Institutional Surgical Volume and Operative Efficiency in Robotic-Assisted Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry.

BACKGROUND

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 R A-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 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 cumulative sum 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 the high-volume institutions achieved the efficiency target, compared to 42.9% of the medium-volume and 39.7% of the low-volume institutions (P < 0.001).

CONCLUSIONS

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.