ISAKOS Congress 2021

2021 ISAKOS Biennial Congress ePoster


Can Robot-Assisted Total Knee Arthroplasty Be A Cost-Effective Procedure? A Markov Decision Analysis.

Hannes Vermue, MD, Ghent BELGIUM
Philip Tack, MD, Ghent BELGIUM
Tom Gryson, MD, Ghent BELGIUM
Jan M. K. Victor, MD, PhD, GENT BELGIUM

Ghent University Hospital, Ghent, BELGIUM

FDA Status Not Applicable


Robot-assisted TKA might be a cost-effective procedure compared to conventional TKA if a minimum of 253 cases are performed on a yearly basis, based on the assumption of higher revision rates in case of coronal malalignment.

ePosters will be available shortly before Congress



A rising prevalence of knee osteoarthritis is leading to an increase in total knee arthroplasties (TKA) performed worldwide. The accompanying revisions pose an increasing economic burden on health care systems. Robot-assisted (RA) TKA has been developed to improve revision rates due to component malalignment and soft tissue imbalance.
With this study, the authors aim to prove a theoretical, preliminary cost-effectiveness analysis of RA TKA.


A Markov state-transition model was designed to evaluate the health status of a 67-year-old with knee osteoarthritis undergoing TKA over a 20 year time period. Associated probabilities and (dis)utilities to all states were derived from existing literature. Conventional TKA and RATKA differed based on the a higher outlier rate outisde of neutral mechanical alignment, possibly leading to a higher revision rate.


With an acceptable threshold of 50000/QALY for cost-effectiveness, only 2.18% of cases proved to be cost-effective. At least 253 cases per robot per year need to be performed to prove cost-effective based on the model presented in this study. Utilities of primary and revision TKA had the highest impact on the Markov model.


Robot-assisted TKA could be a cost-effective procedure compared to conventional TKA if a minimum of 253 cases are performed on a yearly basis. The cost-benefit of the robotic TKA surgery is based on a decreased revision rate. This study is based on the assumption that alignment is a predictor of success after total knee arthroplasty. Until there is data confirming the assertion that alignment predicts success robot-assisted surgery should not be recommended.

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