Technology-Assisted Hip and Knee Arthroplasties: An Analysis of Utilization Trends

Abstract

Background: Robotic and computer navigation technology is available to surgeons for use in hip and knee arthroplasties to increase the precision of component placement. However, they do add significant costs to these procedures, and the long-term clinical outcomes and value of technology assistance for joint replacement remain unclear.

Methods: We identified 321,522 patients in Medicare Severity Diagnosis Related Groups 469 and 470 who underwent primary total hip arthroplasty (N = 133,472) or primary total or unicompartmental knee arthroplasty (N = 188,050) between 2008 and 2015 in the New York Statewide Planning and Research Cooperative System (SPARCS).

Results: Among all total joint arthroplasties performed during this period, technology assistance was used in 5.1% of cases. Technology assistance was more common for knee (7.3%) than hip (1.9%) arthroplasty (P < .001). The proportion of cases using technology assistance grew each year, increasing from 2.8% (knee 4.3% and hip 0.5%) in 2008 to 8.6% (knee 11.6% and hip 5.2%) in 2015 (P trend <.001). The proportion of hospitals and surgeons using robotic assistance also increased during the study period, increasing from 16.2% of hospitals and 6.2% of surgeons in 2008 to 29.2% of hospitals and 17.1% of surgeons in 2015 (P trend <.001 for both). Technology was more likely to be used for patients with private insurance (5.9%) compared with Medicare (4.7%, P < .001) or Medicaid (2.2%, P < .001), and for patients at high-volume (6.9%, P < .001) or very high-volume (6.1%, P < .001) as compared with low-volume (2.7%) hospitals.

Conclusion: Technology assistance has become increasingly used by orthopedic surgeons for hip and knee arthroplasties, however, adoption has not been uniform.

Keywords: Level III; arthroplasty; disparity; insurance; retrospective study; robotic; technology; volume.