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

Abstract

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.

Keywords

episode-of-care - computed tomography scans - robotic-arm assisted manual - total knee arthroplasty

Publication History

Received: 03 March 2022

Accepted: 16 March 2022

Article published online:
11 July 2022

• References

• 1 Deshpande BR, Katz JN, Solomon DH. et al. The number of persons with symptomatic knee osteoarthritis in the United States: impact of race/ethnicity, age, sex, and obesity. Arthritis Care Res (Hoboken) 2016; 68 (12) 1743-1750
• 2 Marchand RC, Sodhi N, Khlopas A. et al. Coronal correction for severe deformity using robotic-assisted total knee arthroplasty. J Knee Surg 2018; 31 (01) 2-5
• 3 Hampp EL, Chughtai M, Scholl LY. et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2019; 32 (03) 239-250
• 4 Oswald MH, Jakob RP, Schneider E, Hoogewoud HM. Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty. J Arthroplasty 1993; 8 (04) 419-426
• 5 Ranawat CS, Boachie-Adjei O. Survivorship analysis and results of total condylar knee arthroplasty. Eight- to 11-year follow-up period. Clin Orthop Relat Res 1988; (226) 6-13
• 6 Vaidya NV, Deshpande AN, Panjwani T, Patil R, Jaysingani T, Patil P. Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surgery, Sport Traumatol Arthrosc 2022; Feb; 30 (02) 621-626
• 7 Marchand R, Scholl L, Bhowmik-Stoker M. et al. Total knee arthroplasty in the valgus knee: can new operative technologies affect surgical technique and outcomes?. Surg Technol Online 2021; Jul 26; 39: 389-393
• 8 Scholl LY, Hampp EL, de Souza KM. et al. How does robotic-arm assisted technology influence total knee arthroplasty implant placement for surgeons in fellowship training?. J Knee Surg 2022; 35 (02) 198-203
• 9 Khlopas A, Sodhi N, Sultan AA, Chughtai M, Molloy RM, Mont MA. Robotic arm-assisted total knee arthroplasty. J Arthroplasty 2018; 33 (07) 2002-2006
• 10 Marchand RC, Sodhi N, Khlopas A. et al. Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: a short-term evaluation. J Knee Surg 2017; 30 (09) 849-853
• 11 Kayani B, Konan S, Pietrzak JRT, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty. Bone Joint J 2018; Jul; 100-B [phone]
• 12 Batailler C, Fernandez A, Swan J. et al. MAKO CT-based robotic arm-assisted system is a reliable procedure for total knee arthroplasty: a systematic review. Knee Surgery, Sport Traumatol Arthrosc 2021; Nov; 29 (11) 3585-3598
• 13 Bargren JH, Blaha JD, Freeman MAR. Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations. Clin Orthop Relat Res 1983; (173) 178-183
• 14 Bonner TJ, Eardley WGP, Patterson P, Gregg PJ. The effect of post-operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg - Ser B 2011; Sep; 93 (09) 1217-1222
• 15 Moreland JR. Mechanisms of failure in total knee arthroplasty. Clin Orthop Relat Res 1988; (226) 49-64
• 16 Marchand RC, Sodhi N, Anis HK. et al. One-year patient outcomes for robotic-arm-assisted versus manual total knee arthroplasty. J Knee Surg 2019; 32 (11) 1063-1068
• 17 Mahoney O, Kinsey T, Sodhi N. et al. Improved component placement accuracy with robotic-arm assisted total knee arthroplasty. J Knee Surg 2022; 35 (03) 337-344
• 18 Berend ME, Ritter MA, Meding JB. et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004; (428) 26-34
• 19 Zhang J, Matzko CN, Sawires A, Ehiorobo JO, Mont MA, Hepinstall MS. 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. J Knee Surg 2021; (e-pub ahead of print)
• 20 Schiraldi M, Bonzanini G, Chirillo D, de Tullio V. Mechanical and kinematic alignment in total knee arthroplasty. Ann Transl Med 2016; 4 (07) 130
• 21 Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications. Curr Rev Musculoskelet Med 2014; 7 (02) 89-95
• 22 Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J Comp Eff Res 2019; 8 (05) 327-336
