Robotic-Arm Assisted Technology's Impact on Knee Arthroplasty and Associated Healthcare Costs

Abstract

**Background:** The number of total knee arthroplasties (TKA) carried out globally is expected to substantially rise in the coming decades. Consequently, focus has been increasing on improving surgical techniques and minimizing expenses. Robotic arm–assisted knee arthroplasty has garnered interest to reduce surgical errors and improve precision. **Objectives:** Our primary aim was to compare the episode-of-care cost up to 90 days for unicompartmental knee arthroplasty (UKA) and TKA performed before and after the introduction of robotic arm–assisted technology. The secondary aim was to compare the volume of UKA vs TKA. **Methods:** This was a retrospective study design at a single healthcare system. For the cost analysis, we excluded patients with bilateral knee arthroplasty, body mass index >40, postoperative infection, or noninstitutional health plan insurance. Costs were obtained through an integrated billing system and affiliated institutional insurance company. **Results:** Knee arthroplasty volume increased 28% after the introduction of robotic-assisted technology. The TKA volume increased by 17%, while the UKA volume increased 190%. Post introduction, 97% of UKA cases used robotic arm–assisted technology. The cost analysis included 178 patients (manual UKA, n = 6; robotic UKA, n = 19; manual TKA, n = 58, robotic TKA, n = 85). Robotic arm–assisted TKA and UKA were less costly in terms of patient room and operating room costs but had higher imaging, recovery room, anesthesia, and supply costs. Overall, the perioperative costs were higher for robotic UKA and TKA. Postoperative costs were lower for robotic arm–assisted surgeries, and patients used less home health and home rehabilitation. **Discussion:** Surgeons performed higher volumes of UKA, and UKA comprised a greater percentage of total surgical volume after the introduction of this technology. The selective cost analysis indicated robotic arm–assisted technology is less expensive in several cost categories but overall more expensive by up to $550 due to higher cost categories including supplies and recovery room. **Conclusions:** Our findings show a change in surgeons’ practice to include increased incidence and volume of UKA procedures and highlights several cost-saving categories through the use of robotic arm–assisted technology. Overall, robotic arm–assisted knee arthroplasty cost more than manual techniques at our institution. This analysis will help optimize costs in the future.