[Cost reduction in robot-assisted knee arthroplasty can currently be achieved primarily through volume effects : A comparative cost analysis between 2018 and 2024].

Introduction: Robot-assisted technologies in total knee arthroplasty (TKA) have been introduced to increase implantation accuracy, minimize revisions, and ideally improve patient outcomes. However, concerns remain regarding increased costs and extended operating time. The aim of this study was to analyze the development of the cost structure of robot-assisted image-based knee arthroplasty in a specialized center over a 6-year period.

Methods: A retrospective cost analysis of image-based robot-assisted TKA based on data from 2024 was conducted and compared with results from a similar analysis from 2018. Specific parameters such as operating time, number and cost of surgical instrument trays, technology costs (leasing and service costs of the robot system), costs for robot-specific disposable materials, and preoperative CT imaging were considered. All costs were adjusted for inflation, converted to US dollars, and standardized to both a fixed case volume (n = 125 from 2018) and the actual case volume in 2024 (n = 457).

Results: The fixed costs for the robotic technology itself (leasing and service fees per year) showed a slight increase between 2018 and 2024 (USD 151,000 vs. USD 225,620). However, due to the significant volume expansion achieved during this period, case-related technology costs were reduced by 60% (USD 1210 to USD 490). In addition, the costs for disposable materials were reduced by 27% (USD 600 to USD 440), and costs for preoperative CT imaging were reduced by 29% (USD 420 to USD 300). The average operating time was significantly reduced between 2018 and 2024 (73 min to 54 min) and was ultimately 5 min shorter than the comparable time for the manual technique (59 min). Overall, the average case-related total costs were reduced by 50% (USD 2600 to USD 1320) within 6 years.

Conclusion: The total case-related costs of robotic-assisted knee arthroplasty have been reduced by 50% over the past years. This was achieved mainly due to increased case volume and resulting cost efficiencies, shortened operative time, and reductions in disposable material costs. The technology itself has not become cheaper over the years.