The learning curve of robotic-assisted total knee arthroplasty: a systematic review and meta-analysis

To assess the learning curve of robotic-assisted total knee arthroplasty (RA-TKA) as well as its impact on operative time, patient-reported outcomes (PROMs), radiologic outcomes, and complications. MEDLINE, EMBASE, and CENTRAL were searched from inception to October 4, 2024, for studies with the objective of assessing RA-TKA's learning curve. The median learning curve across all studies was calculated. Meta-analyses were conducted on comparative studies reporting outcomes stratified by learning phase or comparing RA-TKA's proficiency phase with conventional total knee arthroplasty (C-TKA). Thirty-one studies (9916 knees) were analyzed. The median learning curve was 17 cases (IQR 9 to 27). Operative time across all eligible comparative studies was 14.19 min shorter in the late/proficiency phase relative to the early/learning phase (p < 0.000). For studies explicitly reporting skin incision to skin closure times, operative time was 17.03 min shorter in the late/proficiency group (p < 0.0001). No clinically significant differences in radiologic parameters were identified across RA-TKA learning and proficiency groups. There was a significant reduction in hip-knee angle outliers in favor of the RA-TKA proficiency group compared to C-TKA (OR 0.11; 95%CI 0.05, 0.27; p < 0.00001). No significant differences were demonstrated in PROMs or complications rates across learning versus proficiency groups. The adoption of RA-TKA is safe and does not result in clinically relevant differences in radiologic outcomes or PROMs across learning and proficiency phases. There is, however, a significant reduction in operative time of up to 17 min from the learning to proficiency phase, which should be factored into operative planning.Level of evidence: IV.