Total Knee Arthroplasty With Robotic and Augmented Reality Guidance: A Hierarchical Task Analysis

Robert Koucheki, MD, MEng; Jesse I. Wolfstadt, MD, MSc, FRCSC, FAAOS; Justin S. Chang, MD, FRCSC; David J. Backstein, MD, MED, FRCSC; Johnathan R. Lex, MBChB

Arthroplasty Today (Jun 2024)

Total Knee Arthroplasty With Robotic and Augmented Reality Guidance: A Hierarchical Task Analysis

Robert Koucheki, MD, MEng,
Jesse I. Wolfstadt, MD, MSc, FRCSC, FAAOS,
Justin S. Chang, MD, FRCSC,
David J. Backstein, MD, MED, FRCSC,
Johnathan R. Lex, MBChB

Affiliations

Robert Koucheki, MD, MEng: Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Corresponding author. Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, ON M5T 1P5, Canada. Tel.: +1 647 393 1357.
Jesse I. Wolfstadt, MD, MSc, FRCSC, FAAOS: Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Granovsky Gluskin Division of Orthopaedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
Justin S. Chang, MD, FRCSC: Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Orthopaedic Surgery, Humber River Hospital, Toronto, ON, Canada
David J. Backstein, MD, MED, FRCSC: Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Granovsky Gluskin Division of Orthopaedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
Johnathan R. Lex, MBChB: Division of Orthopaedic Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada

Journal volume & issue: Vol. 27
p. 101389

Abstract

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Background: Total knee arthroplasty (TKA) is a commonly performed procedure that has traditionally utilized reproducible steps using a set of mechanical instruments. The number of TKAs performed using robotic assistance is increasing, and augmented reality (AR) navigation systems are being developed. Hierarchical task analysis (HTA) aims to describe the steps of a specific task in detail to reduce errors and ensure reproducibility. The objective of this study was to develop and validate HTAs for conventional, robotic-assisted, and AR-navigated TKA. Methods: The development of HTAs for conventional TKA involved an iterative review process that incorporated the input of 4 experienced arthroplasty surgeons. The HTAs were then adapted for robotic-assisted and AR-navigated TKA by incorporating specific steps associated with the use of these systems. The accuracy and completeness of the HTAs were validated by observing 10 conventional and 10 robotic-assisted TKA procedures. Results: HTAs for conventional, robotic-assisted, and AR-navigated TKA were developed and validated. The resulting HTAs provide a comprehensive and standardized plan for each procedure and can aid in the identification of potential areas of inefficiency and risk. Robotic-assisted and AR-navigated approaches require additional steps, and there are an increased number of instances where complications may occur. Conclusions: The HTAs developed in this study can provide valuable insights into the potential pitfalls of robotic-assisted and AR-navigated TKA procedures. As AR-navigation systems are developed, they should be optimized by critical analysis using the developed HTAs to ensure maximum efficiency, reliability, accessibility, reduction of human error, and costs.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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Abstract

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