JOA - 2026-04-09 - Journal Article
Institutional Surgical Volume and Operative Efficiency in Robotic-Assisted Total Knee Arthroplasty: An Analysis from the American Joint Replacement Registry.
Haikal ER, Zaniletti I, Katchis CS, Ang BK, Lafage V, Slover JD
Topics
Key Takeaway
High-volume RA-TKA centers (≥12 cases/month) achieved mean operative times of 85.9 minutes and 66.8% efficiency benchmark attainment, versus 100.4 minutes and 39.7% at low-volume centers across 156,347 cases.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study used AJRR data (2017–2024) to determine whether institutional RA-TKA volume predicts operative efficiency, defined as median operative time ≤90 minutes. High-volume centers (≥12 cases/month) averaged 85.9 ± 30.5 minutes versus 100.4 ± 32.8 minutes at low-volume centers, with CUSUM analysis showing high-volume centers required ~550 cumulative cases to sustain sub-90-minute performance compared to ~650 for medium-volume centers. Low-volume centers never achieved sustained efficiency, and only 39.7% met the benchmark versus 66.8% of high-volume centers (P<0.001).
Key Limitation
The 90-minute efficiency threshold is arbitrary and not validated against patient outcomes, complication rates, or implant survivorship, limiting the clinical significance of the efficiency benchmark itself.
Original Abstract
INTRODUCTION
Robotic-assisted total knee arthroplasty (RA-TKA) has gained momentum as a method to enhance precision and potentially improve surgical outcomes. However, institutional adoption patterns and associated institutional operative efficiency remain inadequately characterized. This study aimed to assess how institutional surgical volume influences the operational efficiency of RA-TKA across the United States.
METHODS
Data were sourced from the American Joint Replacement Registry for all primary elective RA-TKA cases performed between January 2017 and December 2024. A total of 156,347 RA-TKA cases across 451 institutions were analyzed. Institutions were categorized by monthly case volume into low (less than five), medium (five to 11), or high (≥ 12) volume groups. Operative time trends were assessed using a centered linear weighted moving average (window = 50 patients), and efficiency was evaluated through cumulative sum (CUSUM) analysis. Efficiency was defined as achieving a median operative time less than or equal to 90 minutes. Group comparisons were conducted using Chi-square tests, one-way analyses of variance, or Kruskal-Wallis tests as appropriate.
RESULTS
Low-volume centers (40.8%; 8,230 cases [5.3%]) had an average operative time of 100.4 ± 32.8 minutes, medium-volume centers (26.4%; 25,115 cases [16.1%]) 91.6 ± 33.6 minutes, and high-volume centers (32.8%; 123,002 cases [78.7%]) 85.9 ± 30.5 minutes (P < 0.001). The CUSUM analyses showed that high-volume centers required approximately 550 cases to achieve and maintain operation times at or below the 90-minute threshold, compared to 650 cases for medium-volume institutions. Low-volume centers demonstrated a transient decrease, but were unable to sustain sub-90-minute efficiency. Ultimately, 66.8% of high-volume institutions achieved the efficiency target, compared to 42.9% of medium-volume and 39.7% of low-volume institutions (P < 0.001).
CONCLUSION
Higher institutional surgical volume is associated with shorter operative times and more consistent attainment of efficiency benchmarks in RA-TKA. These findings highlight the influence of procedural volume on operative efficiency and may guide future institutional strategies for technology adoption and resource allocation.