The introduction of robotic-arm assisted Total Hip Arthroplasty: Learning curve and effect on theatre utilization.

Abstract

Background: The objective of this study was to report on the learning curve associated with the introduction of robotic-arm assisted Total Hip Arthroplasty with a focus on operating theatre utilization. Methods: A total of 339 primary THA cases (225 robotic-arm assisted, 114 conventional) were eligible for inclusion in this retrospective observational study. All patients underwent hybrid THA by a single surgeon using a posterolateral approach. The anaesthetic, intraoperative, and postoperative protocols remained unchanged during the study. Total case time was defined as the interval from arrival to the operating theatre complex to entering the recovery area. Results: 281 cases were included in the theatre utilization analysis. There were no differences in the demographics between the robotic-arm assisted and conventional THA cases in terms of age (p=0.463) or gender (p=0.953). Total case time for conventional THA was 100 minutes (95% CI: 98.04 to 102.06) and 127.6 minutes (95% CI: 125.5 to 129.63) for robotic-arm assisted. Robotic-arm assisted THA (n=188) cases were analysed in sequential groups of 50 (Groups A to D). Robotic arm THA total case time decreased by 16 minutes between Group A (mean 135.44, 95%CI:131.21 to 139.6) and Group D (mean 119.45, 95%CI: 115.88 to 123.01). Robotic THA cases were associated with a 35% increase in total case time in the early phase which reduced to a 19% increase after 150 cases. Conclusion: Operating theatre utilization analysis revealed increased total case time in robotic-arm assisted cases which gradually improved over the duration of the study.