What is the current consensus among orthopaedic surgeons in South Africa regarding robotic-assisted surgery in total joint arthroplasty?

Abstract

Background: Total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), are successful orthopaedic procedures, with survivorship reported at 98% at ten years and 95% at 20 years. The development of robotic-assisted total joint arthroplasty (RA-TJA) is one example of the continual evolution in technology in an attempt to improve these numbers. The use of RA-TJA is increasing, with little known about the potential factors which may impact the decision of surgeons to integrate robotic-assisted technology into their clinical practice. The aim of this study is to assess the usage and opinions of orthopaedic surgeons in South Africa regarding RA-TJA.

Methods: An anonymous online survey was distributed via email to all orthopaedic surgeons registered with the South African Orthopaedic Association (SAOA). Analysis was subsequently undertaken to establish factors which might influence opinions regarding RA-TJA.

Results: In total, there were 155 responses, with 37% (n = 57) of respondents being fellowship-trained in arthroplasty, either nationally, internationally or both. Seventy-one per cent (n = 110) of respondents were in private practice only, 6% (n = 9) in state practice only, and 23% (n = 36) in both. Forty-four per cent (n = 68) of surgeons are using RA-TJA, with 8% (n = 13) using both RA-THA and RA-TKA, 1% (n = 2) using RA-THA only, and 34% (n = 53) using RA-TKA only. The most common reason for using RA-TJA was higher precision in reproducibility of the procedure, at 91% (n = 62). The most common reason for hesitation in using RA-TJA is cost, at 69% (n = 60). Forty-seven per cent (n = 73) of surgeons believe it takes 11 to 20 cases to become competent using RA-TJA. The formation of an RA-TJA special interest group was agreed to by 71% (n = 110) of respondents.

Conclusion: The usage of RA-TJA in South Africa is higher than in other nations but it follows the same trend that there are more surgeons not using RA-TJA. Cost, lack of long-term data proving superiority, and the learning curve are the most common reported obstacles to RA-TJA, with improved precision a common reason for adopting RA-TJA. RA-TJA is a broad term, and further analysis of the type of systems currently in use and their possible perceived benefits will provide more information regarding the use of RA-TJA.

Level of evidence: 3