Time neutrality and reduced ecological burden - handheld robotic-assisted total knee arthroplasty improves operating...

To evaluate whether imageless handheld robotic-assisted total knee arthroplasty (rTKA) can achieve time neutrality compared with manual TKA (mTKA) within a standardised workflow, while assessing operating-room (OR) efficiency, environmental impact, and intraoperative workload demand.

In this prospective study, 24 consecutive patients undergoing primary TKA were stratified to either rTKA (n = 12) or mTKA (n = 12). A process analysis captured 75 timestamps per case and quantified preparation, surgical, breakdown, turnover, and total OR times. Instrument trays were counted and weighed; reprocessing-related water and electricity consumption and costs were estimated. Perceived workload demand was assessed after both rTKA and mTKA using the NASA Task Load Index.

No statistically significant differences were observed between rTKA and mTKA for any OR time interval (total OR time 79.8 ± 8.1 vs. 75.8 ± 5.3 min, p = 0.19; mean surgical time 40.3 ± 4.2 vs. 37.3 ± 3.9 min, p = 0.10 for rTKA vs. mtKA respectively). The reduction of one tray for rTKA cases corresponded to estimated savings of €13,900, 3,900 L of water, and 140 kWh of electricity in sterilisation based on an annual volume of 250 cases. For rTKA, the NASA-TLX domain scores demonstrated lower perceived workload and frustration for rTKA than for mTKA (all p < 0.001), with a significantly higher perceived performance rating (p = 0.025).

Imageless handheld rTKA achieved time neutrality compared with mTKA in a standardised high-volume workflow and was associated with reduced intraoperative workload demand. These findings support the feasibility of integrating handheld robotic assistance without compromising OR efficiency, while potentially improving staff experience and reducing resource utilisation, thereby contributing to value-based arthroplasty care.