Robotic-assisted total hip arthroplasty: an economic analysis
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). Methods: THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670 mTHA cases were included. 90-day EOC cost, index costs, length of stay and post-index rehabilitation utilization were assessed. Results: RATHA patients were significantly less likely to have post-index inpatient rehabilitation or skilled nursing facility admissions and used fewer home health agency visits, compared with mTHA patients. Total 90-day EOC costs for RATHA patients were found to be US$785 less than those of mTHA patients (p = 0.0095). Conclusion: RATHA was associated with an overall lower 90-day EOC cost when compared with mTHA. The savings associated with RATHA were driven by reduced utilization and cost of post-index rehabilitation services.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
McLawhorn AS, Buller LT. Bundled payments in total joint replacement: keeping our care affordable and high in quality. Curr. Rev. Musculoskelet. Med. 10(3), 370–377 (2017).
2.
Yelin E, Weinstein S, King T. The burden of musculoskeletal diseases in the United States. Semin. Arthritis Rheum. 46(3), 259–260 (2016).
3.
United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States. Osteoarthritis (2014). www.boneandjointburden.org/print/book/export/html/978
4.
Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 370(9597), 1508–1519 (2007).
5.
Lavernia CJ, Alcerro JC. Quality of life and cost–effectiveness 1 year after total hip arthroplasty. J. Arthroplasty 26(5), 705–709 (2011).
6.
Daigle ME, Weinstein AM, Katz JN, Losina E. The cost–effectiveness of total joint arthroplasty: a systematic review of published literature. Best Pract. Res. Clin. Rheumatol. 26(5), 649–658 (2012).
7.
Singh JA, Yu S, Chen L, Cleveland J. Rates of total joint replacement in the United States: future projections to 2020–2040 using the national inpatient sample. J. Rheumatol. 46(9), 1134–1140 (2019).
8.
Bargar WL, Bauer A, Borner M. Primary and revision total hip replacement using the Robodoc System. Clin. Orthop. Relat. Res. (354), 82–91 (1998).
9.
Bargar WL. Robots in orthopaedic surgery: past, present, and future. Clin. Orthop. Relat. Res. 463, 31–36 (2007).
10.
Lang JE, Mannava S, Floyd AJ et al. Robotic systems in orthopaedic surgery. J. Bone Joint Surg. Br. 93(10), 1296–1299 (2011).
11.
Parsley BS. Robotics in orthopaedics: a brave new world. J. Arthroplasty 33(8), 2355–2357 (2018).
12.
Schulz AP, Seide K, Queitsch C et al. Results of total hip replacement using the Robodoc surgical assistant system: clinical outcome and evaluation of complications for 97 procedures. Int. J. Med. Robot. 3(4), 301–306 (2007).
13.
Jacofsky DJ, Allen M. Robotics in arthroplasty: a comprehensive review. J. Arthroplasty 31(10), 2353–2363 (2016).
14.
Sinha RK. Outcomes of robotic arm-assisted unicompartmental knee arthroplasty. Am. J. Orthop. 38(Suppl. 2), 20–22 (2009).
15.
Pearle AD, O'Loughlin PF, Kendoff DO. Robot-assisted unicompartmental knee arthroplasty. J. Arthroplasty 25(2), 230–237 (2010).
16.
Hampp EL, Sodhi N, Scholl L et al. Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when comparted with a manual approach. Bone Joint Res. 8(10), 495–501 (2019).
17.
Chen AF, Kazarian GS, Jessop GW, Makhdom A. Robotic technology in orthopaedic surgery. J. Bone Joint Surg. Am. 100(22), 1984–1992 (2018).
18.
Van der List JP. Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systemic review with meta-analysis. Knee Surg. Sports Traumatol. Arthrosc. 24(11), 3482–3495 (2016).
19.
Tarwala R, Dorr LD. Robotic assisted total hip arthroplasty using the MAKO platform. Curr. Rev. Musculoskelet. Med. 4(3), 151–156 (2011).
20.
Illgen RL, Bukowski BR, Abiola R et al. Robotic-assisted total hip arthroplasty: outcomes at minimum two-year follow up. Surg. Technol. Int. 30, 365–372 (2017).
•• Analysis of a single surgeon’s first 100 manual THAs (mTHAs) versus last 100 mTHAs versus first 100 robotic-assisted total hip arthroplasties (RATHAs) at 2-year follow-up, showing more accurate implant placement, reduced blood loss and reduced dislocation rates for RATHA compared to mTHA.
21.
Kayani B, Konan S, Thakrar RR, Huq SS, Haddad FS. Assuring the long-term total joint arthroplasty: a triad of variables. Bone Joint J. 101-B(1 Suppl. A), 11–18 (2019).