• 23 Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C. Robotic arm-assisted knee surgery: an economic analysis. Am J Manag Care 2020; 26 (07) e205-e210
• 24 Malanga G, Martins D, Nalmachu S. et al. Delay to TKA in patients treated with a multimodal approach using high molecular weight, biologically derived hyaluronic acid. J Long Term Eff Med Implants 2021; 31 (03) 45-50
• 25 Concoff A, Niazi F, Farrokhyar F, Alyass A, Rosen J, Nicholls M. Delay to TKA and costs associated with knee osteoarthritis care using intra-articular hyaluronic acid: analysis of an administrative database. Clin Med Insights Arthritis Musculoskelet Disord 2021; 14: 1179544121994092
• 26 Ong KL, Niazi F, Lau E. et al. Knee OA cost comparison for hyaluronic acid and knee arthroplasty. J Orthop Surg Res 2020; 15 (01) 305
• 27 Weiner JP, Bandeian S, Hatef E, Lans D, Liu A, Lemke KW. In-person and telehealth ambulatory contacts and costs in a large US insured cohort before and during the COVID-19 pandemic. JAMA Netw Open 2021; 4 (03) e212618
• 28 Zerbet A, Nikulin M. A new statistic for detecting outliers in exponential case. Commun Stat Theory Methods 2003; 32: 573-583
• 29 Nooghabi MJ, Nooghabi HJ, Nasiri P. Detecting outliers in gamma distribution. Commun Stat Theory Methods 2010; 39: 698-706
• 30 Chen Z, Bonutti PM, Barsoum WK, Mont MA, Bains SS, Jacofsky DJ. Technology review: CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty. Surg Technol Int 2022; 40: 40
• 31 Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: a prospective cohort study and validation of a new classification system. J Arthroplasty 2018; 33 (08) 2496-2501
• 32 Emara AK, Zhou G, Klika AK. et al. Robotic-arm-assisted knee arthroplasty associated with favorable in-hospital metrics and exponentially rising adoption compared with manual knee arthroplasty. J Am Acad Orthop Surg 2021; 29 (24) e1328-e1342
• 33 Malkani AL, Roche MW, Kolisek FR. et al. Manipulation under anesthesia rates in technology-assisted versus conventional-instrumentation total knee arthroplasty. Surg Technol Int 2020; 36: 336-340
• 34 Khwaja HA, Syed H, Cranston DW. Coding errors: a comparative analysis of hospital and prospectively collected departmental data. BJU Int 2002; 89 (03) 178-180
• 35 Nuttall GA, Houle TT. Liars, damn liars, and propensity scores. Anesthesiology 2008; 108 (01) 3-4
• 36 Okoli GN, Sanders RD, Myles P. Demystifying propensity scores. Br J Anaesth 2014; 112 (01) 13-15
• 37 Brown MJ, Matthews JR, Bayers-Thering MT, Phillips MJ, Krackow KA. Low incidence of postoperative complications with navigated total knee arthroplasty. J Arthroplasty 2017; 32 (07) 2120-2126
• 38 Kamara E, Berliner ZP, Hepinstall MS, Cooper HJ. Pin site complications associated with computer-assisted navigation in hip and knee arthroplasty. J Arthroplasty 2017; 32 (09) 2842-2846
• 39 Cotter EJ, Wang J, Illgen RL. Comparative cost analysis of robotic-assisted and jig-based manual primary total knee arthroplasty. J Knee Surg 2022; Jan; 35 (02) 176-184
• 40 Mont MA, Cool C, Gregory D, Coppolecchia A, Sodhi N, Jacofsky DJ. Health care utilization and payer cost analysis of robotic arm assisted total knee arthroplasty at 30, 60, and 90 days. J Knee Surg 2021; 34 (03) 328-337
• 41 Maldonado DR, Go CC, Kyin C. et al. Robotic arm-assisted total hip arthroplasty is more cost-effective than manual total hip arthroplasty: a Markov model analysis. J Am Acad Orthop Surg 2021; 29 (04) e168-e177
• 42 Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C. Robotic-assisted total hip arthroplasty: an economic analysis. J Comp Eff Res 2021; 10 (16) 1225-1234
• 43 Cool CL, Needham KA, Khlopas A, Mont MA. Revision analysis of robotic arm-assisted and manual unicompartmental knee arthroplasty. J Arthroplasty 2019; 34 (05) 926-931