Adoption of Robotic-Arm-Assisted Total Knee Arthroplasty Is Associated with Decreased Use of Articular Constraint and Manipulation under Anesthesia Compared to a Manual Approach

Robotic Arm-Assisted Total Knee Arthroplasty: Anatomical Alignment and Mid-Term Outcomes from the First Cohort Originating in Greece

Robotic arm-assisted total knee arthroplasty (RATKA) represents a haptic assistive robotic arm used for bone preparation. The purpose of this study was to present implant survivorship, complications and evaluate patients' satisfaction, clinical and functional outcome of RATKA with a minimum of 1-year follow-up. The Oxford Knee Score was recorded preoperatively and at last follow-up. Patients' satisfaction rates, as well as complications and re-operations were studied. Anatomical alignment including varus, valgus deformities and flexion, extension, pre-and postoperatively were evaluated. A total of 156 patients with mean age = 71.9 years were included in the study. The mean follow-up was 35.7 months, while one revision was performed due to infection. Statistically significant improvement of the Oxford Knee Score, as well as of the knee alignment deformities were recorded, while 99.4% of patients reported to be "very satisfied" or "satisfied" with the procedure. RATKA seems to be a safe, as well as reproductible procedure at short-and mid-term follow-up, while the accurate implant positioning may lead to favorable long-term outcomes.

Clinical Outcomes after Computed Tomography-Based Total Knee Arthroplasty: A Minimum 3-Year Analyses

Computed tomography (CT) scan-based three-dimensional (3D) modeling operative technology has been shown to improve upon results of manual total knee arthroplasties (TKAs). Although there are many reports on superior precision of this CT-based technology, there has been continuing interest regarding extended clinical outcomes. The purpose of this study was to compare their clinical outcomes with manual TKAs at approximately 3-year follow-up. Specifically, we analyzed: (1) survivorship, (2) functional outcomes, (3) complications, and (4) radiographic outcomes (i.e., alignment, progressive radiolucencies). A total of 210 patients receiving CT-based TKAs performed by a single surgeon at a single center between July 1, 2016, and February 16, 2018, were compared with 210 manual TKAs completed by the same surgeon immediately preceding implementation of the CT-based technology. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) surveys were collected at ∼3 years postoperatively. Subgroup analyses of pain and physical function scores were performed. Follow-up radiographs were evaluated for alignment, loosening, and/or progressive radiolucencies. There was 100% survivorship at final follow-up. The postoperative mean pain scores for the CT-based cohort and manual cohort were 1 ± 2 (range, 0-14) and 2 ± 3 (range, 0-17), respectively (p < 0.05). The postoperative mean physical function scores for the CT-based cohort and manual cohort were 3 ± 4 (range, 0-18) and 5 ± 5 (range, 0-19), respectively (p < 0.05). The postoperative mean total WOMAC scores for the CT-based cohort and manual cohort were 5 ± 4 (range, 0-32) and 7 ± 8 (range, 0-35), respectively (p < 0.05). There were low numbers of postoperative complications at final follow-up in either cohort. None exhibited progressive radiolucencies by final follow-up. The 3-year postoperative clinical outcomes support excellent survivorship and radiographic outcomes, low complication rates, as well as improved pain, physical function, and total WOMAC scores for CT-based TKAs. Therefore, patients who undergo CT-based 3D modeling TKAs should expect to have superior long-term clinical outcomes.

Systematic review and meta-analysis of economic and healthcare resource utilization outcomes for robotic versus manual total knee arthroplasty

The introduction of robotics in orthopedic surgery has led to improved precision and standardization in total knee arthroplasty (TKA). Clinical benefits of robotic versus manual TKA have been well established; however, evidence for economic and healthcare resource utilization outcomes (HRU) is lacking. The primary objective of this study was to compare economic and HRU outcomes for robotic and manual TKA. The secondary objective was to explore comparative robotic and manual TKA pain and opioid consumption outcomes. Multi-database literature searches were performed to identify studies comparing robotic and manual TKA from 2016 to 2022 and meta-analyses were conducted. This review included 50 studies with meta-analyses conducted on 35. Compared with manual TKA, robotic TKA was associated with a: 14% reduction in hospital length of stay (P = 0.022); 74% greater likelihood to be discharged to home (P < 0.001); and 17% lower likelihood to experience a 90-day readmission (P = 0.043). Robotic TKA was associated with longer mean operating times (incision to closure definition: 9.27 min longer, P = 0.030; general operating time definition: 18.05 min longer, P = 0.006). No differences were observed for total procedure cost and 90-day emergency room visits. Most studies reported similar outcomes for robotic and manual TKA regarding pain and opioid use. Coupled with the clinical benefits of robotic TKA, the economic impact of using robotics may contribute to hospitals' quality improvement and financial sustainability. Further research and more randomized controlled trials are needed to effectively quantify the benefits of robotic relative to manual TKA.

