Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component align
- PDF / 1,558,030 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 28 Downloads / 152 Views
KNEE
Robot‑assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing Hannes Vermue1 · Thomas Luyckx2 · Philip Winnock de Grave2 · Alexander Ryckaert2 · Anne‑Sophie Cools1,2 · Nicolas Himpe2 · Jan Victor1 Received: 30 June 2020 / Accepted: 19 October 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose The application of robotics in the operating theatre for total knee arthroplasty (TKA) remains controversial. As with all new technology, the introduction of new systems is associated with a learning curve and potentially associated with extra complications. Therefore, the aim of this study is to identify and predict the learning curve of robot-assisted (RA) TKA. Methods A RA TKA system (MAKO) was introduced in April 2018 in our service. A retrospective analysis was performed of all patients receiving a TKA with this system by six surgeons. Operative times, implant and limb alignment, intraoperative joint balance and robot-related complications were evaluated. Cumulative summation (CUSUM) analyses were used to assess learning curves for operative time, implant alignment and joint balance in RA TKA. Linear regression was performed to predict the learning curve of each surgeon. Results RA TKA was associated with a learning curve of 11–43 cases for operative time (p 25 cases to the control group. Low, medium and high volume surgeons were seen as surgeons performing 100 TKA cases/ year respectively [9, 20].
Surgery The surgeries were performed by six fellowship-trained surgeons (Table 1). A subvastus approach was used in all cases. The Triathlon (Stryker, Michigan, USA) cruciate retaining (CR) or posterior stabilized (PS) implant was utilized. Femoral pins (4 mm diameter) were positioned in the wound underneath the vastus medialis. Tibial pins (3.2 mm
13
Outcome measures Retrospective review of the office notes, hospital records, radiographs and intra-operative data was independently performed by the principal author (HV). Radiographs were additionally assessed by two other independent reviewers (ASC, NH). Operative time In this study, the operative time was defined as the time between initial skin incision to final wound closure. The operative time was extracted from the electronical patient file, which is filled in during the surgery. Intraoperative plan The intraoperative plan on implant positioning was evaluated, taking into account possible intraoperative alterations. As such, femoral and tibial implant positioning and the planned hip-knee-ankle axis of the involved leg was obtained. Joint balance was evaluated with final medial and lateral gaps between femur and tibia in extension and flexion, similar to the studies of Gu et al. and Song et al. [4, 18, 19]. Imbalance was defined as a mismatch of more than 2 mm in either the medial, lateral, extension or flexion compartment. Tensioning of the gaps was performed manually with spoons or with a lamina spreader unti
Data Loading...
