Learning curve with a new primary total knee arthroplasty implant: a multicenter perspective with more than 2000 patients

Whittaker, John-Paul; Dwyer, Kimberly A.; Howard, James L.; Huey, Verdonna; Lesko, J; Nunley, Ryan M.; Verdonk, Peter

doi:10.1016/j.artd.2018.05.004

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…UKA has a longer learning curve compared with TKA techniques [31], for example 25 cases for Oxford UKA [44]. The learning curve found here was on par with those previously reported for navigated TKA systems of 10 cases [41] and slightly longer than robotic‐arm assisted systems for TKA of 7 cases [20]. Over 90% of knee surgeons perform under 12 UKA per year [25], and a short learning curve means that proficiency can be achieved sooner.…”

Section: Discussionsupporting

confidence: 71%

Robotic-arm assisted unicompartmental knee arthroplasty system has a learning curve of 11 cases and increased operating time

Tay

Carter²,

Bolam

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeUKA has higher revision risk, particularly for lower volume surgeons. While robotic‐arm assisted systems allow for increased accuracy, introduction of new systems has been associated with learning curves. The aim of this study was to determine the learning curve of a UKA robotic‐arm assisted system. The hypothesis was that this may affect operative times, patient outcomes, limb alignment, and component placement. MethodsBetween 2017 and 2021, five surgeons performed 152 consecutive robotic‐arm assisted primary medial UKA, and measurements of interest were recorded. Patient outcomes were measured with Oxford Knee Score, EuroQol‐5D, and Forgotten Joint Score at 6 weeks, 1 year, and 2 years. Surgeons were grouped into ‘low’ and ‘high’ usage groups based on total UKA (manual and robotic) performed per year. ResultsA learning curve of 11 cases was found with operative time (p < 0.01), femoral rotation (p = 0.02), and insert sizing (p = 0.03), which highlighted areas that require care during the learning phase. Despite decreased 6‐week EQ‐5D‐5L VAS in the proficiency group (77 cf. 85, p < 0.01), no difference was found with implant survival (98.2%) between phases (p = 0.15), or between ‘high’ and ‘low’ usage surgeons (p = 0.23) at 36 months. This suggested that the learning curve did not lead to early adverse effects in this patient cohort. ConclusionIntroduction of a UKA robotic‐arm assisted system showed learning curves for operative times and insert sizing but not for implant survival at early follow‐up. The short learning curve regardless of UKA usage indicated that robotic‐arm assisted UKA may be particularly useful for low‐usage surgeons. Level of evidenceLevel III, Retrospective cohort study.

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Section: Discussionsupporting

confidence: 71%

Robotic-arm assisted unicompartmental knee arthroplasty system has a learning curve of 11 cases and increased operating time

Tay

Carter²,

Bolam

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…The first 10 New-TKA learning curve cases that each surgeon implanted were included in this study and have also been analyzed separately to explore the technically demanding skills associated with New-TKA adoption. 12 Both cohorts included all four TKA configurations (cruciate-retaining fixed bearing, cruciate-retaining rotating platform, posterior-stabilized fixed bearing, and posterior-stabilized rotating platform). Study investigators were trained on the New-TKA before enrollment and most attended cadaveric-based training.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Existing and New Total Knee Arthroplasty Implant Systems From the Same Manufacturer: A Prospective, Multicenter Study

