Adult reconstructive orthopedic surgery in the United States is facing an imminent logjam due to the increasing divergence of the demand for services and the ability for the community to supply those services. In combination with several other factors, a perfect storm is brewing that may leave the system overtaxed and the patient population suffering from either a lack of treatment, or treatment by less qualified providers. A key component to improving the overall efficiency of surgical care is to introduce enabling technologies that can effectively increase the throughput while simultaneously improving the quality of care. One such enabling technology that has proven itself in many industries is robotics, which has recently been introduced in surgery with even more recent applications in orthopedic surgery. A surgeon interactive robotic arm has been developed for partial knee arthroplasty (PKA) and total hip arthroplasty (THA). This study aims to analyse the efficiency of a new robotic technology for use in orthopaedic surgery. 18 robotic arm assisted PKA's across 10 sites were recorded to accurately capture the timeline elemental tasks throughout the procedure. Two camera angles were set up to capture both surgical staff group dynamics and individual procedural steps. 17 tasks were identified and measured from video data. (Fig 1) The robotic arm specific tasks were analyzed for correlation to total surgical time (measured as first incision to last suture). The tasks for the surgeons with the shortest and longest total times were compared directly to determine areas of opportunity.INTRODUCTION
METHODS
Cadaveric experiments using knee testing machines have suggested that anatomical ACL reconstruction, replacing both antero-medial (AM) and postero-lateral (PL) bundles, restores knee rotation kinematics more effectively than does a single-bundle. The aim of this study was to measure intra-operatively the control of the translation and coupled rotations that occur with standard clinical laxity tests (anterior drawer, Lachman and pivot shift). The knee kinematics of 10 patients were measured using a surgical navigation system and described in terms of tibial axial rotation and antero-posterior translation. In the ACL deficient knee, the average maximum tibial rotation during the pivot shift test was 29.0° and the mean maximum translation 17.0 mm. Reconstruction of the AM bundle (which behaves in a biomechanically similar way to a single-bundle reconstruction) reduced the rotational component to 16.4° (p<
0.0001) and translation to 6 mm (p = 0.0002). Addition of the PL bundle further reduced rotation to 12.6° (p = 0.0007) but had no significant effect on translation. Addition of the PL bundle also significantly reduced coupled tibial internal rotation during the Lachman and Anterior draw tests. The pivot shift test simulates the instability suffered by patients with ACL deficiency and this study suggests that its rotational component is better restrained by anatomical, 2 bundle ACL reconstruction.
