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

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). 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. 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 ( < 0.001). In raTKA, operative times in the learning phase were longer compared to those in the mastered phase ( < 0.001). Operative times in the learning and mastered phases for all surgeons in raTKA were significantly longer compared to those in maTKA ( < 0.001); however, operative times of the experienced surgeon in the mastered phase of raTKA and in maTKA showed no differences. The learning curve in raTKA is dependent upon the surgeon's previous experience in maTKA.