Conversion to robotic-guided unicompartmental knee arthroplasty is associated with a short learning curve and no concerns with accuracy of implant positioning.
Author(s):
Kayani B. (United Kingdom)
,
Kayani B. (United Kingdom)
Affiliations:
Konan S.
,
Konan S.
Affiliations:
Haddad F.
Haddad F.
Affiliations:
ESSKA Academy. Kayani B. 05/09/18; 209610; P10-1542 Topic: Joint Replacement
Mr. Babar Kayani
Mr. Babar Kayani
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Abstract
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Objectives: Robotic-guided arthroplasty systems use preoperative computerised tomography (CT) and an interactive haptic arm to guide bone resection and optimise implant positioning. Understanding the learning curve of this robotic technology is essential for patient safety, cost and operating room time efficiency. The objective of this study was to establish our surgical teams' learning curve with introducing robotic-guided unicompartmental knee arthroplasty (UKA) surgery.

Methods: This prospective study included 60 consecutive robotic-guided medial UKAs performed by a single-surgeon with cadaveric training on robotic UKA. All patients underwent preoperative planning CT and postoperative plain weight-bearing radiographs to assess accuracy of implant positioning. Learning curve outcomes were reviewed in blocks of five patients to limit bias from difficult anatomy or individual case based technical difficulties.

Results: There was no learning curve for accuracy for femoral (p<0.05) or tibial implant positioning (p<0.05). The learning curve for surgeon comfort was five cases. The key learning was from adapting to change in use of assistants and tactile feedback from the robotic controlled milling burr. One key finding was that the pressure exerted by the surgeon's hand on the burr decreased with five cases. Scrub staff documented improved learning by case five but commented on anxiety when they had not scrubbed for consecutive cases.

Conclusions: Robotic-guided UKA is associated with a learning curve of approximately five cases for surgeon and team comfort and no learning curve for accuracy of implant positioning. Adjustments to tactile feedback of the burr and use of assistants were the key learning aspects for the surgeon.

Keywords:
Implant positioning; Learning curve; Unicompartmental knee arthroplasty; robotics;
Objectives: Robotic-guided arthroplasty systems use preoperative computerised tomography (CT) and an interactive haptic arm to guide bone resection and optimise implant positioning. Understanding the learning curve of this robotic technology is essential for patient safety, cost and operating room time efficiency. The objective of this study was to establish our surgical teams' learning curve with introducing robotic-guided unicompartmental knee arthroplasty (UKA) surgery.

Methods: This prospective study included 60 consecutive robotic-guided medial UKAs performed by a single-surgeon with cadaveric training on robotic UKA. All patients underwent preoperative planning CT and postoperative plain weight-bearing radiographs to assess accuracy of implant positioning. Learning curve outcomes were reviewed in blocks of five patients to limit bias from difficult anatomy or individual case based technical difficulties.

Results: There was no learning curve for accuracy for femoral (p<0.05) or tibial implant positioning (p<0.05). The learning curve for surgeon comfort was five cases. The key learning was from adapting to change in use of assistants and tactile feedback from the robotic controlled milling burr. One key finding was that the pressure exerted by the surgeon's hand on the burr decreased with five cases. Scrub staff documented improved learning by case five but commented on anxiety when they had not scrubbed for consecutive cases.

Conclusions: Robotic-guided UKA is associated with a learning curve of approximately five cases for surgeon and team comfort and no learning curve for accuracy of implant positioning. Adjustments to tactile feedback of the burr and use of assistants were the key learning aspects for the surgeon.

Keywords:
Implant positioning; Learning curve; Unicompartmental knee arthroplasty; robotics;
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