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Published on: September 7, 2022
Approach-specific learning curves for operative efficiency in robotic-assisted total hip arthroplasty
Tjeerd Jager1,2, Fred Ruythooren1,3, Olivier Vinckier1
1Department of Orthopaedic Surgery, AZ Delta, Roeselare, Belgium.
Summary
Robotic-assisted total hip arthroplasty (RA-THA) shows significant learning curves for operative efficiency, with the direct anterior approach (DAA) requiring more cases to achieve proficiency than the posterolateral approach (PL). Experience gradually improves operative times, eventually matching or slightly exceeding conventional methods.
Area of Science:
- Orthopedic Surgery
- Robotics in Medicine
- Surgical Technique Evaluation
Background:
- Robotic-assisted total hip arthroplasty (RA-THA) offers improved component positioning accuracy.
- The learning curve for achieving efficient operative performance in RA-THA is not well-defined.
Purpose of the Study:
- To evaluate the learning curve and operative efficiency of robotic-assisted total hip arthroplasty (RA-THA) using the MAKO system.
- To compare operative times between the direct anterior approach (DAA) and posterolateral approach (PL) in RA-THA.
- To compare RA-THA operative efficiency with conventional total hip arthroplasty (THA).
Main Methods:
- Retrospective review of 579 consecutive RA-THA procedures (MAKO system) and a historical conventional THA cohort.
- Analysis of operative times using cumulative summation (CUSUM) to define learning curves and proficiency points.
- Comparison of demographic variables and operative times between learning-phase, proficiency-phase, and conventional THA groups.
Main Results:
- Proficiency in RA-THA was achieved after 73 cases for DAA and 41 cases for PL.
- Mean operative time significantly decreased from learning to proficiency phases for both DAA (97.9 to 79.7 min) and PL (89.7 to 72.8 min).
- Proficiency-phase RA-THA operative times were slightly shorter for DAA (-3 min) and comparable for PL versus conventional THA.
Conclusions:
- Robotic-assisted THA (RA-THA) demonstrates substantial, approach-specific learning curves for operative efficiency.
- The direct anterior approach (DAA) has a longer learning curve threshold compared to the posterolateral approach (PL).
- Institutions should anticipate learning curves, implement structured training, and prepare for an initial adaptation period when adopting RA-THA.