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Randomized Controlled Trial
. 2025 Jan 1;107-B(1):72-80.
doi: 10.1302/0301-620X.107B1.BJJ-2024-0245.R2.

Robotic arm-assisted medial compartment knee arthroplasty is a cost-effective intervention at ten-year follow-up

Mark J G Blyth  1 , Nick D Clement  2 , Xin Y Choo  1 , James Doonan  1 , Angus MacLean  1 , Bryn G Jones  1
Affiliations
Randomized Controlled Trial

Robotic arm-assisted medial compartment knee arthroplasty is a cost-effective intervention at ten-year follow-up

Mark J G Blyth et al. Bone Joint J. .

Abstract

Aims: The aim of this study was to perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted medial unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA).

Methods: Ten-year follow-up of patients who were randomized to rUKA (n = 64) or mUKA (n = 65) was performed. Patients completed the EuroQol five-dimension health questionnaire preoperatively, at three months, and one, two, five, and ten years postoperatively, which was used to calculate quality-adjusted life years (QALY) gained and the incremental cost-effectiveness ratio (ICER). Costs for the index and additional surgery and healthcare costs were calculated.

Results: mUKA had a lower survival for reintervention (84.8% (95% CI 76.2 to 93.4); p = 0.001), all-cause revision (88.9% (95% CI 81.3 to 96.5); p = 0.007) and aseptic revision (91.9% (95% CI 85.1 to 98.7); p = 0.023) when compared to the rUKA group at ten years, which was 100%. The rUKA group had a greater QALY gain per patient (mean difference 0.186; p = 0.651). Overall rUKA was the dominant intervention, being cost-saving and more effective with a greater health-related quality of life gain. On removal of infected reinterventions (n = 2), the ICER was £757 (not discounted) and £481 (discounted). When including all reintervention costs, rUKA was cost-saving when more than 100 robotic cases were performed per year. When removing the infected cases, rUKA was cost-saving when undertaking more than 800 robotic cases per year.

Conclusion: rUKA had lower reintervention and revision risks at ten years, which was cost-saving and associated with a greater QALY gain, and was the dominant procedure. When removing the cost of infection, which could be a random event, rUKA was a cost-effective intervention with an ICER (£757) which was lower than the willingness-to-pay threshold (£20,000).

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Conflict of interest statement

None declared.

References

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