Abstract
Background/Introduction
As a new generation of robotic systems is introduced into the world of arthroplasty, Robotic-Assisted Total Knee Arthroplasty (TKA) represents a growing proportion of a reconstructive surgeon's operative volume. This study aims to compare the post-operative readmission rate, pain scores, costs, as well as the effects on surgeon efficiency one year after adoption of these technologies into clinical practice.
Methods
A retrospective chart review was conducted regarding all conventional and robotic-assisted TKAs performed by a single surgeon in the year following January 1, 2017, the date MAKO Robotic-Assisted TKAs were introduced at our intuition. All patients over age 18 with a diagnosis of primary osteoarthritis of the knee who underwent TKA during this period were identified. Records were analyzed for differences in readmission, pain scores, tourniquet time, and operating room charges.
Results
A total of 208 patients met inclusion criteria and were included in this analysis (97 Robotic-Assisted TKAs & 111 conventional TKAs). Robotic-Assisted TKAs incurred a mean total OR cost of $44,785 in the first quarter of implementation. This decreased to $43,124 over the subsequent year. Conventional TKAs incurred a mean total OR cost of $41,277. Among Robotic-Assisted TKAs, the mean tourniquet time was 70 minutes in the first month the technology was implemented. Mean tourniquet time for conventional TKAs was 42 minutes. Over time, variance in tourniquet times decreased substantially and tourniquet time for Robotic-Assisted TKAs trended towards being time neutral (49 minutes) (P=0.001). More importantly, in this study Robotic-Assisted TKAs were readmitted at a rate of only 1% (1/97). This represents a substantial reduction in readmission when compared to conventional TKAs, which were readmitted at a rate of 4.5% (5/111) (P=0.13). Interestingly, Robotic-Assisted TKAs averaged lower pain scores (2.9) compared to conventional TKAs (3.2), a finding that trended towards significance (P=0.13).
Discussion/Conclusions
Implementation of Robotic-Assisted TKA resulted in an initial increase in mean OR cost and tourniquet time. Although there is a learning curve with specific regard to surgeon efficiency, there was no increase in the rate of complications and the trend in tourniquet time approached being time neutral one year after implementation. Though Robotic-Assisted TKAs continue to represent an increased cost burden compared to conventional TKAs, this may be offset by lower pain scores and more importantly a substantial reduction in post-operative readmission. Since readmissions represent a relatively rare occurrence following TKA, further large-scale studies are required to validate this preliminary data.
