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. 2019 Mar 12;5(1):88-95.
doi: 10.1016/j.artd.2019.01.002. eCollection 2019 Mar.

Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors

Joseph K Antonios  1 , Shane Korber  1 , Lakshmanan Sivasundaram  2 , Cory Mayfield  1 , Hyunwoo Paco Kang  1 , Daniel A Oakes  1 , Nathanael D Heckmann  1
Affiliations

Trends in computer navigation and robotic assistance for total knee arthroplasty in the United States: an analysis of patient and hospital factors

Joseph K Antonios et al. Arthroplast Today. .

Abstract

Background: Computer navigation and robotic assistance technologies are used to improve the accuracy of component positioning in total knee arthroplasty (TKA), with the goal of improving function and optimizing implant longevity. The purpose of this study was to analyze trends in the use of technology-assisted TKA, identify factors associated with the use of these technologies, and describe potential drivers of cost.

Methods: The Nationwide Inpatient Sample database was used to identify patients who underwent TKA using conventional instrumentation, computer navigation, and robot-assisted techniques between 2005 and 2014. Variables analyzed include patient demographics, hospital and payer types, and hospital charges. Descriptive statistics were used to describe trends. Univariate and multivariate analyses were performed to identify differences between conventional and technology-assisted groups.

Results: Our analysis identified 6,060,901 patients who underwent TKA from 2005 to 2014, of which 273,922 (4.5%) used computer navigation and 24,084 (0.4%) used robotic assistance. The proportion of technology-assisted TKAs steadily increased over the study period, from 1.2% in 2005 to 7.0% in 2014. Computer navigation increased in use from 1.2% in 2005 to 6.3% in 2014. Computer navigation was more likely to be used in the Western United States, whereas robot-assisted TKAs were more likely to be performed in the Northeast. Increased hospital charges were associated with the use of technology assistance ($53,740.1 vs $47,639.2).

Conclusions: The use of computer navigation and robot-assisted TKA steadily increased over the study period, accounting for 7.0% of TKAs performed in the United States in 2014. Marked regional differences in the use of these technologies were identified. The use of these technologies was associated with increased hospital charges.

Keywords: Computer navigation; TKA; Technology assistance; Total knee arthroplasty; Trends.

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Figures

Figure 1
Figure 1
The percent of total knee arthroplasties performed using computer navigation or robotic assistance from 2005 to 2014.
Figure 2
Figure 2
The use of technology-assisted TKAs by hospital location/teaching status from 2009 to 2014.
Figure 3
Figure 3
The median inflation-adjusted hospital charges for total knee arthroplasty performed by conventional or technology-assisted techniques from 2005 to 2014.
See this image and copyright information in PMC

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