Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors

Abstract

Background Computer navigation and robotic assistance technologies are used to improve the accuracy of component positioning in total knee arthroplasty (TKA), with the goal of improving function and optimizing implant longevity. The purpose of this study was to analyze trends in the use of technology-assisted TKA, identify factors associated with the use of these technologies, and describe potential drivers of cost. Methods The Nationwide Inpatient Sample database was used to identify patients who underwent TKA using conventional instrumentation, computer navigation, and robot-assisted techniques between 2005 and 2014. Variables analyzed include patient demographics, hospital and payer types, and hospital charges. Descriptive statistics were used to describe trends. Univariate and multivariate analyses were performed to identify differences between conventional and technology-assisted groups. Results Our analysis identified 6,060,901 patients who underwent TKA from 2005 to 2014, of which 273,922 (4.5%) used computer navigation and 24,084 (0.4%) used robotic assistance. The proportion of technology-assisted TKAs steadily increased over the study period, from 1.2% in 2005 to 7.0% in 2014. Computer navigation increased in use from 1.2% in 2005 to 6.3% in 2014. Computer navigation was more likely to be used in the Western United States, whereas robot-assisted TKAs were more likely to be performed in the Northeast. Increased hospital charges were associated with the use of technology assistance ($53,740.1 vs $47,639.2). Conclusions The use of computer navigation and robot-assisted TKA steadily increased over the study period, accounting for 7.0% of TKAs performed in the United States in 2014. Marked regional differences in the use of these technologies were identified. The use of these technologies was associated with increased hospital charges.

Trends and patient factors associated with technology-assisted total hip arthroplasty in the United States from 2005 to 2014

“…Specifically, we found that TA-THA was more likely to be done in the Western region compared to the Northeast region. This finding is similar to what numerous other studies have shown which is that use of technology assistance in arthroplasty surgery, whether it is computer-assisted navigation or robotic assistance, is more prevalent in the Western region of the United States [22,34].…”

“…We found no differences in the likelihood of undergoing TA-THA based on hospital size or type. These findings are similar to what Antonios et al showed in their analysis of TA-TKA but differ from Bohl et al in their retrospective study of THA with computer- assisted navigation [22,34]. Specifically, Bohl et al [22] showed that large, teaching medical centers had increased utilization of computer-assisted navigation.…”

“…We showed a similar increase from 2005 to 2014, but our study was done using the NIS, a national database. Antonios et al used the NIS to evaluate the national trend of technology-assisted total knee arthroplasty (TA-TKA) and found an increase from 1.2% in 2005 to 7.0% in 2014 [34]. Thus, it is clear that the increasing use of technology assistance is not just limited to THA but also present in other common orthopaedic procedures such as TKA.…”

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

“…Similar patterns of savings have been noted in a recent systematic review of robotic assisted technologies. 7 We found no statistically significant differences in reoperations, complications, ED visits, and 30-or 90-day readmissions comparing raTKA and mTKA. Other investigators have reported differences in these outcomes comparing raTKA and mTKA techniques.…”

“…Previous short-term follow-up studies demonstrate that raTKA results in improved postoperative pain, length of stay (LOS), and discharge disposition compared with jig-based mTKA techniques. 4,[7][8][9] The recent introduction of raTKA techniques precludes comparative survivorship analysis with mTKA technique. Other robotic-assisted surgical platforms including unicompartmental knee arthroplasty (raUKA) and total hip arthroplasty (raTHA) have been in clinical use in the United States for over 8 years.…”