Abstract
Robotic-arm assisted total knee arthroplasty (rTKA) was developed to provide for increased
accuracy of component placement compared with conventional manual TKA (mTKA). Whether
or not rTKA is cost-effective in a bundled payment model has yet to be addressed.
The purpose of this comparative study was to evaluate the short-term clinical outcomes
of rTKA and mTKA. We retrospectively reviewed a series of 4,086 consecutive primary
TKA performed by one of five surgeons across six different hospitals at our institution
from January 2016 to December 2018. Outcomes for rTKA cases (n = 581) and mTKA cases (n = 3,505) were compared using unmatched multivariate analysis and a matched cohort.
We analyzed 90-day outcomes, episode-of-care claims data, and short form (SF-12) outcome
scores to 2 years postoperatively. In matched bivariate analysis, there was no difference
in episode-of-care costs, postacute care costs, complications, 90-day readmission
rates, emergency department/urgent care visits, reoperations, and mortality between
rTKA and mTKA patients (p > 0.05). Matched patients undergoing rTKA did have a shorter hospital length of stay
(1.46 vs. 1.80 days, p < 0.001) and decreased rates of discharge to rehabilitation facilities (5.5 vs. 14.8%,
p < 0.001). SF-12 scores were clinically similar. Multivariate analysis demonstrated
no differences in any 90-day outcome. We conclude that patients undergoing rTKA have
comparable costs, 90-day outcomes, and clinically similar improvements in functional
outcome scores compared with mTKA patients. Further study is needed to determine whether
rTKA will result in improved implant survivorship and long-term functional outcomes
(Level of evidence III).
Keywords
robotics - total knee arthroplasty - short-term outcomes - results
