Robotic-assisted TKA may be linked with reduced readmissions, similar costs vs. manual TKA
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Key takeaways:
- Robotic-assisted total knee arthroplasty was associated with lower readmissions and similar costs compared with manual surgery.
- Total 90-day cost was $15,357 for robotic-assisted vs. $14,944 for manual surgery.
Published results showed robotic-assisted total knee arthroplasty was associated with reduced postoperative visits and readmissions with no differences in total care costs compared with manual TKA.
“We live in a financially conscious health care environment with increasing inflation and overall costs, yet decreasing reimbursements,” Philip Huang, DO, an adult hip and knee reconstruction surgeon at OrthoIndy, told Healio. “This data is critical to show that the implementation of new technology in TKA can be performed in a safe (or safer) and cost-neutral manner.”
Huang and colleagues used the Premier Healthcare Database to compare outcomes of 128,643 manual TKAs vs. 866 robotic-assisted TKAs (Velys Robotic-Assisted Solution, DePuy Synthes) performed between September 2021 and February 2023.
At 90 days, Huang and colleagues found the robotic-assisted group had a rate of all-cause follow-up visits of 13.86% vs. 17.19%% for the manual group. Similarly, researchers found the rate of knee-related follow-up visits was 2.66% for the robotic group and 4.81% for the manual group. In addition, the rate of knee-related readmissions was significantly lower for the robotic group (0.69%) vs. the manual group (1.46%), according to results.
“Importantly, there was no significant difference in the overall cost of care within 90 days,” Huang added.
According to the study, the overall 90-day all-cause cost of care was $15,357 for the robotic-assisted group and $14,944 for the manual group.
Huang and colleagues found OR time was longer for the robotic-assisted group vs. the manual group (138 minutes vs. 134 minutes). However, they noted the difference was likely due to the “integration of robotic instrumentation.”
“The findings of this study demonstrate excellent effectiveness and efficiency with the use of the Velys Robotic-Assisted Solution compared to manual instrumentation for TKA among a large cohort of patients,” Huang said. “I believe the future of TKA lies in improving surgical planning and execution of robotic knee replacement. This can be achieved through robust data collection and correlating patient outcomes to further refine the operation, reducing outliers and patient dissatisfaction.”
Perspective
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Undoubtedly, the use of robotic-assisted total knee arthroplasty is increasing. Not only are more surgeons starting to adopt the technology, but many patients are seeking surgeons who use robotics. That said, there is still limited yet growing data to show support for better clinical and functional outcomes.
As a robotic user, the publishing of studies showing the advantages of using this technology is important. Nevertheless, this study has several limitations that limit its value. First, this is a large, retrospective database study. Second, data compared less than 1,000 robotic-assisted patients using one specific implant type to more than 100,000 manual TKA patients with any kind of implant. The retrospective nature, use of a national database and large variability in the number of patients, surgical technique and implant system may lead to too many unknown and confounding variables to interpret or generalize data.
I feel strongly that we need more users of these technologies to perform higher-level randomized control trials to help garner rigorous evidence-based support for the continued use of this powerful technology.
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