Association of Technology Usage and Decreased Revision TKA Rates for Low-Volume Surgeons Using an Optimal Prosthesis...

Area of Science:

• Orthopedic Surgery
• Medical Technology
• Biomechanical Engineering

Background:

• The efficacy of technology (navigation and robotics) in total knee arthroplasty (TKA) is well-documented for high-volume surgeons.
• However, the benefits for lower-volume surgeons remain uncertain.
• This study investigated the relationship between surgeon volume, technology adoption, and revision rates in TKA using an optimal prosthesis combination (OPC).

Purpose of the Study:

• To determine if surgeon volume influences the effectiveness of technology-assisted (TA) versus conventional-instrumentation (CV) total knee arthroplasty (TKA).
• To assess the impact of technology usage on revision rates across different surgeon volumes.
• To compare revision rates for TA-TKA and CV-TKA relative to a benchmark of 100 TKAs/year.

Main Methods:

• Analysis of Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data from 2008-2022 for primary TKA procedures.
• Comparison of revision rates between technology-assisted (TA) and conventional-instrumentation (CV) TKA based on surgeon volume (≥5 years post-first procedure).
• Kaplan-Meier estimates for cumulative percent revision (CPR) and Cox proportional-hazards models to assess revision rates and interactions.

Main Results:

• Out of 53,264 TKAs, 31,536 were TA-TKA and 21,728 were CV-TKA.
• Technology significantly reduced all-cause revision rates for surgeons performing <50 TKAs/year and minor revision rates for those performing <40 TKAs/year.
• No significant interaction was found between surgeon volume and major revision rates; however, TA-TKA showed no difference in all-cause or major revision rates for surgeons <100 TKAs/year compared to those performing 100 TKAs/year.

Conclusions:

• Technology-assisted total knee arthroplasty (TA-TKA) is associated with decreased revision rates specifically for lower-volume surgeons.
• Higher-volume surgeons did not demonstrate significant alterations in revision rates regardless of technology use.
• Consideration of preferential adoption of TA-TKA by lower-volume surgeons is recommended to potentially improve outcomes.