The Impact of Robotics on Procedural Flow and Surgeon Strain in Total Knee Arthroplasty

This study aimed to identify the impact of robot assistance on the progression of total knee arthroplasty (TKA) operations by observing flow disruptions (FD), deviations in the natural progression of a task, while also evaluating the differences in surgeon cognitive and physical strain with each approach.

Conventional (C-TKA) and robot-assisted (R-TKA) total knee arthroplasty procedures were observed at a nonprofit academic medical center in Southern California over 3 months in 2022. All procedures were observed in 3 operative phases: (1) wheels-in to procedure start; (2) procedure start to procedure end; and (3) procedure end to wheels-out. FDs were recorded and classified into 8 categories. SURG-TLX and Borg Scale questionnaires were also administered.

Thirteen TKA procedures (C-TKA: n=6; R-TKA: n=7) were observed. Mean total operative duration was 159.2±44.7 minutes for C-TKA and 201.9±25.8 minutes for R-TKA.Mean phase 2 durations were 91.1±34.1 minutes for C-TKA and 134.0±25.4 minutes for R-TKA. Overall FD rate was 7.6±1.4 FDs/hour for C-TKA and 9.9±2.3 FDs/hour for R-TKA procedures. Major disruption types consisted of coordination, training, and communication for C-TKA and coordination, surgical task considerations, and environment for R-TKA. Mean SURG-TLX values were highest for the Task Complexity domain following C-TKA procedures and for the Physical Demands domain following R-TKA procedures.

Investigating FDs provides insights on the potential impact of robotics on orthopedic procedures and may aid in understanding barriers to efficiency in robot-assisted and conventional orthopedic operations.