PDF herunterladen
CC BY 4.0 · J Knee Surg 2024; 37(12): 864-872
DOI: 10.1055/a-2343-2444
Original Article

Early Clinical and Economic Outcomes for the VELYS Robotic-Assisted Solution Compared with Manual Instrumentation for Total Knee Arthroplasty

Philip Huang
1   OrthoIndy, Indianapolis, Indiana
,
Michael Cross
1   OrthoIndy, Indianapolis, Indiana
,
Anshu Gupta 
2   Epidemiology and Real-World Data Sciences, Johnson and Johnson MedTech, New Brunswick, New Jersey
,
Dhara Intwala
3   DePuy Synthes Digital, Robotics and Emerging Channels, Raynham, Massachusetts
,
Jill Ruppenkamp
2   Epidemiology and Real-World Data Sciences, Johnson and Johnson MedTech, New Brunswick, New Jersey
,
Daniel Hoeffel
4   DePuy Synthes, Medical Affairs, Palm Beach Gardens, Florida
› Institutsangaben Funding This study was supported by the Johnson and Johnson MedTech.
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Robotic-assisted total knee arthroplasty (TKA) has been developed to improve functional outcomes after TKA by increasing surgical precision of bone cuts and soft tissue balancing, thereby reducing outliers. The DePuy Synthes VELYS robotic-assisted solution (VRAS) is one of the latest entrants in the robotic TKA market. Currently, there is limited evidence investigating early patient and economic outcomes associated with the use of VRAS. The Premier Healthcare Database was analyzed to identify patients undergoing manual TKA with any implant system compared with a cohort of robotic-assisted TKAs using VRAS between September 1, 2021 and February 28, 2023. The primary outcome was all-cause and knee-related all-setting revisits within 90-day post-TKA. Secondary outcomes included number of inpatient revisits (readmission), operating room time, discharge status, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. The cohorts included 866 VRAS and 128,643 manual TKAs that had 90-day follow-up data. The rates of both all-cause and knee-related all-setting follow-up visits (revisits) were significantly lower in the VRAS TKA cohort compared with the manual TKA cohort (13.86 vs. 17.19%; mean difference [MD]: −3.34 [95% confidence interval: −5.65 to −1.03] and 2.66 vs. 4.81%; MD: −2.15 [−3.23 to −1.08], respectively, p-value < 0.01) at 90-day follow-up. The incidence of knee-related inpatient readmission was also significantly lower (53%) for VRAS compared with manual TKA. There was no significant difference between total cost of care at 90-day follow-up between VRAS and manual TKA cases. On average, the operating room time was higher for VRAS compared with manual TKA (138 vs. 134 minutes). In addition, the discharge status and revision rates were similar between the cohorts. The use of VRAS for TKA is associated with lower follow-up visits and knee-related readmission rates in the first 90-day postoperatively. The total hospital cost was similar for both VRAS and manual TKA cohort while not accounting for the purchase of the robot.

