Eytan M. Debbi

As robotic total knee arthroplasty (TKA) adoption grows, the learning curve for new users remains a concern for both physicians and staff. Previous studies have reported on clinical outcomes for TKA with a novel implant-agnostic, handheld, wireless robotic TKA system (rTKA). This study investigates the rTKA adoption learning curve relevant to multiple clinical stakeholders. This multicenter, multi-surgeon observational study includes up to the first 25 rTKA procedures by 7 surgeons. Observers noted timing and workflow at 8/25 rTKA cases and 2 standard-of-care benchmark TKAs (prior manual or robotic use by user), and analyzed logs for all rTKA cases. Learning curves were assessed via benchmark TKA time neutrality, statistical comparison between early and later cases, and cumulative sum (CUSUM) analysis. Surgeon and staff surveys followed each observed rTKA case. Each analysis type demonstrated a different learning curve duration: surgeons averaged approximately 10 cases to time neutrality, with 2 not reaching time neutrality within the observed case series. Cases 3 and onward were significantly faster than cases 1–2 (p = 0.0454), indicating early operative time improvement after initial system exposure. Average observed skin-to-skin time was 68 min. Surgeons and staff rated the system easy to use and were familiar with the system after 4 cases. Use of the handheld surgical robot for rTKA demonstrated a short learning curve and high reported ease of adoption by surgeons and staff. This study demonstrates the rTKA system exhibits a short learning curve and high reported ease of adoption, and may compare favorably with previously reported learning curves for other robotic TKA systems. Level of evidence: IV.

Purpose: The percentage of total knee arthroplasty (TKA) performed robotically (rTKA) is rising exponentially. While this technique has well‐established accuracy improvements, there are mixed patient‐reported outcome measure (PROM) benefits compared to manual TKA (mTKA). Potential challenges in workflow, restricted implant compatibility to the robot and system cost have limited robotic adoption. A new robot seeks to address these and other rTKA concerns. Methods: This was a single surgeon retrospective series of the first 25 rTKA cases performed with a novel, wireless, handheld, open‐implant robot and 25 mTKA cases. Data were recorded to observe performance and safety outcomes, including X‐ray‐based hip‐knee‐ankle (HKA) angle measurements, adverse events (AEs), range of motion (ROM), and PROMs including pain and knee society score (KSS). Case times for a subset of cases were recorded. rTKA cases were completed with implants not previously used by the surgeon. mTKA cases used implants and instrumentation standard to the surgeon's practice. Patients were tracked up to 3 months. Results: rTKA and mTKA cases both yielded positive clinical results. There were 0/25 HKA angle outliers (>3° from plan) and 1/25 outliers in the rTKA and mTKA cohorts, respectively. No AEs were observed in either group at follow‐up. rTKA case times were similar to mTKA by case 5, with rTKA setup under 8 min for most cases. There were no differences in ROM or PROMs between cohorts. Conclusion: rTKA preliminarily showed safe and effective outcomes in early results. Surgeon and staff adoption showed minimal hurdles at this institution, as rTKA case with an implant system new to the surgeon were similar within five cases to mTKA case times using an implant system known to the surgeon, with comparable clinical results. This initial experience suggests the system may offer a more accessible alternative to existing robotic options, though further study is needed. Level of Evidence: Level IV.

» As healthcare systems shift to value-based models, patient-reported outcome measures (PROMs) are increasingly used to measure effectiveness, efficiency, and patient satisfaction. » PROMs provide valuable insights into treatment efficacy from the patient's perspective and are increasingly essential in value-based healthcare models. » A variety of both joint-specific PROMs (i.e., Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement [HOOS-JR]/Knee Injury and Osteoarthritis Outcome Score for Joint Replacement [KOOS-JR]) and general PROMs (i.e., Patient-Reported Outcomes Measurement Information System [PROMIS]) currently exist for utilization in TJA practices. » We recommend collection of the PROMIS score, the HOOS-JR/KOOS-JR, and either the University of California Los Angeles activity score or Forgotten Joint Score within 3 months preoperatively and at 1, 3, 6, and 12 months postoperatively, with final collection between 10 and 14 months. » Continued integration of PROM research and practice will enable orthopaedic surgeons to further improve patient outcomes and overall care in TJA.

Simultaneous bilateral total hip arthroplasty (blTHA) offers the benefit of a single episode of care with the potential for lower cumulative operative times and rehabilitation periods than staged bilateral total hip arthroplasty (stTHA). This study analyzes short-term complication rates after blTHA relative to unilateral THA (ulTHA) and projected stTHA in patients with bilateral hip osteoarthritis. We compared complications in a simultaneous blTHA group and a ulTHA group using the National Surgical Quality Improvement Program (NSQIP) database. ulTHA patients were propensity-matched two-to-one against blTHA patients using morbidity probability score. Thirty-day complication rates were compared. Outcomes in staged procedures (stTHA) were projected by doubling complication rates in ulTHA procedures. There were 805 blTHA patients and 1,610 ulTHA patients used to estimate stTHA outcomes. The rate of major complications or death after blTHA was no higher than the projected stTHA rate (2.0 vs 3.0%, p = 0.179), but minor complications were more common after blTHA than stTHA projections (13.5 vs 6.8%, p < 0.001). Mean operative time for blTHA was 39.2 minutes shorter than that for stTHA (p < 0.001); mean hospital stay was 1 day shorter for blTHA than that for stTHA (p < 0.001). Thirty-day rates of periprosthetic fracture (0.62 vs 0.12%, p = 0.045) and dislocation (0.50 vs 0.1%, p = 0.1) were higher after blTHA than stTHA. Simultaneous blTHA appears safe in patients medically fit to tolerate longer uninterrupted surgery and appears to shorten operative time and hospital stay relative to staged THA. There is a significantly higher risk of blood transfusion, periprosthetic fracture, and dislocation after blTHA.