{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:01:54Z","timestamp":1789844514356,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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\u2010centre observational evaluation assessed the impact of a handheld robotic\u2010assisted surgical system on intra\u2010operative workload using the NASA Task Load Index instrument to compare robotic\u2010assisted and manual instrumentation approaches during revision knee arthroplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010operative theatre staff.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The results demonstrated a significant reduction in the overall workload with robotic\u2010assistance compared with manual instrumentation (median overall workload score 0.0 vs. 8.5 respectively,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003). Domain\u2010specific analyses revealed significantly lower mental demand, physical demand and effort in the robotic\u2010assisted 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\u2010assisted surgical system may mitigate cognitive and physical strain during complex revision knee arthroplasty procedures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This evaluation underscores the potential of robotic\u2010assisted technology to enhance surgical ergonomics, reduce surgeon fatigue and improve well\u2010being, which may translate into sustained surgical performance. Future work should incorporate objective ergonomic measures, expand participant roles and explore long\u2010term impacts on clinical outcomes and staff welfare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70737","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:46:27Z","timestamp":1777538787000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reduced workload demand with handheld robotic\u2010assisted revision knee arthroplasty: A multi\u2010centre NASA Task Load Index analysis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4364-8822","authenticated-orcid":false,"given":"Andrew","family":"Porteous","sequence":"first","affiliation":[{"name":"Southmead Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Murray","sequence":"additional","affiliation":[{"name":"Southmead Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0909-9097","authenticated-orcid":false,"given":"Max","family":"Ettinger","sequence":"additional","affiliation":[{"name":"Pius Hospital Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4791-6051","authenticated-orcid":false,"given":"Peter","family":"Savov","sequence":"additional","affiliation":[{"name":"Pius Hospital Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Innocenti","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero\u2010Universitaria Careggi, Universit\u00e0 degli Studi di Firenze Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3720-8927","authenticated-orcid":false,"given":"Gijs","family":"van Hellemondt","sequence":"additional","affiliation":[{"name":"Sint Marteenskliniek Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6933-205X","authenticated-orcid":false,"given":"Koen","family":"DeFoort","sequence":"additional","affiliation":[{"name":"Sint Marteenskliniek Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5092-8144","authenticated-orcid":false,"given":"Juan Carlos","family":"Martinez\u2010Pastor","sequence":"additional","affiliation":[{"name":"Hospital Clinic Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8611-2876","authenticated-orcid":false,"given":"Peter","family":"Bollars","sequence":"additional","affiliation":[{"name":"Sint\u2010Trudo Ziekenhuis Sint\u2010Truiden Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7634-5692","authenticated-orcid":false,"given":"Francesco","family":"Zambianchi","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliero\u2010Universitaria di Modena Universit\u00e0 degli Studi di Modena e Reggio\u2010Emilia Modena Italia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1923-2712","authenticated-orcid":false,"given":"Alberto","family":"Belluati","sequence":"additional","affiliation":[{"name":"Ospedale S. 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