BACKGROUND Technology (navigation and robotics) usage during total knee arthroplasty (TKA) is often supported by literature involving high-volume surgeons and hospitals, but the value of technology for lower-volume surgeons is uncertain. This study aimed to determine if there was a relationship among surgeon volume, technology usage, and revision rate when using an optimal prosthesis combination (OPC). METHODS Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data were obtained from January 1, 2008, to December 31, 2022, for all primary TKA procedures performed for osteoarthritis using an OPC by a known surgeon ≥5 years after their first recorded procedure. The interaction between surgeon volume and conventional-instrumentation (CV) versus technology-assisted (TA) TKA was assessed. The cumulative percent revision (CPR) was determined by Kaplan-Meier estimates. Cox proportional-hazards methods were used to compare rates of revision by surgeon volume and by the interaction of volume and technology. Subanalyses were undertaken to examine major and minor revisions separately, and to assess the influence of technology on revision rates relative to those of a surgeon undertaking 100 TKA/year. RESULTS Of the 53,264 procedures that met the inclusion criteria, 31,536 were TA-TKA and 21,728 were CV-TKA. Use of technology reduced the all-cause revision rate for surgeons with a volume of <50 TKA/year and the rate of minor revisions for surgeons with a volume of <40 TKA/year. No interaction between surgeon volume and the rate of major revision surgery was found. With CV-TKA by a surgeon with a 100-TKA/year volume as the comparator, all-cause and major revision rates were significantly elevated for surgeons undertaking <50 and <100 TKA/year, respectively. In contrast, analysis of TA-TKA showed no difference in rates of all-cause or major revisions for surgeons undertaking <100 TKA/year compared with 100 TKA/year. CONCLUSIONS TA-TKA was associated with a decrease in the revision rate for lower-volume surgeons but no significant alterations in revision rate for higher-volume surgeons. Preferential use of TA-TKA by lower-volume surgeons should be considered. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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使用最佳假体组合的小批量外科医生的技术使用与降低的 TKA 翻修率关联：对 53,264 例初次 TKA 的分析。


背景技术全膝关节置换术（TKA）期间的技术（导航和机器人技术）的使用通常得到涉及大量外科医生和医院的文献的支持，但技术对于少量外科医生的价值是不确定的。本研究旨在确定使用最佳假体组合 (OPC) 时外科医生手术量、技术使用和翻修率之间是否存在关系。方法 澳大利亚骨科协会国家关节置换登记处 (AOANJRR) 数据是从 2008 年 1 月 1 日到 2022 年 12 月 31 日期间获取的，涉及由已知外科医生在首次记录手术后 ≥ 5 年使用 OPC 进行的所有针对骨关节炎的初次 TKA 手术。评估了外科医生手术量与传统器械 (CV) 与技术辅助 (TA) TKA 之间的相互作用。累积百分比修正 (CPR) 由 Kaplan-Meier 估计确定。 Cox 比例风险法用于比较外科医生手术量以及手术量和技术的相互作用的翻修率。我们进行了亚组分析，分别检查大翻修和小翻修，并评估技术对每年进行 100 次 TKA 手术的外科医生翻修率的影响。结果 在符合纳入标准的 53,264 例手术中，31,536 例为 TA-TKA，21,728 例为 CV-TKA。技术的使用降低了每年 <50 TKA 手术量的外科医生的全因翻修率，以及每年 <40 TKA 手术量的外科医生的小翻修率。未发现外科医生手术量与大翻修手术率之间存在交互作用。 以每年 100 次 TKA 手术量的外科医生进行 CV-TKA 作为比较，每年进行 <50 和 <100 TKA 的外科医生的全因翻修率和重大翻修率分别显着升高。相比之下，TA-TKA 分析显示，每年进行 <100 TKA 的外科医生与每年进行 100 TKA 的外科医生的全因或重大翻修率没有差异。结论 TA-TKA 与手术量较低的外科医生的翻修率下降相关，但对于手术量较高的外科医生来说，翻修率没有显着变化。应考虑由小手术量的外科医生优先使用 TA-TKA。证据级别 治疗级别 III。有关证据级别的完整描述，请参阅作者须知。