The learning curve for a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system

Background: Adoption of robotic-assisted total hip arthroplasty (RA-THA) systems can improve the accuracy of acetabular cup placement, but no group has reported the learning curve of novel, fluoroscopy-based RA-THA systems. Methods: A learning-curve cumulative summation (LC-CUSUM) analysis was performed on a consecutive series of the first 100 patients who received fluoroscopy-based RA-THA by the study surgeon. Operative times and specific robotic timepoints were compared between learning and proficiency phases. Results: Implementation of fluoroscopy-based RA-THA was associated with a learning curve of 12 cases. A 6-min increase in operative time was seen during the learning phase compared to the proficiency phase (44.3 +/- 4.4 vs. 38.0 +/- 7.1 min; p < 0.001), with a 3-min longer robotic cup impaction sequence during the learning phase (7.8 +/- 1.9 vs. 4.8 +/- 1.3 min; p < 0.001). Conclusion: Adoption of fluoroscopy-based RA-THA is associated with a brief learning curve of 12 cases, with the most significant improvements in surgical efficiency realised during acetabular cup placement.