Are all robotic technologies created equal? Comparing one of the latest image-free robotic technologies to all other robotic systems for total knee arthroplasty

Abstract

Background: Robotic-assisted technologies have been developed to increase surgical precision and reduce surgical variability in total knee arthroplasty (TKA). Several different robotic systems have been introduced in the last decade for TKA. The DePuy Synthes VELYS^TM Robotic-Assisted Solution (VRAS) is an imageless system designed to eliminate the need for preoperative CT scans and is one of the latest entrants in the rapidly evolving field of robotic technology in TKA. This study compared the clinical and economic outcomes associated with VRAS compared to other robotic-assisted technology for primary TKA. Methods: A retrospective cohort study using the Premier Healthcare Database included patients who received their primary TKA with VRAS compared with other robotic-assisted technologies from January 1, 2022, to April 30, 2023. The primary outcome for the study was hospital follow-up visits (revisits) within 90 days post-TKA. Secondary outcomes included readmission and revision rates within 90-day post-TKA, operating room time, length of stay, discharge status and hospital costs. Cohorts were balanced using propensity score fine stratification and generalized linear models were constructed to evaluate outcomes. Results: The study included 827 VRAS TKA cases and 16,428 TKA cases performed with other robotic-assisted technologies. The 90-day all-cause and knee-related revisit rates were statistically significantly lower for VRAS compared to other robotic-assisted technologies (all-cause 13.9% vs. 22.8% and knee-related 2.8% vs. 5.4%, respectively, p-value < 0.01). The all-cause and knee-related 90-day readmission rates were also lower for VRAS though the differences were not statistically significant. 90-day revision rates were similar for VRAS and other robotic-assisted technologies (0.48% vs. 0.45%), as was operating room time (138 vs. 137 minutes). The 90-day knee-related cost for the VRAS cohort was $15,048 compared to $16,867 for other robotic technologies. Conclusions: This database study demonstrates that early post-operative revisit rates and total cost of care is lower for VRAS compared to the class of all other robotic-assisted technologies for TKA, while operating room time and discharge status were similar. These are important findings in ever-evolving healthcare systems which are increasingly cost-conscious and cognizant of principles associated with value-based care.