A 90-Day Episode-of-Care Analysis Including Computed Tomography Scans of Robotic-Arm Assisted versus Manual Total Knee Arthroplasty

In this observational, retrospective study, we performed economic analyses between robotic arm-assisted total knee arthroplasty (RATKA) and manual total knee arthroplasty (MTKA). Specifically, we compared: (1) index costs including computed tomography (CT) scans; (2) 90-day postoperative health care utilization, (3) 90-day episode-of-care (EOC) costs, and (4) lengths of stay between CT scan-based robotically-assisted versus MTKAs. A large national database, Blue Health Intelligence (BHI), was used for RATKAs and MTKAs performed between April 1, 2017 and September 30, 2019. Based on strict inclusion-exclusion criteria, with propensity score matching, 4,135 RATKAs and 4,135 MTKAs were identified and analyzed. Index costs to the payer for RATKA patients were found to be less than those for MTKA patients ($29,984 vs. $31,280, p <0.0001). Overall, 90-day EOC costs for RATKA patients were found to be less than that for MTKA patients in the inpatient and outpatient settings. This also holds true for the use of skilled nursing facilities, pharmacies, or other services. In conclusion, the results from our study show that RATKA were associated with lower costs than MTKAs, even when including the cost of CT scans. These results are of marked importance given the emphasis to contain and reduce health care costs.

Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients

BACKGROUND

The purpose of this study was to compare the serum inflammatory indicators and radiographic results of conventional manual total knee arthroplasty (CM-TKA) with those of MAKO-robotic assisted total knee arthroplasty (MA-TKA).

METHODS

We retrospectively analysed 65 patients with knee osteoarthritis who underwent unilateral TKA from December 2020 to November 2021 in our department, which included 34 patients who underwent MA-TKA and 31 patients who underwent CM-TKA. The tourniquet time and estimated blood loss (EBL) were compared between the two groups. Knee function was evaluated using range of motion (ROM), functional score and pain score. Leukocytes, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), creatine kinase (CK), and neutrophil-to-lymphocyte ratio (NLR) were recorded at 3 time points (preoperative, and on the first and third postoperative days). The hip-knee-ankle angle (HKA) and the femoral and tibial component angles in the coronal and sagittal planes were used for postoperative radiographic evaluation.

RESULTS

The postoperative MA-TKA group had less EBL (496.9 ± 257.8 vs. 773.0 ± 301.3 ml, p < 0.001). There was no significant difference in knee function scores at 6 weeks postoperatively (p > 0.05). IL-6 levels were significantly lower in the MA-TKA group on the 1st postoperative day (11.4 (5.2, 21.0) vs. 24.6 (86.3, 170.8), p = 0.031). This difference in inflammatory indices became more pronounced at 72 hours after the operation because CRP, ESR, IL-6, and CK values were significantly lower in the MA-TKA group on the 3rd postoperative day (72 h) (p < 0.05). Postoperative radiographic examinations performed 2 days after the MA-TKA group suggested that only 2 cases of HKA had outlier values, which was remarkably better than the 12 cases found in the CM-TKA group (5.9% vs. 38.7%, p < 0.001). The frontal femoral component was significantly closer to the expected value of 90° in the MA-TKA group (90.9 (90.5, 92.3) vs. 92.4 (91.3, 93.7), p = 0.031). The remaining imaging evaluation parameters were not significantly different between the two groups (p > 0.05).

CONCLUSIONS

In Chinese patients with OA, there was a milder systemic inflammatory response in the early postoperative period after MA-TKA compared to that of CM-TKA, as well as better radiographic outcomes. However, the tourniquet time was prolonged, and no advantages were observed in terms of functional score or pain score in the short-term follow-up.

Robotic-Arm Assisted Total Knee Arthroplasty: Cost Savings Demonstrated at One Year

Purpose

Robotic-arm assisted total knee arthroplasty (RATKA) has the potential to enhance radiographic, clinical, and patient-reported outcomes. The purpose of this study was to compare resource utilization, episode-of-care (EOC) costs, readmissions, and complications of robotic-arm assisted total knee arthroplasty (RATKA) and manual TKA (MTKA).

Methods

TKA procedures were identified from a private payer claims database. RATKA procedures required both a robotic arm-assisted procedure code and a 60-day pre-operative computed tomography scan. Propensity score matching (1:5 RATKA to MTKA) was performed, based on various patient characteristics and comorbidities. After matching, 4452 patients (742 RATKA and 3710 MTKA) were analyzed for 90-day and one-year EOC costs, index TKA costs, lengths of stay (LOS), discharge statuses, rehabilitation utilizations, as well as 90-day and one-year readmissions- and knee-related complications.

Results

RATKA patients had shorter LOS (mean 1.56 versus 1.91 days; p < 0.001), lower index costs by $1762 ($32,747 versus $34,509; p = 0.003), and higher discharges to home rates (51.8 versus 47.8%; p = 0.049) than MTKA patients. RATKA patients had less 90-day (68.5 versus 72.0%; p = 0.048) and one-year (70.8 versus 75.0%; p = 0.016) home health utilizations. The RATKA cohort had lower 90-day ($39,260 versus $41,458; p = 0.001) and one-year ($51,462 versus $54,171; p = 0.011) EOC costs. No significant differences in readmission and overall complication rates were observed (p > 0.05).

Conclusion

RATKA was associated with lower index costs and EOC costs at both 90 days and one year. These patients had shorter LOS, were discharged home more frequently, and used less home health services. Cost savings were demonstrated for RATKA beyond the 90-day period with an increase in savings between 90-day and one-year time points. These data may be of importance to payers and providers interested in the longer-term value of RATKA.