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Contemporary analysis of the learning curve for robotic-assisted total hip arthroplasty emerging technologies

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Abstract

Robotic assisted (RA) total hip arthroplasty (THA) offers improved acetabular component placement and radiographic outcomes, but inconsistent assessment methods of its learning curves render the evaluation of adopting novel platforms challenging. Therefore, we conducted a systematic review to assess the learning curve associated with RA-THA, both tracking a surgeon's performance across initial cases and comparing their performance to manual THA (M-THA). PubMed, MEDLINE, EBSCOhost, and Google Scholar were searched on June 16, 2023, to identify studies published between January 1, 2000 and June 16, 2023 (PROSPERO registration: CRD42023437339). The query yielded 655 unique articles, which were screened for eligibility. The final analysis included 11 articles, evaluating 1351 THA procedures. Risk of bias was assessed via the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean MINORS score was 21.3 ± 0.9. RA-THA provided immediate improvements in acetabular component placement accuracy and radiographic outcomes compared to M-THA, with little to no experience required to achieve peak proficiency. A modest learning curve (12–17 cases) was associated with operative time, which was elevated compared to M-THA (+ 9–13 min). RA-THA offers immediate advantages to M-THA for component placement accuracy and radiographic outcomes. Surgeons should expect to experience increased operative times, which become less pronounced or equivalent to M-THA after a modest caseload.

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References

  1. Del Schutte HJ, Lipman AJ, Bannar SM et al (1998) Effects of acetabular abduction on cup wear rates in total hip arthroplasty. J Arthroplasty 13:621–626. https://doi.org/10.1016/S0883-5403(98)80003-X

    Article  PubMed  Google Scholar 

  2. Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty 17:282–288. https://doi.org/10.1054/arth.2002.30286

    Article  CAS  PubMed  Google Scholar 

  3. D’Lima DD, Urquhart AG, Buehler KO et al (2000) The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am 82:315–321. https://doi.org/10.2106/00004623-200003000-00003

    Article  PubMed  Google Scholar 

  4. Lu Y, Xiao H, Xue F (2019) Causes of and treatment options for dislocation following total hip arthroplasty. Exp Ther Med 18:1715. https://doi.org/10.3892/ETM.2019.7733

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sarin VK, Pratt WR, Bradley GW (2005) Accurate femur repositioning is critical during intraoperative total hip arthroplasty length and offset assessment. J Arthroplasty 20:887–891. https://doi.org/10.1016/J.ARTH.2004.07.001

    Article  PubMed  Google Scholar 

  6. Emara AK, Samuel LT, Acuña AJ et al (2021) Robotic-arm assisted versus manual total hip arthroplasty: Systematic review and meta-analysis of radiographic accuracy. Intern J Med Robot Comput Assist Surg. https://doi.org/10.1002/rcs.2332

    Article  Google Scholar 

  7. Sato K, Sato A, Okuda N et al (2023) A propensity score-matched comparison between Mako robotic arm-assisted system and conventional technique in total hip arthroplasty for patients with osteoarthritis secondary to developmental dysplasia of the hip. Arch Orthop Trauma Surg 143:2755–2761. https://doi.org/10.1007/S00402-022-04524-Z

    Article  PubMed  Google Scholar 

  8. Kara GK, Turan K, Eroglu ON et al (2023) Is the acetabular cup orientation different in robot-assisted and conventional total hip arthroplasty with right-handed surgeons using an anterolateral approach? Cureus. https://doi.org/10.7759/CUREUS.42335

    Article  PubMed  PubMed Central  Google Scholar 

  9. Guo XZ, Dou BX, Liu Q et al (2007) Comparison of the acetabular orientation after minimally-invasive total hip arthroplasty with and without computer-navigation: a clinical report of 106 hip in 87 patients. Nat Med J China 87:2489–2493

    Google Scholar 

  10. Leenders T, Vandevelde D, Mahieu G, Nuyts R (2002) Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Comput Aided Surg 7:99–106. https://doi.org/10.1002/IGS.10033

    Article  CAS  PubMed  Google Scholar 

  11. Sharma AK, Cizmic Z, Carroll KM et al (2022) Computer navigation for revision total hip arthroplasty reduces dislocation rates. Indian J Orthop 56:1061–1065. https://doi.org/10.1007/s43465-022-00606-7

    Article  PubMed  PubMed Central  Google Scholar 

  12. DiGioia AM, Jaramaz B, Plakseychuk AY et al (2002) Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 17:359–364. https://doi.org/10.1054/arth.2002.30411

    Article  PubMed  Google Scholar 

  13. Kolodychuk N, Su E, Alexiades MM et al (2021) Can robotic technology mitigate the learning curve of total hip arthroplasty? Bone Jt Open 2:365–370. https://doi.org/10.1302/2633-1462.26.BJO-2021-0042.R1

