# Analysis of the Initial Learning Curve for Robotic-Assisted Total Knee Arthroplasty Using the ROSA® Knee System

## TL;DR

This study examines how surgeons learn to use a robotic system for knee replacement surgery, finding that experienced surgeons adapt faster.

## Contribution

The study quantifies the learning curve for robotic-assisted knee surgery and shows how prior experience affects it.

## Key findings

- Experienced surgeons needed 43 robotic cases to master the procedure, while all surgeons needed 61 cases.
- Operative times were longer during the learning phase of robotic surgery compared to the mastered phase.
- Operative times for robotic surgery remained longer than manual surgery even after mastery for most surgeons.

## Abstract

Background/Objectives: Total knee arthroplasty (TKA) is a frequent procedure in orthopedic surgery. Advances in TKA include the development of robotic-assisted systems. Training in raTKA entails a learning curve to achieve proficiency comparable to conventional manual TKA (maTKA). Methods: We conducted a prospective study of the learning curve in raTKA using the Robotic Surgical Assistant (ROSA) Knee System. The study included 180 patients (90 raTKAs; 90 maTKAs) and three surgeons (one with >15 years of experience in maTKA). The cumulative sum control chart method (CUSUM) was used to define the transition from the learning phase to the mastered phase in raTKA. Results: The learning curves were 43 cases (experienced surgeons) and 61 cases (all surgeons). Mean operative times for both phases in raTKA were longer than in maTKA (p < 0.001). In raTKA, operative times in the learning phase were longer compared to those in the mastered phase (p < 0.001). Operative times in the learning and mastered phases for all surgeons in raTKA were significantly longer compared to those in maTKA (p < 0.001); however, operative times of the experienced surgeon in the mastered phase of raTKA and in maTKA showed no differences. Conclusions: The learning curve in raTKA is dependent upon the surgeon’s previous experience in maTKA.