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Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation

Several computer-assisted technologies, such as navigation and robotics, have been introduced to Total Knee Arthroplasty (TKA) in order to increase surgical precision and reduce complications. However, these technologies are often criticized due to the increased costs and effort associated with them...

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Autores principales: Christen, Bernhard, Tanner, Lars, Ettinger, Max, Bonnin, Michel P., Koch, Peter P., Calliess, Tilman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880057/
https://www.ncbi.nlm.nih.gov/pubmed/35207672
http://dx.doi.org/10.3390/jpm12020184
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author Christen, Bernhard
Tanner, Lars
Ettinger, Max
Bonnin, Michel P.
Koch, Peter P.
Calliess, Tilman
author_facet Christen, Bernhard
Tanner, Lars
Ettinger, Max
Bonnin, Michel P.
Koch, Peter P.
Calliess, Tilman
author_sort Christen, Bernhard
collection PubMed
description Several computer-assisted technologies, such as navigation and robotics, have been introduced to Total Knee Arthroplasty (TKA) in order to increase surgical precision and reduce complications. However, these technologies are often criticized due to the increased costs and effort associated with them; however, comparative data are missing. The aim of the present study was to evaluate differences in intraoperative workflows and the related perioperative cost-profiles of four current computer-assisted technologies, used to implant a TKA, in order to gain a comparison to conventional instrumentation. For the cost analysis, additional preoperative imaging and instruments, increased operating room (OR) and planning-time, and expenditures for technical support of the equipment and disposals were calculated, in comparison to conventional TKA, for (1) standard computer-navigation, (2) patient specific instruments (PSI), (3) image-based robotic assistance, and (4) imageless robotic assistance. Workflows at four expert centers which use these technologies were reviewed by an independent observer. The total cost calculation was based on a 125 TKA per year unit in Switzerland. Computer-navigation resulted in 14 min (+23%) increased surgery time and, overall, USD 650 in additional costs. PSI technology saved 5 min (8%) OR time but it created USD 1520 in expenditures for imaging and disposals. The image-based robotic system was the most expensive technology; it created overall additional costs of USD 2600, which predominately resulted from technical support, disposals, the CT-Scan, and 14 min of increased OR time. The imageless robotic assistance resulted in the largest increase in OR-time, as it resulted in an additional 25 min (+42%) on average. Overall, additional costs of USD 1530 were calculated. Every one of the assistive technologies in this study increased the total cost of TKA when compared to a conventional technique, and the most important variables, related to cost, were technical support and additional disposables. The longer surgical times and additional surgical trays required for the techniques had a marginal effect on overall costs. This comparative cost analysis gives valuable information for future efforts to calculate the real costs of these technologies and the subsequent return on investment of each technique.
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spelling pubmed-88800572022-02-26 Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation Christen, Bernhard Tanner, Lars Ettinger, Max Bonnin, Michel P. Koch, Peter P. Calliess, Tilman J Pers Med Article Several computer-assisted technologies, such as navigation and robotics, have been introduced to Total Knee Arthroplasty (TKA) in order to increase surgical precision and reduce complications. However, these technologies are often criticized due to the increased costs and effort associated with them; however, comparative data are missing. The aim of the present study was to evaluate differences in intraoperative workflows and the related perioperative cost-profiles of four current computer-assisted technologies, used to implant a TKA, in order to gain a comparison to conventional instrumentation. For the cost analysis, additional preoperative imaging and instruments, increased operating room (OR) and planning-time, and expenditures for technical support of the equipment and disposals were calculated, in comparison to conventional TKA, for (1) standard computer-navigation, (2) patient specific instruments (PSI), (3) image-based robotic assistance, and (4) imageless robotic assistance. Workflows at four expert centers which use these technologies were reviewed by an independent observer. The total cost calculation was based on a 125 TKA per year unit in Switzerland. Computer-navigation resulted in 14 min (+23%) increased surgery time and, overall, USD 650 in additional costs. PSI technology saved 5 min (8%) OR time but it created USD 1520 in expenditures for imaging and disposals. The image-based robotic system was the most expensive technology; it created overall additional costs of USD 2600, which predominately resulted from technical support, disposals, the CT-Scan, and 14 min of increased OR time. The imageless robotic assistance resulted in the largest increase in OR-time, as it resulted in an additional 25 min (+42%) on average. Overall, additional costs of USD 1530 were calculated. Every one of the assistive technologies in this study increased the total cost of TKA when compared to a conventional technique, and the most important variables, related to cost, were technical support and additional disposables. The longer surgical times and additional surgical trays required for the techniques had a marginal effect on overall costs. This comparative cost analysis gives valuable information for future efforts to calculate the real costs of these technologies and the subsequent return on investment of each technique. MDPI 2022-01-30 /pmc/articles/PMC8880057/ /pubmed/35207672 http://dx.doi.org/10.3390/jpm12020184 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Christen, Bernhard
Tanner, Lars
Ettinger, Max
Bonnin, Michel P.
Koch, Peter P.
Calliess, Tilman
Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation
title Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation
title_full Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation
title_fullStr Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation
title_full_unstemmed Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation
title_short Comparative Cost Analysis of Four Different Computer-Assisted Technologies to Implant a Total Knee Arthroplasty over Conventional Instrumentation
title_sort comparative cost analysis of four different computer-assisted technologies to implant a total knee arthroplasty over conventional instrumentation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8880057/
https://www.ncbi.nlm.nih.gov/pubmed/35207672
http://dx.doi.org/10.3390/jpm12020184
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