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kamara E, Robinson J, Bas MA et al (2017) Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty: is acetabular positioning improved in the learning curve? J Arthroplasty 32:125–130. https://doi.org/10.1016/j.arth.2016.06.039

    Article  PubMed  Google Scholar 

  15. Buchan GBJ, Hecht CJ, Lawrie CM et al (2023) The learning curve for a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system. Int J Med Robot. https://doi.org/10.1002/RCS.2518

    Article  PubMed  Google Scholar 

  16. Kayani B, Konan S, Huq SS et al (2021) The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty. Hip Int 31:311–319. https://doi.org/10.1177/1120700019889334

    Article  PubMed  Google Scholar 

  17. Pernar LIM, Robertson FC, Tavakkoli A et al (2017) An appraisal of the learning curve in robotic general surgery. Surg Endosc 31:4583–4596. https://doi.org/10.1007/s00464-017-5520-2

    Article  PubMed  Google Scholar 

  18. Soomro NA, Hashimoto DA, Porteous AJ et al (2020) Systematic review of learning curves in robot-assisted surgery. BJS Open 4:27–44. https://doi.org/10.1002/BJS5.50235

    Article  CAS  PubMed  Google Scholar 

  19. Mazzon G, Sridhar A, Busuttil G et al (2017) Learning curves for robotic surgery: a review of the recent literature. Curr Urol Rep. https://doi.org/10.1007/s11934-017-0738-z

    Article  PubMed  Google Scholar 

  20. Arora KS, Khan N, Abboudi H et al (2015) Learning curves for cardiothoracic and vascular surgical procedures—a systematic review. Postgrad Med 127:202–214. https://doi.org/10.1080/00325481.2014.996113

    Article  PubMed  Google Scholar 

  21. Khan N, Abboudi H, Khan MS et al (2014) Measuring the surgical “learning curve”: methods, variables and competency. BJU Int 113:504–508. https://doi.org/10.1111/BJU.12197

    Article  PubMed  Google Scholar 

  22. Shlobin NA, Huang J, Wu C (2022) Learning curves in robotic neurosurgery: a systematic review. Neurosurg Rev. https://doi.org/10.1007/S10143-022-01908-Y

    Article  PubMed  Google Scholar 

  23. Luft HS, Bunker JP, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:1364–1369. https://doi.org/10.1056/NEJM197912203012503

    Article  CAS  PubMed  Google Scholar 

  24. Avendano JP, Sudah SY, Gencarelli P et al (2023) The learning curve for anatomic and reverse total shoulder arthroplasty: a systematic review. JSES Reviews, Reports, and Techniques 3:150. https://doi.org/10.1016/J.XRRT.2022.12.001

    Article  PubMed  Google Scholar 

  25. Tian R, Duan X, Kong N et al (2023) Precise acetabular positioning, discrepancy in leg length, and hip offset using a new seven-axis robot-assisted total hip arthroplasty system requires no learning curve: a retrospective study. J Orthop Surg Res. https://doi.org/10.1186/s13018-023-03735-3

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kong X, Yang M, Jerabek S et al (2020) A retrospective study comparing a single surgeon’s experience on manual versus robot-assisted total hip arthroplasty after the learning curve of the latter procedure—a cohort study. Int J Surg 77:174–180. https://doi.org/10.1016/j.ijsu.2020.03.067

    Article  PubMed  Google Scholar 

  27. Guo D, hui, Li X ming, Ma S qiang, et al (2022) Total hip arthroplasty with robotic arm assistance for precise cup positioning: a case-control study. Orthop Surg 14:1498–1505. https://doi.org/10.1111/OS.13334

    Article  PubMed  PubMed Central  Google Scholar 

  28. Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/J.1445-2197.2003.02748.X

    Article  PubMed  Google Scholar 

  29. Redmond JM, Gupta A, Hammarstedt JE et al (2015) The learning curve associated with robotic-assisted total hip arthroplasty. J Arthroplasty 30:50–54. https://doi.org/10.1016/J.ARTH.2014.08.003

    Article  PubMed  Google Scholar 

  30. Ying Heng Y, Gunaratne R, Ironside C et al (2018) Conventional vs robotic arm assisted total hip arthroplasty (THA) surgical time. Transfus Leng Stay Complicat Learn Curve. https://doi.org/10.4172/2167-7921.1000272

    Article  Google Scholar 

  31. Smith R, Borukhov I, Hampp E et al (2020) Comparison of precision for manual versus robotic-assisted total hip arthroplasty performed by fellows. J Hip Surg 4:117–123. https://doi.org/10.1055/S-0040-1714333

    Article  Google Scholar 

  32. Zhang J, Ng N, Scott CEH et al (2022) Robotic arm-assisted versus manual unicompartmental knee arthroplasty : a systematic review and meta-analysis of the MAKO robotic system. Bone Joint J. https://doi.org/10.1302/0301-620X.104B5.BJJ-2021-1506.R1

