Implant-agnostic, handheld wireless robotics: multicenter efficiency and learning curve for total knee arthroplasty

As robotic total knee arthroplasty (TKA) adoption grows, the learning curve for new users remains a concern for both physicians and staff. Previous studies have reported on clinical outcomes for TKA with a novel implant-agnostic, handheld, wireless robotic TKA system (rTKA). This study investigates the rTKA adoption learning curve relevant to multiple clinical stakeholders. This multicenter, multi-surgeon observational study includes up to the first 25 rTKA procedures by 7 surgeons. Observers noted timing and workflow at 8/25 rTKA cases and 2 standard-of-care benchmark TKAs (prior manual or robotic use by user), and analyzed logs for all rTKA cases. Learning curves were assessed via benchmark TKA time neutrality, statistical comparison between early and later cases, and cumulative sum (CUSUM) analysis. Surgeon and staff surveys followed each observed rTKA case. Each analysis type demonstrated a different learning curve duration: surgeons averaged approximately 10 cases to time neutrality, with 2 not reaching time neutrality within the observed case series. Cases 3 and onward were significantly faster than cases 1–2 (p = 0.0454), indicating early operative time improvement after initial system exposure. Average observed skin-to-skin time was 68 min. Surgeons and staff rated the system easy to use and were familiar with the system after 4 cases. Use of the handheld surgical robot for rTKA demonstrated a short learning curve and high reported ease of adoption by surgeons and staff. This study demonstrates the rTKA system exhibits a short learning curve and high reported ease of adoption, and may compare favorably with previously reported learning curves for other robotic TKA systems. Level of evidence: IV.