Trends in Computer-Assisted Surgery for Total Knee Arthroplasty in Germany: An Analysis Based on the Operative Procedure Classification System between 2010 to 2021

Abstract

Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (−3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard.

Initial Learning Curve for Robot-Assisted Total Knee Arthroplasty in a Dedicated Orthopedics Center

“…These encouraging results are confirmed by the increased interest in RA-TKA, despite the high initial cost, and is preferred to manual TKA in multiple hospitals worldwide [65][66][67][68][69]. The decreased blood loss combined with superior patient outcomes and reduction in revision TKA and opioid use are strong arguments in favor of choosing RA-TKA over manual TKA [65][66][67]70].…”

Navigation und Robotik in der Totalendoprothetik des Kniegelenks – Evidenz?

“…In Deutschland wurden demgegenüber zwischen 2010 und 2021 nur etwa 8 % der Knieendoprothesen mittels Computernavigation implantiert. Auch hier ist der Trend zugunsten der Robotik rückläufig [15]. Ursächlich für diesen Trend dürfte sein, dass in den letzten Jahren mit zunehmender Entwicklung der Robotik viele Navigationssysteme nicht mehr als isolierte Navigation weiterentwickelt bzw.…”

Robotic Total Knee Arthroplasty: An Update

“…Many different robotic devices are available for clinical practice, depending on the degree of freedom of action. They can be classified into active, which perform their task autonomously, semi-active, which provide haptic feedback to avoid potential harms, and passive, which are continuously governed by the operator [ 4 ]. Results are conflicting and still unclear.…”