    Article  PubMed  PubMed Central  Google Scholar 

  33. Wang W, Zhang Z, Wang G et al (2023) Prospective randomized controlled trial on the accuracy of prosthesis positioning in total hip arthroplasty assisted by a newly designed whole-process robotic arm. Int Orthop 47:413–419. https://doi.org/10.1007/s00264-022-05501-2

    Article  PubMed  Google Scholar 

  34. Domb BG, El Bitar YF, Sadik AY et al (2014) Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study hip. Clin Orthop Relat Res 472:329–336. https://doi.org/10.1007/s11999-013-3253-7

    Article  PubMed  Google Scholar 

  35. Ma M, Song P, Zhang S et al (2023) Does robot-assisted surgery reduce leg length discrepancy in total hip replacement? Robot-assisted posterior approach versus direct anterior approach and manual posterior approach: a propensity score-matching study. J Orthop Surg Res 18:445. https://doi.org/10.1186/s13018-023-03864-9

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kumar V, Patel S, Baburaj V et al (2021) Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis. Postgrad Med J 99(1171):375–383

    Article  Google Scholar 

  37. Kayani B, Konan S, Thakrar RR et al (2019) Assuring the long-term total joint arthroplasty: a triad of variables. Bone Joint J 101B:11–18. https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0377.R1

    Article  Google Scholar 

  38. Chen X, Xiong J, Wang P et al (2018) Robotic-assisted compared with conventional total hip arthroplasty: systematic review and meta-analysis. Postgrad Med J 94:335–341. https://doi.org/10.1136/POSTGRADMEDJ-2017-135352

    Article  PubMed  Google Scholar 

  39. Han PF, Chen CL, Zhang ZL, Han YC et al (2019) Robotics-assisted versus conventional manual approaches for total hip arthroplasty: a systematic review and meta-analysis of comparative studies. Int J Med Robot. https://doi.org/10.1002/RCS.1990

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kort N, Stirling P, Pilot P, Müller JH (2021) Clinical and surgical outcomes of robot-assisted versus conventional total hip arthroplasty: a systematic overview of meta-analyses. EFORT Open Rev 6:1157–1165. https://doi.org/10.1302/2058-5241.6.200121

    Article  PubMed  PubMed Central  Google Scholar 

  41. Perets I, Mu BH, Mont MA et al (2020) Current topics in robotic-assisted total hip arthroplasty: a review. Hip Int 30:118–124. https://doi.org/10.1177/1120700019893636

    Article  PubMed  Google Scholar 

  42. Maldonado DR, Go CC, Kyin C et al (2021) Robotic arm-assisted total hip arthroplasty is more cost-effective than manual total hip arthroplasty: a markov model analysis. J Am Acad Orthop Surg 29:E168–E177. https://doi.org/10.5435/JAAOS-D-20-00498

    Article  PubMed  Google Scholar 

  43. Remily EA, Nabet A, Sax OC et al (2021) Impact of robotic assisted surgery on outcomes in total hip arthroplasty. Arthroplast Today 9:46–49. https://doi.org/10.1016/J.ARTD.2021.04.003

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Christian J. Hecht, Joshua R. Porto, Parshva A. Sanghvi & Atul F. Kamath

  2. Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan

    Yasuhiro Homma

  3. Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan

    Yasuhiro Homma

  4. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA

    Peter K. Sculco

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  1. Christian J. Hecht
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Contributions

CJH, JRP, PAS were involved in conceptualization, methodology, formal analysis, visualization, writing original draft, and writing review and editing. YH, PKS, and AFK were involved in conceptualization, methodology, project administration, formal analysis, visualization, writing original draft, writing review and editing, and supervision.

Corresponding author

Correspondence to Atul F. Kamath.

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Conflict of interest

A.F.K. reports the following disclosures: paid presenter or speaker (Zimmer Biomet), paid consultant (Zimmer Biomet, BodyCad, Ortho Development, United Ortho), stock or stock options (Zimmer Biomet, Johnson & Johnson, and Procter & Gamble), IP royalties (Innomed), and board or committee member (AAOS, AAHKS, and Anterior Hip Foundation). P.K.S. reports the following disclosures: research support (Intelijoint Surgical), paid presenter of speaker (Intelijoint Surgical, DePuy, EOS Imaging), paid consultant (Intelijoint Surgical, Zimmer Biomet, DePuy, EOS Imaging, Lima Corporate), and stock or stock options (Intelijoint Surgical, Parvizi Surgical Innovation). CJH, JRP, PAS, and YH have no disclosures.

Ethical approval

Ethical approval was waived as our analysis does not contain human data. Registration: PROSPERO registration of the study protocol: CRD42023437339, 27 June 2023.

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Hecht, C.J., Porto, J.R., Sanghvi, P.A. et al. Contemporary analysis of the learning curve for robotic-assisted total hip arthroplasty emerging technologies. J Robotic Surg 18, 160 (2024). https://doi.org/10.1007/s11701-024-01928-4

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