ArticleJournal of robotic surgery2026
Transferability of robotic surgical proficiency across platforms in knee replacement: analysis of the early learning curve in an experienced surgeon.
Article in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Learning curves for robotic total knee arthroplasty (TKA) have been widely described during the initial adoption of robotic technology. However, it remains unclear whether robotic surgical proficiency is platform-specific or transferable between systems based on different modelling paradigms. The purpose of this study was to evaluate whether an experienced robotic surgeon demonstrates a measurable learning curve when transitioning from imageless to CT-based robotic TKA. A senior surgeon with experience exceeding 1000 robotic knee arthroplasties performed using imagel-ess platforms transitioned to a CT-based robotic TKA system. The first 25 consecutive CT-based robotic TKAs were prospectively analysed. Operative time and postoperative radiographic alignment (HKA, LDFA, MPTA, tibial slope) were assessed. Learning curve dynamics were evaluated using cumulative sum (CUSUM) and segmented regression analyses. Radiographic outliers were defined as deviations greater than 2° from the planned target. Operative time decreased from 65 min in the first case to a steady-state mean of 55 ± 3 min (95% CI 53.8-56.2) by case 3, corresponding to a 15.4% reduction. Continuous CUSUM demonstrated an inflection point at case 2, confirmed by segmented regression (p < 0.05). Mean postoperative alignment was 0.7° ± 1.2° for HKA, 88.5° ± 1.1° for LDFA, 87.8° ± 1.2° for MPTA, and 4.8° ± 0.7° for tibial slope. No radiographic outliers (> 2°) were observed after case 2. In an experienced robotic surgeon, transition from imageless to CT-based robotic TKA was not associated with a clinically relevant learning curve. Operative efficiency stabilised rapidly and radiographic alignment accuracy was maintained from the earliest procedures. These findings suggest that robotic TKA proficiency may be transferable across platforms, although confirmation through multicentre comparative studies remains necessary. Level IV.
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