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Clement ND, Fraser E, Gilmour A, Doonan J, MacLean A, Jones BG, Blyth MJG. Cost-utility analysis of robotic arm-assisted medial compartment knee arthroplasty. Bone Jt Open 2023; 4:889-899. [PMID: 37992738 PMCID: PMC10665097 DOI: 10.1302/2633-1462.411.bjo-2023-0090.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Aims To perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA). Methods This was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated. Results rUKA was associated with a relative 0.012 QALY gain at five years, which was associated with an incremental cost per QALY of £13,078 for a unit undertaking 400 cases per year. A cost per QALY of less than £20,000 was achieved when ≥ 300 cases were performed per year. However, on removal of the cost for a revision for presumed infection (mUKA group, n = 1) the cost per QALY was greater than £38,000, which was in part due to the increased intraoperative consumable costs associated with rUKA (£626 per patient). When the absolute cost difference (operative and revision costs) was less than £240, a cost per QALY of less than £20,000 was achieved. On removing the cost of the revision for infection, rUKA was cost-neutral when more than 900 cases per year were undertaken and when the consumable costs were zero. Conclusion rUKA was a cost-effective intervention with an incremental cost per QALY of £13,078 at five years, however when removing the revision for presumed infection, which was arguably a random event, this was no longer the case. The absolute cost difference had to be less than £240 to be cost-effective, which could be achieved by reducing the perioperative costs of rUKA or if there were increased revision costs associated with mUKA with longer follow-up.
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Affiliation(s)
- Nick. D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ewen Fraser
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Alisdair Gilmour
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G. Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Mark J. G. Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Lee GC, Smith GH, Wakelin EA, Garino JP, Plaskos C. What is the Value of a Balanced Total Knee Arthroplasty? Getting it Right the First Time. J Arthroplasty 2023; 38:S177-S182. [PMID: 36933683 DOI: 10.1016/j.arth.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Instability is a leading cause of early failure following total knee arthroplasty. Enabling technologies can improve accuracy, but their clinical value remains undetermined. The purpose of this study was to determine the value of achieving a balanced knee joint at the time of TKA. METHODS A Markov model was developed to determine the value from reduced revisions and improved outcomes associated with TKA joint balance. Patients were modelled for the first 5 years following TKA. The threshold to determine cost-effectiveness was set at an Incremental Cost Effectiveness Ratio (ICER) of $50,000/quality-adjusted life year (QALY). A sensitivity analysis was performed to evaluate the influence of QALY improvement (ΔQALY) and Revision Rate Reduction (ΔRevision) on additional value generated compared to a conventional TKA cohort. The impact of each variable was evaluated by iterating over a range of ΔQALY (0 to 0.046) and ΔRevision (0 to 30%) and calculating the value generated while satisfying the ICER threshold. Finally, the impact of surgeon volume on these outcomes were analyzed. RESULTS The total value of a balanced knee for the first 5 years was $8,750, $6,575, and $4,417 per case, for low, medium, and high-volume surgeons, respectively. Change in QALY accounted for greater than 90% of the value gain with a reduction in revisions making up the rest in all scenarios. The economic contribution of revision reduction was relatively constant regardless of surgeon volume ($500/case). CONCLUSIONS Achieving a balanced knee had the greatest impact on QALY improvement over early revision rate. These results can help assign value to enabling technologies with joint balancing capabilities.
