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Evaluating the cost of robotic-assisted total and unicompartmental knee arthroplasty

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Abstract

As uptake of robotic-assisted arthroplasty increases there is a need for economic evaluation of the implementation and ongoing costs associated with robotic surgery. The aims of this study were to describe the in-hospital cost of robotic-assisted total knee arthroplasty (RA-TKA) and robotic-assisted unicompartmental knee arthroplasty (RA-UKA) and determine the influence of patient characteristics and surgical outcomes on cost. This prospective cohort study included adult patients (≥ 18 years) undergoing primary unilateral RA-TKA and RA-UKA, at a tertiary hospital in Sydney between April 2017 and June 2021. Patient characteristics, surgical outcomes, and in-hospital cost variables were extracted from hospital medical records. Differences between outcomes for RA-TKA and RA-UKA were compared using independent sample t-tests. Logistic regression was performed to determine drivers of cost. Of the 308 robotic-assisted procedures, 247 were RA-TKA and 61 were RA-UKA. Surgical time, time in the operating room, and length of stay were significantly shorter in RA-UKA (p < 0.001); whereas RA-TKA patients were older (p = 0.002) and more likely to be discharged to in-patient rehabilitation (p = 0.009). Total in-hospital cost was significantly higher for RA-TKA cases (AU$18580.02 vs $13275.38; p < 0.001). Robotic system and maintenance cost per case was AU$3867.00 for TKA and AU$5008.77 for UKA. Patients born overseas and lower volume robotic surgeons were significantly associated with higher total cost of RA-UKA. Increasing age and male gender were significantly associated with higher total cost of RA-TKA. Total cost was significantly higher for RA-TKA than RA-UKA. Robotic system costs for RA-UKA are inflated by the software cost relative to the volume of cases compared with RA-TKA. Cost is an important consideration when evaluating long term benefits of robotic-assisted knee arthroplasty in future studies to provide evidence for the economic sustainability of this practice.

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Data availability

Data supporting this study are not publicly available due to privacy constraints on highly sensitive medical data. The data that support the findings of this study may be made available on reasonable request from the corresponding author by contacting our institution at SLHD-SOuRCe@health.nsw.gov.au.

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Acknowledgements

We would like to thank the Sydney Local Health District Performance Unit for their support provided towards this manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, PO Box M157 Camperdown, Sydney, NSW, 2050, Australia

    Kate Alexander, Sascha Karunaratne, Kate McBride & Daniel Steffens

  2. Orthopaedic Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Verinder Sidhu, Brett Fritsch, Sanjeev Gupta, Mark Horsley, Maurice Guzman & Richard Boyle

  3. Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Kate McBride & Daniel Steffens

Authors
  1. Kate Alexander
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  2. Sascha Karunaratne
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  3. Verinder Sidhu
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  4. Brett Fritsch
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  5. Sanjeev Gupta
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  6. Mark Horsley
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  7. Maurice Guzman
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  8. Richard Boyle
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  9. Kate McBride
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  10. Daniel Steffens
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kate Alexander, Sascha Karunaratne and Daniel Steffens. The first draft of the manuscript was written by Kate Alexander and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kate Alexander.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

Ethics approval was granted by the Sydney Local Health District Human Ethics Committee (X19-0456, HREC number: 2019/ETH13554). A waiver of consent was approved for the analysis of routinely collected data for use in this study.

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Alexander, K., Karunaratne, S., Sidhu, V. et al. Evaluating the cost of robotic-assisted total and unicompartmental knee arthroplasty. J Robotic Surg 18, 206 (2024). https://doi.org/10.1007/s11701-024-01932-8

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  • DOI: https://doi.org/10.1007/s11701-024-01932-8

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