The learning curve for a novel, fluoroscopy‐based robotic‐assisted total hip arthroplasty system

Abstract

Background Adoption of robotic‐assisted total hip arthroplasty (RA‐THA) systems can improve the accuracy of acetabular cup placement, but no group has reported the learning curve of novel, fluoroscopy‐based RA‐THA systems. Methods A learning‐curve cumulative summation (LC‐CUSUM) analysis was performed on a consecutive series of the first 100 patients who received fluoroscopy‐based RA‐THA by the study surgeon. Operative times and specific robotic timepoints were compared between learning and proficiency phases. Results Implementation of fluoroscopy‐based RA‐THA was associated with a learning curve of 12 cases. A 6‐min increase in operative time was seen during the learning phase compared to the proficiency phase (44.3 ± 4.4 vs. 38.0 ± 7.1 min; p < 0.001), with a 3‐min longer robotic cup impaction sequence during the learning phase (7.8 ± 1.9 vs. 4.8 ± 1.3 min; p < 0.001). Conclusion Adoption of fluoroscopy‐based RA‐THA is associated with a brief learning curve of 12 cases, with the most significant improvements in surgical efficiency realised during acetabular cup placement.

Improved perioperative narcotic usage patterns in patients undergoing robotic-assisted compared to manual total hip arthroplasty

“…Fourth, as the RA-THA cohort included the first fluoroscopy-based RA-THA cases performed by the study surgeon, it is possible that there was a learning curve effect for postoperative pain control. However, it has been previously reported that no learning curve effect was seen with this robotic system with respect to cup placement [ 32 ], thus it is unlikely that a learning curve exists with respect to postoperative pain control.…”

Robotic-assisted Total Hip Arthroplasty Utilizing a Fluoroscopy-guided System Produced Similar Cup Accuracy and Precision Relative to a Computerized Tomography-based Robotic Platform

“…The second signi cant nding of this study was that the FL-RTHA and CT-RTHA platforms had similar accuracy outcomes, and also had similar proportions of cups placed within the Lewinnek zone. The authors surmise that the observed 1.2° difference in inclination accuracy between systems is a result of the FL-RTHA cohort including cases from the surgeon's learning period with the system, which is traditionally associated with inferior surgical performance compared to the post-pro ciency stage [32,33]. One investigation reported an average cup implantation angle difference of 2.8° for inclination, and 3.5° for anteversion between pre-and post-pro ciency procedures when adopting an intra-operative assistance system for THA [34].…”

Use of a fluoroscopy‐based robotic‐assisted total hip arthroplasty system resulted in greater improvements in hip‐specific outcome measures at one‐year compared to a CT‐based robotic‐assisted system

“…Racial minorities historically experience diminished pre-and post-operative PROMs relative to Caucasians, [39][40][41][42] and patients with a pre-operative diagnosis of avascular necrosis may report inferior pain outcomes following THA compared with patients with osteoarthritis. 43 Additionally, unlike the CT-RTHA cohort, the FL-RTHA cohort included cases performed during the surgeon's learning period for the robot, 44 which could have resulted in inferior outcomes relative to cases performed post-proficiency. 45 The learning period is likely an important driving factor for the 1.06°d ifference in inclination accuracy observed between the FL-RTHA and CT-RTHA cohorts.…”