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Affiliation(s)
- Gwo-Chin Lee
- Hospital for Special Surgery, New York, New York
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Li H, Zhuang T, Wu W, Gan W, Wu C, Peng S, Huan S, Liu N. A systematic review on the cost-effectiveness of the computer-assisted orthopedic system. HEALTH CARE SCIENCE 2022; 1:173-185. [PMID: 38938554 PMCID: PMC11080830 DOI: 10.1002/hcs2.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 06/29/2024]
Abstract
Computer-assisted orthopedic system (CAOS) is rapidly gaining popularity in the field of precision medicine. However, the cost-effectiveness of CAOS has not been well clarified. We performed this review to summarize and assess the cost-effectiveness analyses (CEAs) with regard to CAOS. Publications on CEA in CAOS have been searched in PubMed and CEA Registry up to May 31, 2022. The Quality of Health Economic Studies (QHES) instrument was used to estimate the quality of studies. Relationships between qualities and potential factors were also examined. There were 15 eligible studies in the present review. Twelve studies evaluated CAOS joint arthroplasties and found that CAOS joint arthroplasties were cost-effective compared to manual methods. Three studies focused on spinal surgery, two of which analyzed the cost-effectiveness of CAOS for patients after spinal fusion, with conflicting results. One study demonstrated that CAOS was cost-effective in spinal pedicle screw insertion. The mean QHES score of CEAs included was 86.1. The potential factors had no significant relationship with the quality of studies. Based on available studies, our review reflected that CAOS was cost-effective in the field of joint arthroplasty. While in spinal surgery, the answer was unclear. Current CEAs represent high qualities, and more CEAs are required in the different disciplines of orthopedics where CAOS is employed.
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Affiliation(s)
- Hua Li
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Tengfeng Zhuang
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenrui Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenyi Gan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Chongjie Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Sijun Peng
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Songwei Huan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Ning Liu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
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Çabuk H, Turan K, Muratoğlu OG, Ergün T, Öztürk Ç, Ertürer RE. Comparison of the radiological parameters between dynamic-referencing tactile guidance robotic system and Microplasty® instrumentation in unicompartmental knee arthroplasty. Jt Dis Relat Surg 2022; 33:580-587. [PMID: 36345186 PMCID: PMC9647677 DOI: 10.52312/jdrs.2022.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This study aims to compare the radiological outcomes of unicompartmental knee arthroplasty (UKA) performed by a navigation-based robotic system versus Microplasty® instrumentation. PATIENTS AND METHODS Between January 2018 and January 2019, a total of 90 knees of 75 patients (65 males, 10 females; mean age: 62.0±9.4 years; range, 50 to 73 years) were included. Among these, 54 knees underwent Oxford mobile-bearing UKA with an Microplasty® instrumentation set and 36 knees were operated with the aid of a Restoris® MCK with MAKO navigation-based robotic system. Postoperative anteroposterior and lateral X-rays of all patients were evaluated according to nine different parameters. On the femoral side, femoral varus-valgus angle, flexion-extension angle, femoral condyle posterior fit; on tibial side, tibial component varus/valgus, tibial posterior slope, medial, anterior, posterior and lateral fit of tibial component assessed. RESULTS There was no significant difference between groups in terms of age, sex, and affected side. On the femoral side, no significant difference was observed in the component position between groups. On the tibial side, tibial component medial fit (p=0.032) and anterior fit (p=0.007) were better in navigation-based robotic system group. CONCLUSION Microplasty® instrumentation may lead to comparable implant positioning compared to a tactile-based navigated robotic instrumentation.
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Affiliation(s)
- Haluk Çabuk
- Department of Orthopedics and Traumatology, Istinye University, Istanbul, Türkiye
| | - Kaya Turan
- Department of Orthopedics and Traumatology, Istinye University, Istanbul, Türkiye
| | | | - Tuğrul Ergün
- Department of Orthopedics and Traumatology, Istinye University, Istanbul, Türkiye
| | - Çağatay Öztürk
- Department of Orthopedics and Traumatology, Istinye University, Istanbul, Türkiye
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Tuecking LR, Ettinger M, Windhagen H, Savov P. [Market overview: Robotic-assisted arthroplasty : Current robotic systems, learning curve and cost analysis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:727-738. [PMID: 35945459 DOI: 10.1007/s00132-022-04286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Robotic-assisted arthroplasty has been rapidly entering clinical routine in recent years. The leading endoprosthesis manufacturers have all meanwhile placed robotic systems on the market, which, however, differ significantly from one another technically. Current systems are currently classified according to the degree of autonomy (active vs. semi-active vs. passive) and the data/image source (image-based: CT vs. X‑ray, imageless). Some systems already offer the possibility of robotic-assisted or navigated implantation of hip endoprostheses. In the following review article, the currently leading robotic systems will be presented and compared with regard to their characteristics. Furthermore, the analysis of the learning curves for the different systems, currently available cost analysis models and an outlook on future developments and challenges will be given.
