Reduced workload demand with handheld robotic‐assisted revision knee arthroplasty: A multi‐centre NASA Task Load Index analysis

Purpose: Revision total knee arthroplasty is a complex and technically demanding procedure, with an increasing global incidence. This complexity heightens the cognitive and physical demands of surgical teams, contributing to elevated burnout, musculoskeletal injuries and psychological stress. This European wide multi-centre observational evaluation assessed the impact of a handheld robotic-assisted surgical system on intra-operative workload using the NASA Task Load Index instrument to compare robotic-assisted and manual instrumentation approaches during revision knee arthroplasty. Methods: Data were collected from 212 surveys following 100 revision knee arthroplasty procedures, capturing subjective workload measures across six NASA Task Load Index domains from surgeons and peri-operative theatre staff. Results: The results demonstrated a significant reduction in the overall workload with robotic-assistance compared with manual instrumentation (median overall workload score 0.0 vs. 8.5 respectively, p = 0.0003). Domain-specific analyses revealed significantly lower mental demand, physical demand and effort in the robotic-assisted group without compromising perceived surgical performance, temporal demand, or frustration. A subgroup analysis of the lead surgeons showed consistent perceived workload reductions consistent with the overall findings. These results suggest that the handheld robotic-assisted surgical system may mitigate cognitive and physical strain during complex revision knee arthroplasty procedures. Conclusions: This evaluation underscores the potential of robotic-assisted technology to enhance surgical ergonomics, reduce surgeon fatigue and improve well-being, which may translate into sustained surgical performance. Future work should incorporate objective ergonomic measures, expand participant roles and explore long-term impacts on clinical outcomes and staff welfare. Level of Evidence: Level II.