The Impact of Robotics on Procedural Flow and Surgeon Strain in Total Knee Arthroplasty

Objectives: This study aimed to identify the impact of robot assistance on the progression of total knee arthroplasty (TKA) operations by observing flow disruptions (FD), deviations in the natural progression of a task, while also evaluating the differences in surgeon cognitive and physical strain with each approach. Methods: Conventional (C-TKA) and robot-assisted (R-TKA) total knee arthroplasty procedures were observed at a nonprofit academic medical center in Southern California over 3 months in 2022. All procedures were observed in 3 operative phases: (1) wheels-in to procedure start; (2) procedure start to procedure end; and (3) procedure end to wheels-out. FDs were recorded and classified into 8 categories. SURG-TLX and Borg Scale questionnaires were also administered. Results: Thirteen TKA procedures (C-TKA: n=6; R-TKA: n=7) were observed. Mean total operative duration was 159.2±44.7 minutes for C-TKA and 201.9±25.8 minutes for R-TKA. Mean phase 2 durations were 91.1±34.1 minutes for C-TKA and 134.0±25.4 minutes for R-TKA. Overall FD rate was 7.6±1.4 FDs/hour for C-TKA and 9.9±2.3 FDs/hour for R-TKA procedures. Major disruption types consisted of coordination, training, and communication for C-TKA and coordination, surgical task considerations, and environment for R-TKA. Mean SURG-TLX values were highest for the Task Complexity domain following C-TKA procedures and for the Physical Demands domain following R-TKA procedures. Conclusions: Investigating FDs provides insights on the potential impact of robotics on orthopedic procedures and may aid in understanding barriers to efficiency in robot-assisted and conventional orthopedic operations.