Learning curve of robotic-assisted total knee arthroplasty: a literature review

To perform a literature review analyzing the surgical team learning curve (LC) for robotic-assisted total knee arthroplasty (RATKA), assessing: (1) operative time, (2) accuracy to reproduce the planned limb alignment, (3) accuracy for implant positioning, (4) functional outcomes and (5) reoperation and complication rates. A systematic search of the literature was performed using two different electronic databases: PubMed (MEDLINE) and Cochrane Library. The search strategy was: "Knee" AND ("Robot" OR "Robotic") AND ("Learning" OR "Curve" OR "Time"). All manuscripts with full text available, written in English or Spanish and published up to December 2024 analyzing RATKA LC were included in the review. Thirty-two articles published between 2018 and 2024 were included. Eighteen (56%) were published in the last two years, reflecting a growing interest in RATKA LC. The 96.9% of the articles analyzed the LC of operative time. The mean number of cases required to reach the proficiency phase was 16 ± 12 (range: 3-61), and the mean number of cases needed to match the operative time of manual TKA was 32 ± 24 (range: 3-73). Accuracy in reproducing planned limb alignment and implant positioning was assessed in 25.0% and 28.1% of the articles, respectively; 94% of them (16/17) reported no LC effect. Only a few studies analyzed the LC of functional outcomes (3/32) and reoperation or complication rates (5/32), and all reported no LC effect. There is a significant learning curve effect for operative time in robotic-assisted TKA, with a mean of 16 ± 12 cases required to reach the proficiency phase and 32 ± 24 cases needed to match the operative time of manual TKA. However, there is no learning curve for accuracy in achieving the planned limb alignment and implant positioning, functional outcomes, or reoperation and complication rates.