Keywords

robotic surgery - total knee arthroplasty - VELYS - VRAS - real world data

Supplementary Material



Publikationsverlauf

Eingereicht: 23. April 2024

Angenommen: 11. Juni 2024

Accepted Manuscript online:
12. Juni 2024

Artikel online veröffentlicht:
28. Juni 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kayani B, Konan S, Tahmassebi J, Pietrzak JRT, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with improved early functional recovery and reduced time to hospital discharge compared with conventional jig-based total knee arthroplasty: a prospective cohort study. Bone Joint J 2018; 100-B (07) 930-937
    CrossrefPubMedGoogle Scholar
  • 2 Khlopas A, Sodhi N, Hozack WJ. et al. Patient-reported functional and satisfaction outcomes after robotic-arm-assisted total knee arthroplasty: early results of a prospective multicenter investigation. J Knee Surg 2020; 33 (07) 685-690
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 3 Liow MHL, Goh GS, Wong MK, Chin PL, Tay DK, Yeo SJ. Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 2017; 25 (09) 2942-2951
    CrossrefPubMedGoogle Scholar
  • 4 Marchand RC, Sodhi N, Anis HK. et al. One-year patient outcomes for robotic-arm-assisted versus manual total knee arthroplasty. J Knee Surg 2019; 32 (11) 1063-1068
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Blum CL, Lepkowsky E, Hussein A, Wakelin EA, Plaskos C, Koenig JA. Patient expectations and satisfaction in robotic-assisted total knee arthroplasty: a prospective two-year outcome study. Arch Orthop Trauma Surg 2021; 141 (12) 2155-2164
    CrossrefPubMedGoogle Scholar
  • 6 Zhang J, Ndou WS, Ng N. et al. Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30 (08) 2677-2695
    CrossrefPubMedGoogle Scholar
  • 7 Mulpur P, Masilamani ABS, Prakash M, Annapareddy A, Hippalgaonkar K, Reddy AVG. Comparison of patient reported outcomes after robotic versus manual total knee arthroplasty in the same patient undergoing staged bilateral knee arthroplasty. J Orthop 2022; 34: 111-115
    CrossrefPubMedGoogle Scholar
  • 8 Hampp EL, Sodhi N, Scholl L. et al. Less iatrogenic soft-tissue damage utilizing robotic-assisted total knee arthroplasty when compared with a manual approach: a blinded assessment. Bone Joint Res 2019; 8 (10) 495-501
    CrossrefPubMedGoogle Scholar
  • 9 Kayani B, Konan S, Pietrzak JRT, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: a prospective cohort study and validation of a new classification system. J Arthroplasty 2018; 33 (08) 2496-2501
    CrossrefPubMedGoogle Scholar
  • 10 Jeon SW, Kim KI, Song SJ. Robot-assisted total knee arthroplasty does not improve long-term clinical and radiologic outcomes. J Arthroplasty 2019; 34 (08) 1656-1661
    CrossrefPubMedGoogle Scholar
  • 11 Kayani B, Fontalis A, Haddad IC, Donovan C, Rajput V, Haddad FS. Robotic-arm assisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten joint scores compared with conventional manual total knee arthroplasty at five-year follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31 (12) 5453-5462
    CrossrefPubMedGoogle Scholar
  • 12 Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc 2019; 27 (04) 1132-1141
    CrossrefPubMedGoogle Scholar
  • 13 Song SJ, Park CH. Learning curve for robot-assisted knee arthroplasty; optimizing the learning curve to improve efficiency. Biomed Eng Lett 2023; 13 (04) 515-521
    CrossrefPubMedGoogle Scholar
  • 14 Tompkins GS, Sypher KS, Griffin TM, Duwelius PD. Can a reduction in revision rates make robotic total knee arthroplasty cost neutral with manual total knee arthroplasty at ten-year follow-up? an episode cost analysis. J Arthroplasty 2022; 37 (8S): S777-S781 , 781.e3
    CrossrefPubMedGoogle Scholar
  • 15 Mancino F, Jones CW, Benazzo F, Singlitico A, Giuliani A, De Martino I. Where are we now and what are we hoping to achieve with robotic total knee arthroplasty? A critical analysis of the current knowledge and future perspectives. Orthop Res Rev 2022; 14: 339-349
    PubMedGoogle Scholar
  • 16 Johnson & Johnson MedTech. VELYS™ robotics designed for digital precision in knee replacement surgery. Accessed November 2, 2023 at: https://www.jnjmedtech.com/en-US/patient/velys/robotic-assisted-solution
    PubMedGoogle Scholar
  • 17 Clatworthy M. Patient-specific TKA with the VELYS™ robotic-assisted solution. Surg Technol Int 2022; 40: 315-320
    PubMedGoogle Scholar
