Health Care Utilization and Payer Cost Analysis of Robotic Arm Assisted Total Knee Arthroplasty at 30, 60, and 90 Days

Abstract

This study performed a health care utilization analysis between robotic arm assisted total knee arthroplasty (rTKA) and manual total knee arthroplasty (mTKA) techniques. Specifically, we compared (1) index costs and (2) discharge dispositions, as well as (3) 30-day (4) 60-day, and (5) 90-day (a) episode-of-care costs, (b) postoperative health care utilization, and (c) readmissions. The 100% Medicare Standard Analytical Files were used for rTKAs and mTKAs performed between January 1, 2016, and March 31, 2017. Based on strict inclusion–exclusion criteria and 1:5 propensity score matching, 519 rTKA and 2,595 mTKA patients were analyzed. Total episode payments, health care utilization, and readmissions, at 30-, 60-, and 90-day time points were compared using generalized linear model, binomial regression, log link, Mann–Whitney, and Pearson's chi-square tests. The rTKA versus mTKA cohort average total episode payment was US$17,768 versus US$19,899 (p < 0.0001) at 30 days, US$18,174 versus US$20,492 (p < 0.0001) at 60 days, and US$18,568 versus US$20,960 (p < 0.0001) at 90 days. At 30 days, 47% fewer rTKA patients utilized skilled nursing facility (SNF) services (13.5 vs. 25.4%; p < 0.0001) and had lower SNF costs at 30 days (US$6,416 vs. US$7,732; p = 0.0040), 60 days (US$6,678 vs. US$7,901, p = 0.0072), and 90 days (US$7,201 vs. US$7,947, p = 0.0230). rTKA patients also utilized fewer home health visits and costs at each time point (p < 0.05). Additionally, 31.3% fewer rTKA patients utilized emergency room services at 30 days postoperatively and had 90-day readmissions (5.20 vs. 7.75%; p = 0.0423). rTKA is associated with lower 30-, 60-, and 90-day postoperative costs and health care utilization. These results are of marked importance given the emphasis to contain and reduce health care costs and provide initial economic insights into rTKA with promising results.

Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis

“…There were seven clinical studies reporting the functional outcomes following RATKA compared to mTKA (Table 5) [19,23,28,30,31,35,49]. Different outcome scores were utilised across the included studies, with the Knee Society Table 1 Studies included in the systematic review according to how they were identified, when they were published, design, patient demographics, follow up and type of implant [23,28].…”

Comparative Cost Analysis of Robotic-Assisted and Jig-Based Manual Primary Total Knee Arthroplasty

“…in utilization of ED when comparing raTKA to mTKA in an analysis of 3,114 Medicare patients. 19 A separate study of Medicare patients found a 33% reduction in 90-day readmission rate comparing raTKA with mTKA. 4 Malkani et al recently reported a 4.5-fold decrease in rates of manipulation for raTKA compared with mTKA.…”

Expanding Robotic Arm-Assisted Knee Surgery: The First Attempt to Use the System for Knee Revision Arthroplasty

“…Case Reports in Orthopedics that robotic arm-assisted THA improved accuracy for both acetabular abduction angles, as well as acetabular anteversion, and demonstrated lower dislocation rates, when compared to manual THA [12][13][14][15]. Finally, RATKA has shown very promising short-term results [8]. In this present paper, we described the first revision from UKA to TKA with the off-label utilization of the robotic arm-assisted arthroplasty platform enhanced with a single-stage manual intervention.…”

“…The most significant haptic tactile system is the Robotic Arm Interactive Orthopedic MAKO Stryker (RIO; MAKO Stryker, Fort Lauderdale, Florida) system, counting over 700 systems, in use, worldwide. The potential for improving surgical outcomes with the use of the robotic arm-assisted arthroplasty system has already been documented [1,[6][7][8][9].…”