Original Article

Pilot study comparing operating room workflow and team ergonomics in robotic-assisted versus navigated total knee arthroplasty

¹ Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d’Avron, Paris 75020, France
² DEO.Care, Beringen, Belgium

^* Corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received: 1 December 2025
Accepted: 31 March 2026

Abstract

Background: Robotic-assisted systems have been developed to improve the accuracy and reproducibility of total knee arthroplasty (TKA). While outcomes have been widely studied, the effects of these systems on intraoperative workflow and surgical team workload have received less attention. The aim of this study was to compare procedural setup, efficiency, workload, and ergonomics between the VELYS robotic-assisted solution (VRAS) and computer-navigated TKA (NAVI). Methods: Twenty patients who underwent primary TKA performed by a single surgeon, using a single implant type, were enrolled in this research (10VRAS, 10NAVI). Procedural efficiency was assessed by reference to an AI-backed process digital twin platform. Workload was evaluated using NASA-TLX questionnaires, objective ergonomic measures (power tool holding times, retractor holding times, and leg holding times), and a tray analysis. Results: The mean total operating room (OR) time was 69.4 min for the VRAS group and 72.9 min for the NAVI group, with no significant difference. The preparation (22 min) and the breakdown times (12.6 vs.11.7 min) were equivalent. The skin-to-skin times averaged 34.3 min for the VRAS group versus 38.9 min for the NAVI group. NASA-TLX scores revealed significantly lower mental, physical, and temporal demands, reduced effort and frustration, and better perceived performance of the surgeon in the VRAS group (p < 0.05). The instrument burden was similar, 5 trays (21.5 kg) for VRAS and 4 trays (20.9 kg) for NAVI. The objective workload was reduced for the VRAS group, with shorter power tool holding (2.7 vs. 7.7 min, p < 0.001), retractor holding (7.8 vs. 13.0 min, p = 0.01), and leg holding times (3.4 vs. 4.7 min, p = 0.02). Discussion: Compared with navigated TKA, robotic assistance did not prolong overall OR time and was associated with lower measured NASA-TLX scores. These findings suggest that robotic-assisted TKA may offer workflow and ergonomic advantages, although further studies with larger samples are needed to confirm these preliminary observations. Level of evidence: Level 4, retrospective study.