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Three-year experience with training courses using a TKA simulator - clinical impact and lessons learned.
Heiko Graichen1, George Mihai Avram2,3, R von Eisenhart-Rothe4
1Department of Personalised Orthopaedics (PersO) at Privatklinik Siloah, Worbstrasse 324, 3073, Muri bei Bern, Switzerland.
Journal of Orthopaedics
|October 27, 2025
Summary
Simulator training significantly improves decision quality and efficiency for robotic Total Knee Arthroplasty (TKA) surgery. However, low surgeon compliance with training exercises remains a challenge for widespread adoption.
Area of Science:
- Orthopedic Surgery
- Surgical Simulation
- Robotic Surgery
Background:
- Robotic systems and personalized alignment in Total Knee Arthroplasty (TKA) present new training challenges.
- Simulator training offers a potential solution to reduce errors and enhance efficiency in TKA procedures.
Purpose of the Study:
- To analyze the impact of simulator training on the quality and efficiency of Total Knee Arthroplasty (TKA) procedures.
- To assess surgeon acceptance and compliance with simulator-based TKA training.
Main Methods:
- Utilized the Knee-CAT simulator for 35 training courses involving 638 surgeons over three years.
- Evaluated decision quality (bone cuts, soft tissue, balancing, alignment) and procedural efficiency.
- Measured training effectiveness by comparing pre- and post-training exercise outcomes and assessed delegate compliance.
Main Results:
- Simulator training led to significant improvements in decision quality (51%) and efficiency (62%) for TKA.
- Positive effects were observed in both basic and advanced TKA alignment courses.
- Delegate compliance was low (36-51%), though those who started training completed most exercises.
Conclusions:
- Simulator training is a promising method for enhancing TKA robotic and alignment skills, improving both decision quality and efficiency.
- Low compliance rates necessitate exploring integrated training options like VR and careful trainee selection.
- Motivating conventional TKA surgeons to adopt robotic procedures remains critical for successful implementation.
