Over exposure to Robotic assisted TKAs by resident doctors may result in decreased comfort with traditional instrumentation

As robotic-assisted total knee replacement (rTKA) continues to gain popularity, the impact of this technology on resident education remains unknown.

I.M. Duensing et al conducted a study to describe trainee experience and perceptions of rTKA and its effect on surgical training.

Two hundred and twenty two (222) senior orthopaedic residents attending a national board review course completed a 17-question survey regarding their experience and perceptions regarding rTKA. Mean and standard deviations were calculated for Likert scale questions, and bivariate analyses were utilized to compare answer groups.

Key findings of the study:

• Seventy percent of respondents reported exposure to rTKA during their training.

• Of those with robotic exposure, 20% reported that greater than half of their TKA experience involved robotics.

• Only 29% percent agreed that robotics improved outcomes, whereas 21% disagreed and the remainder were unsure.

• Over half of respondents agreed that robotics is used primarily for marketing purposes.

• Of those who trained with rTKA, 45% percent believed that robotics improved their understanding of the surgical procedure; however, 25% felt robotics negatively compromised their training with traditional instrumentation.

• Higher robotic case exposure (P = .001) and attending an industry-sponsored course (P = .02) was associated with the belief that robotics improved outcomes.

• Robotic case volume and percentage was associated with the belief that robotics improved understanding of the surgical procedure, however, it also was associated with reduced comfort performing traditional knee arthroplasty (P =.001).

“In conclusion, robotic-assisted technology has infiltrated the field of adult reconstruction with unclear clinical benefit to patient outcomes. There are potentially unforeseen, unpredictable, and possibly untoward effects on resident education and surgical training with the increasing use of robotic assistance in residency training programs. While the use of technology may aid in surgical education, it is clear that concern exists that robotics may have detrimental impacts on educating trainees in TKA techniques and concepts, particularly when it comes to the use of manual instrumentation. Continuing to familiarize trainees with manually instrumented total knee arthroplasties should remain at the forefront of training” - the authors commented.

Further reading:

The Impact of Robotic-Assisted Total Knee Arthroplasty on Resident Training

Ian M. Duensing, Wells Stewart et al

The Journal of Arthroplasty 38 (2023) S227-S231

https://doi.org/10.1016/j.arth.2023.02.016