Lower TKA Readmission Rate With Robotic Assist: HSS Study

Those who are accustomed to using robots are seeing lower complication rates when it comes to total knee arthroplasty (TKA), according to a new study from Hospital for Special Surgery (HSS) in New York. The new work, “Trends of Utilization and 90-Day Complication Rates for Computer-Assisted Navigation and Robotic Assistance for Total Knee Arthroplasty in the United States From 2010 to 2018,” appears in the October 2021 edition of Arthroplasty Today.

Geoffrey Westrich, M.D. and colleagues used the PearlDiver All Payer Claims Database to retrospectively identified all patients who had primary, elective total knee arthroplasty (TKA) between 2010 and 2018.

Not only did they determine that knee replacement performed with a helping robotic hand resulted in a lower complication rate in the first three months following surgery, but they found that the frequency of U.S. robotic system use for knee replacement surgeries increased more than 2,000% from 2010 to 2018.

“The use of computer-assisted navigation and robotic assistance for total knee replacement has increased tremendously and shows no sign of slowing down,” Dr. Westrich said. “Among American Association of Hip and Knee Surgeons attending the 2020 annual meeting, 77% of respondents indicated that they used technology in their surgical cases. The most common reason they cited was to increase surgical precision.”

The researchers classified the surgeries as either conventional, computer-assisted navigation, or robotic-assisted TKAs.

They then collected data from 1,307,411 elective TKAs in the United States. Ninety-three percent (92.8%) were conventional TKA surgeries, 95.2% were computer-assisted and 4.9% robotic-assisted. The team also investigated regional differences, finding that surgeons practicing in the Western region of the United States were most likely to employ these software-driven technologies, while surgeons in the Midwestern region had the lowest rate of adoption.

In terms of TKA 90-day post-operative readmission rates, the HSS team found that conventional TKA surgeries had the highest rate while robotic-assisted TKA was lowest. To put a finer point on that, the research team wrote that robotic-assisted and the computer-assisted TKA cases were significantly less likely to result in a readmission within the 90-day period for ALL complications when compared to conventional TKA.

“The benefits clearly justify the cost of the robot,” concluded Dr. Westrich to OTW.

Next Gen Homing in on Robots

OTW asked Dr. Westrich about rates of robotic or navigation system adoption given this kind of encouraging data. Dr. Westrich explained, “There are always some surgeons who like the way they have traditionally done knee replacements with standard mechanical instrumentation and are apprehensive to switch to newer technology. Some surgeons are reluctant to spend the time learning a new technique and some are concerned about the additional operating room time that may come with the learning curve. Having said that, when you speak to the joint replacement fellows that we train annually, most if not all of them, seek job opportunities now where they will have access to robotic technology, as they see the benefits and have trained with this newer technology.”