, AUSTRIA Rosa Berndt, MD, GERMANY Carsten Perka, MD, PhD, GERMANY Clemens Gwinner, MD, GERMANY Moses Kamal Dieter El Kayali, MD, GERMANY
The Knee Pain Decreases After Total Hip Arthroplasty ePoster Presentation Yugo Morita, MD, PhD, JAPAN Yaichiro Okuzu, MD, PhD, JAPAN Toshiyuki Kawai, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Shinichiro Nakamura, MD, PhD, JAPAN Yutaka Kuroda, MD, PhD, JAPAN Shinichi Kuriyama, MD, PhD, JAPAN Shuichi Matsuda, MD, PhD, JAPAN
Influence of Femorotibial Posterior Overhang and Posterior Tibial Slope on Patellar Changes After TKA ePoster Presentation Shunsuke Utsumi, MD, JAPAN Takashi Aki, PhD, JAPAN Masayuki Kamimura, JAPAN Kento Harada, MD, JAPAN Toshimi Aizawa, JAPAN
The Mind Matters: Psychological Factors Influence Subjective Outcomes Following Unicompartmental Knee Arthroplasty - A Prospective Study ePoster Presentation Gaby Victoria Ten Noever De Brauw, NETHERLANDS Margot B. Aalders, MD, NETHERLANDS Hendrik Aernout Zuiderbaan, MD PhD, NETHERLANDS Lucien C.M. Keijser, MD PhD, NETHERLANDS Joyce L. Benner, PhD, NETHERLANDS
Oxford Partial Knee Femoral Sizing Via Preoperative Mri Scan – A Novel Template Method ePoster Presentation Ritwik Kejriwal, FRACS(Orth), NEW ZEALAND
An Isakos Funded Study - Physical Activity Outcomes In Patellofemoral Vs. Total Knee Replacements: A Randomised Control Trial For Isolated Patellofemoral Joint Osteoarthritis . ePoster Presentation Martinique Vella-Baldacchino, MD, MRCS, PG CERT (HEALTH LEADERSHIP), IOC DIp Spo, UNITED KINGDOM Julie Heegaard, MD, DENMARK Snorre Stephensen, MD, DENMARK Soeren Rytter , MD, DENMARK Per Wagner Kristensen, MD, DENMARK Zahid Asghar , PhD, UNITED KINGDOM Alex D Liddle, MBBS BSc DPhil FRCS(Orth), UNITED KINGDOM Justin Cobb, MCh FRCS, UNITED KINGDOM Anders Odgaard, DENMARK
Functional Alignment Restores Native Kinematics More Consistently than Mechanical Axis Alignment in Total Knee Arthroplasty ePoster Presentation Jonathan R Manara, BMBS, FRCS (Tr & Orth), UNITED KINGDOM Rick Steer, FRACS, AUSTRALIA Sarah L. Whitehouse, PhD, AUSTRALIA Dermot M Collopy, FRACS, AUSTRALIA Gavin William Clark, MBBS, FRACS, AUSTRALIA

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Learning Curves in 204 Robotic-Assisted Total Knee Replacements: Comparing Senior, Intermediate, and Senior-Junior Surgical Teams

Learning Curves in 204 Robotic-Assisted Total Knee Replacements: Comparing Senior, Intermediate, and Senior-Junior Surgical Teams

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Knee Arthroplasty ePosters

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Learning Curves in 204 Robotic-Assisted Total Knee Replacements: Comparing Senior, Intermediate, and Senior-Junior Surgical Teams

Learning Curves in 204 Robotic-Assisted Total Knee Replacements: Comparing Senior, Intermediate, and Senior-Junior Surgical Teams

Introduction

Objective

Methods

Results

Discussion