Does the use of Robotic Technology Improve Surgeon Ergonomic Safety during TKA?

Abstract

Surgeon physical stress in the operating room is a known potential cause of musculoskeletal overuse injuries, specifically in surgeons who perform total knee arthroplasty (TKA). Injuries have been attributed to ergonomically challenging postures. This study compared surgeon lower back and shoulder posture between manual TKA (MTKA) and robotic assisted TKA (RATKA). Two surgeons performed a total six MTKA and six RATKA on a set of cadaveric knees. Movement and EMG sensors were secured to each surgeon to monitor lower back and shoulder movements, as well as muscle activities. Data was analyzed and activities were assessed as low, medium, or high risk, providing a score between 0-lowest and 16-highest. Risk data was compared between MTKA and RATKA for three separate surgical tasks: 1-bone cut preparation & cutting (MTKA = placement of cutting jigs, bone cutting, RATKA = array placement, bone registration, bone cutting), 2-knee balancing and 3-trialing. Overall, there were more high-risk shoulder than lower back activities in MTKA and RATKA. More high-risk movement and EMG stimulation were measured in the dominant shoulder than the non-dominant. When lower back and shoulder data were combined, highest risk task was bone cut preparation & cutting (MTKA: 13 vs. 6 vs. 6 and RATKA: 11 vs. 8 vs. 6), with a higher risk for MTKA than RATKA. Poor posture can be a potential cause for surgeon work-related injuries. This study evaluated which tasks presented highest risk to surgeon ergonomic safety while performing TKA, and found lower overall ergonomics risk for performing RATKA vs. MTKA. Although this study provides data indicating reduced ergonomic risk with RATKA, additional studies in the operating room need to be performed.