OR Manager - November 2019 - 27

Technology
accurate bone cuts, implant placement,
and gap balancing.17
To assess 1-year postoperative patient
satisfaction outcomes in RATKA
versus manual TKA, Marchand et al. analyzed
53 consecutive RATKA and 53
consecutive manual TKAs performed by
a single orthopedic surgeon at a highvolume
institution. Patients completed
the Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC)
survey, a validated questionnaire focused
on physical function and pain scores.
Researchers found significantly lower
total WOMAC scores-indicating overall
improved outcomes-in the RATKA cohort
(P<0.05) compared with the manual
cohort. More patients in the RATKA cohort
reported lower, and therefore improved,
physical function scores (P<0.05)
than in the manual cohort. Mean postoperative
pain scores were 2±3 points
(range, 0-14 points) in the RATKA cohort
(P=0.06) vs 3±4 points (range, 0-11
points) in the manual cohort.18
Outlook for the future
Since its introduction in the market,
robotic-assisted technology has generated
data showing potential clinical10-18
and health economic advantages19
over conventional or manual
techniques. Features that may be contributing
to improved outcomes in TKA
patients include:
* individualized 3D preoperative planning
*
intraoperative visual, auditory, and
tactile feedback to the user
* an auto switch-off feature that is
designed to prevent the sawblade
from cutting outside the designated
field established during preoperative
planning and bone registration
* the ability for intraoperative adjustments
*
haptic guided bone resections.
In a longitudinal, retrospective analysis
of Medicare claims data evaluating
the 90-day EOC costs for manual total
knee vs robotic-assisted total knee surwww.ormanager.com
Episode
of care cost in manual versus RATKA
RATKA
Manual
TKA
Index facility cost
Post 90-day costs
by setting
 Inpatient
 Outpatient
 Emergency room
 Skilled nursing facility
 Home health
Total post 90 days
Total episode of care cost
(index + 90-day post index)
$12,075
$699
$614
$7,201
$3,045
$5,234
$13,267
$839
$736
$7,947
$3,536
$6,978
($1,192)
($141)
($122)
($746)
($491)
0.4904
0.0019*
0.1600
0.0230*
<0.0001*
($1,744) <0.0001*
$18,568 $20,960 ($2,391) <0.0001*
Adapted from Cool C L, Jacofsky D J, Seeger K A, et al.
A 90-day episode-of-care cost analysis of robotic-arm assisted total knee
arthroplasty. J Comp Eff Res. 2019;8(5):327-336. Used with permission.
*Indicates a statistically significant P-value.
$12,384
$13,024
Difference
($640)
P-value
0.0001*
Studies have linked RATKA
with reduced ergonomic risks.
geries, index cost (cost for surgery),
LOS, discharge disposition, and readmission
rates were assessed. TKA
procedures were identified using the
100% Medicare Standard Analytic File.
Accounting for baseline differences, propensity
score matching was performed
1:5.
The study included 519 RATKA and
2,595 manual TKA procedures. The
study showed a reduction in LOS by
0.7 days, significantly fewer patients
discharged to SNF (12.52% RATKA vs
21.70 mTKA, P<0.0001) as well as
a 33% reduction in 90-day readmissions.
The overall 90-day average EOC
costs to Medicare were $2,391 less for
RATKA (P<0.0001). These cost reductions
are likely attributable to the significantly
lower index costs, increased
likelihood of being discharged to home
shorter LOS, and decreased readmission
rates, when compared with mTKA
costs.19 (See Episode of Care Cost
table above.)
Haptic-guided RATKA has demonstrated
favorable intraoperative, early
postoperative, and health economic advantages
compared to conventional/
manual TKA in various case control
studies. Available short-term data show
promising results, but further research
is needed to measure the long-term
impact of this technology with regard to
clinical and functional outcomes.
Robotic-arm assisted TKA has the
potential to improve patient outcomes
and help contain healthcare costs to
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OR Manager | November 2019
27
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OR Manager - November 2019

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