22.
Perets I, Walsh JP, Close MR, Mu BH, Yuen LC, Domb BG. Robot-assisted total hip arthroplasty: clinical outcomes and complication rate. Int. J. Med. Robot. 14(4), 1–8 (2018).
23.
Domb BG, Chen JW, Lall AC, Perets I, Maldonado DR. Minimum 5-year outcomes of robotic-assisted primary total hip arthroplasty with a nested comparison against manual primary total hip arthroplasty: a propensity score-matched study. J. Am. Acad. Orthop. Surg. 28(20), 847–856 (2020).
•• Study comparing 66 RATHAs with 66 matched mTHAs at 5-year follow-up, showing higher patient-reported outcome scores and reduced risk of acetabular implant placement outside the designated safe zones.
24.
Cool CL, Jacofsky DJ, Seeger KA, Sodhi N, Mont MA. A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty. J. Comp. Eff. Res. 8(5), 327–336 (2019).
• Comparison of Medicare costs for 519 robotic-assisted versus 2595 manual total knee arthroplasties over 90 days, showing reduced lengths of stay, increase in home discharge, reduced readmissions and average savings for the robotic-assisted procedure over a 90-day EOC.
25.
Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C. Robotic arm-assisted knee surgery: an economic analysis. Am. J. Manag. Care 26(7), e205–e210 (2020).
• Compared 357 robotic-assisted versus 1785 manual total knee arthroplasties, showing reduced lengths of stay, reduced utilization of post-operative services and average savings for the robotic-assisted procedure over a 90-day episode-of-care in commercially insured patients.
26.
Yang JY, Webster-Clark M, Lund JL, Sandler RS, Dellon ES, Stürmer T. Propensity score methods to control for confounding in observational cohort studies: a statistical primer and application to endoscopy research. Gastrointest. Endosc. 90(3), 360–369 (2019).
27.
Pirracchio R, Resche-Rigon M, Chevret S. Evaluation of the propensity score methods for estimating marginal odds ratios in case of small sample size. BMC Med. Res. Methodol. 12, 70 (2012).
28.
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav. Res. 46(3), 399–424 (2011).
29.
Staffa SJ, Zurakowski D. Five steps to successfully implement and evaluate propensity score matching in clinical research studies. Anesth. Analg. 127(4), 1066–1073 (2018).
30.
Suarez-Ahedo C, Gui C, Martin TJ, Chandrasekaran S, Lodhi P, Domb BG. Robotic arm-assisted total hip arthroplasty results in smaller acetabular cup size in relation to the femoral head size: a matched-pair controlled study. Hip Int. 27(2), 147–152 (2017).
31.
Heng YY, Gunaratne R, Ironside C, Taheri A. Conventional vs robotic arm assisted total hip arthroplasty (THA) surgical time, transfusion rates, length of stay, complications and learning curve. J. Arthritis 7(4), 1–4 (2018).
32.
McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J. Bone Joint Surg. Br. 77(6), 865–869 (1995).
33.
Charles MN, Bourne RB, Davey JR, Greenwald AS, Morrey BF, Rorabeck CH. Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr. Course Lect. 54, 131–141 (2005).
34.
Centers for Medicare & Medicaid Services. Comprehensive care for joint replacement model three year extension and changes to episode definition and pricing (2020). www.cms.gov/newsroom/fact-sheets/comprehensive-care-joint-replacement-model-three-year-extension-and-changes-episode-definition-and
35.
Mechanic R. Post-acute care – the next frontier for controlling Medicare spending. N. Engl. J. Med. 370(8), 692–694 (2014).
36.
Feder J. Bundle with care – rethinking Medicare incentives for post-acute care services. N. Engl. J. Med. 369(5), 400–401 (2013).
37.
Centers for Medicare & Medicaid Services. Bundled Payments for Care Improvement (BPCI) initiative (2020). https://innovation.cms.gov/innovation-models/bundled-payments
38.
Hackbarth G, Reischauer R, Mutti A. Collective accountability for medical care-toward bundled Medicare payments. N. Engl. J. Med. 359(1), 3–5 (2008).
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Pages: 1225 - 1234
PubMed: 34581189
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© 2021 Future Medicine Ltd.
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Received: 12 November 2020
Accepted: 19 August 2021
Published online: 28 September 2021
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Robotic-assisted total hip arthroplasty: an economic analysis. (2021) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2020-0255
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- Duncan E J Whittaker, Gareth Medlock, David W Neilly, Thomas I Diffley, Haroon Rehman, Comparative analysis of CT-based and 2D digital templating in robotic hip arthroplasty, HIP International, 10.1177/11207000251352128, 36, 1, (12-17), (2025).
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