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Affiliation(s)
- Lars-René Tuecking
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland.
| | - Max Ettinger
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
| | - Henning Windhagen
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
| | - Peter Savov
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
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Goh GS, Haffar A, Tarabichi S, Courtney PM, Krueger CA, Lonner JH. Robotic-Assisted Versus Manual Unicompartmental Knee Arthroplasty: A Time-Driven Activity-Based Cost Analysis. J Arthroplasty 2022; 37:1023-1028. [PMID: 35172186 DOI: 10.1016/j.arth.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The cost-effectiveness of robotic-assisted unicompartmental knee arthroplasty (RA-UKA) remains unclear. Time-driven activity-based costing (TDABC) has been shown to accurately reflect true resource utilization. This study aimed to compare true facility costs between RA-UKA and conventional UKA. METHODS We identified 265 consecutive UKAs (133 RA, 132 conventional) performed at a specialty hospital in 2016-2020. Itemized facility costs were calculated using TDABC. Separate analyses including and excluding implant costs were performed. Multiple regression was performed to determine the independent effect of robotic assistance on facility costs. RESULTS Due to longer operative time, RA-UKA patients had higher personnel costs and total facility costs ($2,270 vs $1,854, P < .001). Controlling for demographics and comorbidities, robotic assistance was associated with an increase in personnel costs of $399.25 (95% confidence interval [CI] $343.75-$454.74, P < .001), reduction in supply costs of $55.03 (95% CI $0.56-$109.50, P = .048), and increase in total facility costs of $344.27 (95% CI $265.24-$423.31, P < .001) per case. However, after factoring in implant costs, robotic assistance was associated with a reduction in total facility costs of $235.87 (95% CI $40.88-$430.85, P < .001) per case. CONCLUSION Using TDABC, overall facility costs were lower in RA-UKA despite a longer operative time. To facilitate wider adoption of this technology, implant manufacturers may negotiate lower implant costs based on volume commitments when robotic assistance is used. These supply cost savings appear to offset a portion of the increased costs. Nonetheless, further research is needed to determine if RA-UKA can improve clinical outcomes and create value in arthroplasty.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Amer Haffar
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Saad Tarabichi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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Robotics in orthopaedic surgery: why, what and how? Arch Orthop Trauma Surg 2021; 141:2035-2042. [PMID: 34255170 DOI: 10.1007/s00402-021-04046-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Robotics applied to orthopedics has become an interesting topic both from the surgical point of view and the engineering one. The main goal of those systems is the enhancement of joint arthroplasty surgery, providing the robotic support to precisely and accurately prepare the bone, restore the limb alignment and the physiological kinematics of the joint. Various robotic systems are currently available on the market, each addressing specific kind of surgeries and characterized by a series of specific features that may involve different requirements and/or modus operandi. MATERIAL AND METHODS An overview of these devices was performed, addressing the different categories in which robots are subdivided in terms of: operations performed, requirements and level of interaction of the surgeon. The main models currently available on the market were addressed and relative studies in the literature were reported and compared, to highlight the benefits and drawbacks of the different technologies. RESULTS The different robotic systems were subdivided in: open/closed platform, image-based/imageless and active/passive/semi-active. Regardless of the typology of robotic system, the main aim is to improve precision and accuracy of the operation. It is to be noted that, regardless of the typology of robotic system, the surgeon is still in charge of the planning and approval of the operation: only the precise and consistent execution of his directives is entrusted to the robot. The positive factors have however to be weighed against the fact that robotic systems involve an important initial investment and most of the times require the surgeons and the staff to learn how to operate them (with a learning curve differing from system to system). CONCLUSIONS Each surgeon, when considering if and which robotic system to adopt, has to properly evaluate the different benefits and drawbacks involved to find the surgical robot that fits his needs the best.
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