  • 18 Morrisey ZS, Barra MF, Guirguis PG, Drinkwater CJ. Transition to robotic total knee arthroplasty with kinematic alignment is associated with a short learning curve and similar acute-period functional recoveries. Cureus 2023; 15 (05) e38872
    PubMedGoogle Scholar
  • 19 Doan GW, Courtis RP, Wyss JG, Green EW, Clary CW. Image-free robotic-assisted total knee arthroplasty improves implant alignment accuracy: a cadaveric study. J Arthroplasty 2022; 37 (04) 795-801
    CrossrefPubMedGoogle Scholar
  • 20 Singh V, Teo GM, Long WJ. Versatility and accuracy of a novel image-free robotic-assisted system for total knee arthroplasty. Arch Orthop Trauma Surg 2021; 141 (12) 2077-2086
    CrossrefPubMedGoogle Scholar
  • 21 PINC AI Applied Sciences. PINC AI™ healthcare database: data that informs and performs. July 2023. https://offers.premierinc.com/rs/381-NBB-525/images/PINC_AI_Healthcare_Data_White_Paper.pdf
    PubMedGoogle Scholar
  • 22 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
    CrossrefPubMedGoogle Scholar
  • 23 Menendez ME, Neuhaus V, van Dijk CN, Ring D. The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res 2014; 472 (09) 2878-2886
    CrossrefPubMedGoogle Scholar
  • 24 Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 2005; 58 (06) 595-602
    CrossrefPubMedGoogle Scholar
  • 25 Groll DL, Heyland DK, Caeser M, Wright JG. Assessment of long-term physical function in acute respiratory distress syndrome (ARDS) patients: comparison of the Charlson Comorbidity Index and the Functional Comorbidity Index. Am J Phys Med Rehabil 2006; 85 (07) 574-581
    CrossrefPubMedGoogle Scholar
  • 26 Desai RJ, Rothman KJ, Bateman BT, Hernandez-Diaz S, Huybrechts KF. A propensity-score-based fine stratification approach for confounding adjustment when exposure is infrequent. Epidemiology 2017; 28 (02) 249-257
    CrossrefPubMedGoogle Scholar
  • 27 Hong G. Marginal mean weighting through stratification: a generalized method for evaluating multivalued and multiple treatments with nonexperimental data. Psychol Methods 2012; 17 (01) 44-60
    CrossrefPubMedGoogle Scholar
  • 28 Zhang Z, Kim HJ, Lonjon G, Zhu Y. written on behalf of AME Big-Data Clinical Trial Collaborative Group. Balance diagnostics after propensity score matching. Ann Transl Med 2019; 7 (01) 16
    CrossrefPubMedGoogle Scholar
  • 29 U. S. Bureau of Labor Statistics. Consumer Price Index. Accessed February 13, 2024 at: https://www.bls.gov/cpi/
    PubMedGoogle Scholar
  • 30 Mahure SA, Teo GM, Kissin YD, Stulberg BN, Kreuzer S, Long WJ. Learning curve for active robotic total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30 (08) 2666-2676
    CrossrefPubMedGoogle Scholar
  • 31 Tay ML, Carter M, Zeng N, Walker ML, Young SW. Robotic-arm assisted total knee arthroplasty has a learning curve of 16 cases and increased operative time of 12 min. ANZ J Surg 2022; 92 (11) 2974-2979
    CrossrefPubMedGoogle Scholar
  • 32 Ong KL, Coppolecchia A, Chen Z, Watson HN, Jacofsky D, Mont MA. Robotic-arm assisted total knee arthroplasty: cost savings demonstrated at one year. Clinicoecon Outcomes Res 2022; 14: 309-318
    CrossrefPubMedGoogle Scholar
  • 33 Kolessar DJ, Hayes DS, Harding JL, Rudraraju RT, Graham JH. Robotic-arm assisted technology's impact on knee arthroplasty and associated healthcare costs. J Health Econ Outcomes Res 2022; 9 (02) 57-66
    CrossrefPubMedGoogle Scholar
  • 34 Cotter EJ, Wang J, Illgen RL. Comparative cost analysis of robotic-assisted and jig-based manual primary total knee arthroplasty. J Knee Surg 2022; 35 (02) 176-184
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 35 Alton TB, Chitnis AS, Goldstein L. et al. Resource utilization and costs for robotic-assisted and manual total knee arthroplasty - a premier healthcare database study. Expert Rev Med Devices 2023; 20 (04) 303-311
    CrossrefPubMedGoogle Scholar
  • 36 Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C. Robotic arm-assisted knee surgery: an economic analysis. Am J Manag Care 2020; 26 (07) e205-e210
    CrossrefPubMedGoogle Scholar
  • 37 Mitchell J, Wang J, Bukowski B. et al. Relative clinical outcomes comparing manual and robotic-assisted total knee arthroplasty at minimum 1-year follow-up. HSS J 2021; 17 (03) 267-273
    CrossrefPubMedGoogle Scholar
  • 38 Severson ELT, Fleming M. et al. Resource utilization with robotic and manual total knee arthroplasty in the critical access hospital setting. Presented at: Mid-America Orthopaedic Association (MAOA) 2023 ; April 19–23, 2023; Miramar Beach, FL.
    PubMedGoogle Scholar