Hamilton

Brenkel²,

Barnett³

et al. 2021

JAAOS Glob Res Rev

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Introduction: This study evaluated total knee arthroplasty (TKA) outcomes for an Existing-TKA versus New-TKA from the same manufacturer. Methods: TKA outcomes for 752 with Existing-TKA versus 1129 subjects with New-TKA were followed through 2 years using patient-reported outcome measures (PROMs). Responders were assessed per Outcome Measures in Rheumatology-Osteoarthritis Research Society International criteria. Kaplan-Meier implant survivorship was estimated. Radiographs had an independent radiographic review. Results: Two-year follow-up was 84.6% (636/752) for Existing-TKA and 82.5% (931/1129) for New-TKA. Two-year PROMs mean outcomes for New-TKA versus Existing-TKA at 2 years were: Knee Injury and Osteoarthritis Outcome Score (ADL: 89.0 versus 86.8, P = 0.005; pain: 88.9 versus 87.1, P = 0.019; symptoms: 84.1 versus 82.2, P = 0.017; Sport/Rec: 63.9 versus 58.8, P = 0.001; and QOL: 77.0 versus 73.5, P = 0.003), Patient's Knee Implant Performance (overall: 76.5 versus 73.5, P = 0.003; confidence: 8.4 versus 8.1, P = 0.004; stability: 8.6 versus 8.3, P = 0.006; satisfaction: 8.3 versus 8.1, P = 0.042; and modifying activities: 6.6 versus 6.4, P = 0.334), Oxford Knee Score (41.9 versus 41.1, P = 0.027), and EQ5D-3L (0.88 versus 0.88, P = 0.737). Two-year responder rates using WOMAC were 93.9% versus 90.6% ( P = 0.018) for New-TKA versus Existing-TKA. Independent radiographic review showed that tibial and femoral radiolucencies ≥2 mm were similar ( P ≥ 0.05) or favored New-TKA. Implant survivorship was similar between groups (log-rank P = 0.9994). Discussion: New-TKA versus Existing-TKA demonstrated slightly better PROMs with similar radiographic and implant survivorship outcomes.

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“…Their study was, however, a retrospective study with a risk of selection bias, and all trainee surgeons had 2 years of surgical education prior to performing the surgery and were supervised throughout the operation by senior surgeons. Relatedly, a multicenter study examining the learning curve of a novel TKA introduction found no difference in intraoperative outcome and patient reported outcome measures (PROMs), and only a slight increase in operation time[ 15 ]. All surgeons in our study were very experienced at performing knee arthroplasty, thus limiting the learning curve.…”

Section: Discussionmentioning

confidence: 99%

Early clinical outcome and learning curve following unilateral primary total knee arthroplasty after introduction of a novel total knee arthroplasty system

Omari¹,

Troelsen²,

Nielsen³

et al. 2020

WJO

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BACKGROUND New implants for total knee arthroplasty (TKA) are continuously introduced with the proposed benefit of increased performance and improved outcome. Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation. AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system. METHODS A novel TKA system was introduced at our institution on 30th November 2015. Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons (25 TKAs/surgeon) were identified as the Introduction Group. Moreover, the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group. A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period. Demographics, surgery-related factors and alignment data were recorded, and intergroup differences compared. RESULTS Following introduction of the novel implant, Persona TKA was utilized in 69% (71%), 53% (54%), and 45% (75%) of primary TKA procedures by the three surgeons, respectively (Follow-up Group). Mean surgery time was increased by 28% ( P < 0.0001) and mean intra-operative blood loss by 25% ( P = 0.002) in the Introduction Group, while only the mean surgery time was increased in the Follow-up Group by 18% ( P < 0.0001). Overall alignment was similar between the groups apart from femoral flexion (FF) and tibial slope (TS). The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group. CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction. These differences diminished one year after introduction of the new implant. Fewer outliers with respect to FF and TS were seen when using the novel TKA implant. Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.

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Learning curve with a new primary total knee arthroplasty implant: a multicenter perspective with more than 2000 patients

Cited by 8 publications

References 19 publications

Robotic-arm assisted unicompartmental knee arthroplasty system has a learning curve of 11 cases and increased operating time

Robotic-arm assisted unicompartmental knee arthroplasty system has a learning curve of 11 cases and increased operating time

Comparison of Existing and New Total Knee Arthroplasty Implant Systems From the Same Manufacturer: A Prospective, Multicenter Study

Early clinical outcome and learning curve following unilateral primary total knee arthroplasty after introduction of a novel total knee arthroplasty system

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