Early clinical outcomes and learning curve study of robot-assisted precision osteotomy in total knee arthroplasty in the context of enhanced recovery after surgery

To compare the early clinical outcomes of robot-assisted total knee arthroplasty (RA-TKA) with those of conventional manual total knee arthroplasty (CM-TKA) and analyse their learning curves. Patients who underwent initial unilateral total knee arthroplasty for osteoarthritis of the knee at Panzhihua Central Hospital between June and November 2023 were included in the study. A total of 130 patients were randomly divided into two groups: RA-TKA group underwent total knee arthroplasty with the HURWA Orthopaedic System (65 patients), and CM-TKA group patients underwent surgery with conventional tools (65 patients). Basic data, surgical information, imaging data and postoperative functional data were compared between the two groups. Surgical time was analysed via the cumulative sum analysis method (CUSUM), and the goodness of fit was assessed via R². The baseline data were consistent between the two groups; moreover, the FFC of the patients in RA-TKA group was closer to 90° than that in CM-TKA group (89.1 ± 1.0° vs. 87.6 ± 1.9°, respectively; P < 0.001), the LTC was concentrated at 87° (86.8 ± 0.9° vs. 85.9 ± 2.3°, respectively; P = 0.006), and the HKA was concentrated at 180° (179.1 ± 1.0 vs. 176.7 ± 1.7, P < 0.001). There was no significant difference observed in inflammatory indicators or perioperative blood loss. Overall, 7.80% (RA-TKA group) and 9.52% (CM-TKA group) of the patients developed lower extremity intermuscular venous thrombosis, but there was no difference in knee function, pain or satisfaction. The operation time of RA-TKA group was approximately 11.3 min longer than that of CM-TKA group. The learning curve was best fitted as a cubic curve, and the fitted curve reached its apex when the number of surgical cases increased to 22. During the entire learning curve, no surgical termination or accidental injury caused by the failure of the robotic system occurred, and none of the patients suffered from serious complications such as infections, periprosthetic fracture, or cardiac and cerebral vascular accidents. HURWA robot-assisted TKA with learning curve fixation in approximately 22 patients achieved good lower limb force line reconstruction and precise implantation of the prosthesis, which is a safe and effective surgical procedure for treating osteoarthritis of the knee. The study was retrospectively registered on China Clinical Trials Registry (identifcation number: ChiCTR2400086729) on 07/09/2024. https://www.chictr.org.cn/bin/project/edit?pid=201488 .