The introduction of robotics for total knee arthroplasty (TKA) into the operating theatre is often associated with a learning curve and is potentially associated with additional complications. The purpose of this study was to determine the learning curve of robotic-assisted (RA) TKA within a multi-surgeon team. This prospective cohort study included 83 consecutive conventional jig-based TKAs compared with 53 RA TKAs using the Robotic Surgical Assistant (ROSA) system (Zimmer Biomet, Warsaw, Indiana, USA) for knee osteoarthritis performed by three high-volume (> 100 TKA per year) orthopaedic surgeons. Baseline characteristics including age, BMI, sex and pre-operative Kellgren-Lawrence graded and Hip-Knee-Ankle Axis were well-matched between the conventional and RA TKA groups. Cumulative summation (CUSUM) analysis was used to assess learning curves for operative times for each surgeon. Peri-operative and delayed complications (infection, periprosthetic fracture, thromboembolism, and compromised wound healing) and revisions were reviewed. The CUSUM analysis for operative time demonstrated an inflexion point after 5, 6 and 15 cases for each of the three surgeons, or 8.7 cases on average. There were no significant differences (p = 0.53) in operative times between the RA TKA learning (before inflexion point) and proficiency (after inflexion point) phases. Similarly, the operative times of the RA TKA group did not differ significantly (p = 0.92) from the conventional TKA group. There was no discernible learning curve for the accuracy of component planning using the RA TKA system. The average length of post-operative follow-up was 21.3 ± 9.0 months. There was one revision for instability in the conventional TKA group and none in the RA TKA group. There were no significant difference (p > 0.99) in post-operative complication rates between the conventional TKA and RA TKA groups. The introduction of the RA TKA system was associated with a learning curve for operative time of 8.7 cases. Operative times between the RA TKA and conventional TKA group were similar. The short learning curve implies this RA TKA system can be adopted relatively quickly into a surgical team with minimal risks to patients.

中文翻译：

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引入 ROSA 机械臂系统进行全膝关节置换术与手术时间的最小学习曲线相关

将用于全膝关节置换术 (TKA) 的机器人技术引入手术室通常与学习曲线相关，并且可能与其他并发症相关。本研究的目的是确定多外科医生团队中机器人辅助 (RA) TKA 的学习曲线。这项前瞻性队列研究包括 83 例连续常规基于夹具的 TKA，而 53 例 RA TKA 使用机器人手术助手 (ROSA) 系统（Zimmer Biomet，华沙，美国印第安纳州）治疗膝骨关节炎，由三名大容量（> 100 TKA/年）整形外科医生。包括年龄、BMI、性别和术前 Kellgren-Lawrence 分级和髋-膝-踝轴在内的基线特征在常规和 RA TKA 组之间非常匹配。累积求和 (CUSUM) 分析用于评估每位外科医生的手术时间的学习曲线。审查了围手术期和延迟并发症（感染、假体周围骨折、血栓栓塞和伤口愈合受损）和翻修。对手术时间的 CUSUM 分析表明，三位外科医生中的每一个在 5、6 和 15 例后出现拐点，平均为 8.7 例。RA TKA 学习（拐点之前）和熟练（拐点之后）阶段之间的手术时间没有显着差异（p = 0.53）。同样，RA TKA 组的手术时间与传统 TKA 组没有显着差异 (p = 0.92)。使用 RA TKA 系统进行组件规划的准确性没有明显的学习曲线。术后随访的平均时间为 21.3 ± 9.0 个月。常规 TKA 组有 1 次不稳定翻修，而 RA TKA 组则没有。常规 TKA 和 RA TKA 组的术后并发症发生率无显着差异 (p > 0.99)。RA TKA 系统的引入与 8.7 例手术时间的学习曲线相关。RA TKA 组和传统 TKA 组的手术时间相似。较短的学习曲线意味着该 RA TKA 系统可以相对较快地应用于外科团队，对患者的风险最小。99）在传统 TKA 和 RA TKA 组之间的术后并发症发生率。RA TKA 系统的引入与 8.7 例手术时间的学习曲线相关。RA TKA 组和传统 TKA 组的手术时间相似。较短的学习曲线意味着该 RA TKA 系统可以相对较快地应用于外科团队，对患者的风险最小。99）在传统 TKA 和 RA TKA 组之间的术后并发症发生率。RA TKA 系统的引入与 8.7 例手术时间的学习曲线相关。RA TKA 组和传统 TKA 组的手术时间相似。较短的学习曲线意味着该 RA TKA 系统可以相对较快地应用于外科团队，对患者的风险最小。