Early Economic Analysis of Robotic-Assisted Unicondylar Knee Arthroplasty May Be Cost Effective in Patients with End-Stage Osteoarthritis

Abstract

Unicondylar knee arthroplasty (UKA), as an alternative to total knee arthroplasty (TKA), has been shown to be an effective option for patients with single-compartment end-stage knee osteoarthritis. Implant survival is contingent upon proper alignment, which has been improved with the advent of robotic-assisted surgery (r-UKA), but whether this outweighs the increased cost of the robotic-assist device has not been analyzed in the literature. The purpose of this study was to investigate the mid-term cost-effectiveness of r-UKA compared with UKA with traditional instrumentation (t-UKA) in the United States. A cost-effectiveness analysis using a four-state Markov model was performed using data from the 2018 National Joint Registry of England and Wales and a retrospective multicenter, cohort study on a cohort of 65-year-old patients having undergone r-UKA. The main outcome was cost per revision avoided and sensitivity analyses were conducted to evaluate the impact of using different model assumptions on the results. The Markov model illustrated that the benefit derived from r-UKA versus t-UKA was beneficial from a payer's perspective. The estimated incremental cost-effectiveness ratio (ICER) was $14,737 per revision avoided in a facility seeing 100 patients a year. Case volume was shown to be the primary variable affecting cost-effectiveness, with the value of r-UKA directly increasing with higher case volumes. Cost-effectiveness analyses demonstrated that the use of r-UKA is an effective alternative to t-UKA in patients with single-compartment knee osteoarthritis. While this study could benefit from longer follow-up clinical studies to illustrate the benefits of r-UKAs beyond the current 2 years time horizon, r-UKAs remained cost-effective, even after investigating several different assumptions.

Robotic‐arm assisted bicompartmental knee arthroplasty: Durable results up to 7‐year follow‐up

“…However despite the increased cost, when assessing RA‐UKA patient cost, Yeroushalmi et al. found cost savings due to fewer revisions 30,31 . Similarly, Cotter et al.…”

“…However despite the increased cost, when assessing RA-UKA patient cost, Yeroushalmi et al found cost savings due to fewer revisions. 30,31 Similarly, Cotter et al found the higher intraoperative cost of RA-TKA was made up by reduced length of stay and less postoperative discharge costs when compared to manual TKA. 31 While there are no current studies on the financial impact of RA-BiKA, there is a possibility it follows a similar trend and actually provides cost benefit despite the higher upfront and intraoperative cost.…”

Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty

“…Hassebrock and colleagues even suggested that preoperative advanced imaging is not benign and may create unnecessary workup of clinically insignificant incidental findings, incurring "hidden costs" [28]. Certainly, the utilization of robotic technologies has the potential of improved surgical technique and reduced complications, but the question remains whether it justifies exposing patients to radiation and creating unnecessary costs from incidental findings [25][26][27][28][29]. However, there is a paucity of literature investigating the benefits of preoperative CT imaging following the identification of significant incidental findings by radiologists, advancing patient care.…”

A new robotically assisted system for total knee arthroplasty: A sheep model study

“…The implementation of TKA is subject to technical thresholds and errors that potentially lead to joint instability, loosening or persistent pain 37–39 . Therefore, robotic‐assisted TKA systems may be an accurate and safe tool that decreases the need for revision and reduces complications and overall costs 40–42 …”