Learning curve analysis of robotic-assisted total knee arthroplasty with the HURWA surgical system

Abstract Purpose The aim of this study was to analyze the learning curve of total operative time, bone-cutting accuracy, and limb alignment in robot-assisted total knee arthroplasty (TKA) using the innovative image-based knee surgery robot known as HURWA. Additionally, a comparison was conducted with conventional TKA to ascertain the benefits of robotic-assisted TKA.Methods In this retrospective study, we analyzed a series of patients (n = 90) who underwent robotic-assisted total knee arthroplasty using the HURWA robot between December 2021 and October 2022. The procedures were performed by one of three orthopedic surgeons with varying levels of experience. As a control group, we selected the last 30 conventional TKA cases performed by each of these three surgeons. To determine the learning curve, we recorded the operative time, bone-cutting error, and pre- and postsurgery radiographs.Results The study found no significant differences in total operative time, bone-cutting accuracy, or limb alignment between the three surgeons. Of the three surgeons, surgeon 1, who had the most experience in joint arthroplasty, reached the learning curve in case 8, with the shortest bone-cutting time and robot time. Surgeon 2 reached the learning curve in case 16, while surgeon 3 reached the learning curve in case 9. There was no observable learning curve effect for bone-cutting accuracy and limb alignment. However, the percentage of cases where limb alignment differed from preoperative planning by 3° or less was higher in robotic-assisted TKA (77.97%) compared to conventional TKA (47.19%).Conclusion The study determined that the learning curve for robotic-assisted TKA using the HURWA knee surgery robot ranged from 8 to 20 cases. No observable learning curve effect was detected for bone-cutting accuracy or limb alignment. Experienced surgeons using the HURWA robot for bone- cutting took less time and reached the learning curve earlier. The HURWA robot achieved better limb alignment without depending on the experience of conventional TKA.The Translational Potential of this Article: The study of the learning curve of the surgical robot will give an indication of the ease of learning of the surgical robot and thus provide strong evidence for the extension and diffusion of the surgical robot to primary hospitals.