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Integrating Robotic-Assisted Arthroplasty into Orthopaedic Education: The Fellows' Perspective
Michael Danaher1, Christopher Lin1, Nathaniel Nelms1
1University of Vermont Medical Center, Orthopedics and Rehabilitation Center, and the Department of Orthopaedics and Rehabilitation, The Robert Larner, M.D., College of Medicine at The University of Vermont, Burlington, VT.
Background:
Robotic-assisted total joint arthroplasty (RTJA) is increasingly used to improve patient outcomes and reduce revision rates in total joint arthroplasty (TJA). With robotic-assisted total knee arthroplasty (RTKA) projected to exceed 70% of cases by 2030, concern exists about whether orthopaedic residents are being adequately trained.
Methods:
Orthopaedic arthroplasty fellows between 2023 and 2025 completed an anonymous electronic survey assessing exposure to RTJA and conventional TJA (CTJA), impact on fellowship selection, and projected future use. Incomplete responses and non-fellows were excluded.
Results:
Of 60 respondents, 78% were exposed to RTKA, 52% to robotic-assisted unicompartmental knee arthroplasty (RUKA), and 48% to robotic-assisted total hip arthroplasty (RTHA). Satisfaction with training was higher for conventional procedures: 82 versus 53% (TKA), 97 versus 32% (THA), and 23 versus 31% (UKA). Most felt comfortable performing conventional TKA (CTKA) and THA (CTHA) independently; among robotic procedures, only RTKA had similar comfort levels. Fellowship selection was influenced by a desire for balanced robotic and manual experience (66.7%). While 42% did not believe robotics should be required in residency, most agreed it improved understanding and performance (68% RTKA, 61% RUKA, and 75% RTHA respondents). Robotic exposure during residency was associated with higher satisfaction and preparedness (P < 0.001) and increased support for requiring training in RUKA (P = 0.015) and RTHA (P = 0.006). Regional differences in exposure and satisfaction were also observed. Fellows planning to use robotics in greater than 50% of future cases were more likely to choose robotics-focused fellowships (P = 0.003).
Conclusion:
Arthroplasty fellows reported high satisfaction with conventional arthroplasty training, whereas satisfaction and self-reported preparedness for robotic-assisted procedures were lower. Prior robotic exposure during residency was associated with higher satisfaction and preparedness, and fellows expressed interest in balanced robotic and manual fellowship experiences. These findings provided a baseline of current trainee perceptions.
