Robotic-assisted total knee arthroplasty in the USA: Nationwide adoption trends towards 70 % by 2030.

Background: Robotic-assistance is becoming more prevalent in total knee arthroplasty (TKA). This study aims to (1) project the volume and percentage of manual (M-TKA) and robotic-assisted TKA (RA-TKA) in the United States through 2030, and (2) compare healthcare utilization and postoperative complications between RA-TKA and M-TKA. Methods: Two national databases (Nationwide Inpatient Database and National Ambulatory Surgery Service Database) from 2012 to 2020 were queried for manual and robotic TKAs using ICD-10 and CPT codes. Future RA-TKA utilization was estimated using log-binomial regression modeling. The predicted probabilities from the regression models were multiplied by the projected population of each age-sex-hospital region subgroup per year through 2030. Results: RA-TKA utilization increased from 0.01 % in 2008 to 8.5 % in 2020. Projections indicate that by 2030, RA-TKA is expected to represent 70.1 % (95 % CI:65.5-74.5) of the 2,631,972 TKAs performed. M-TKA exhibited higher incidences of mechanical, non-mechanical, and infective complications compared to RA-TKA (1.8 % vs. 0.7 %; 30.1 % vs. 24.9 %; 1.8 % vs. 0.7 % respectively, p < 0.0001). A greater proportion of RA-TKA patients were discharged to home health care (88.7 % vs. 73 %, p < 0.0001), and they had shorter hospital stays (1.9 vs. 2.8 days, p < 0.0001). Conclusion: RA-TKA is anticipated to make up more than 70 % of all TKAs performed in the United States by 2030. The increasing integration of robotic technology raises the need for deeper explorations into value based on training, cost efficiency and long-term outcomes to understand the ramifications of widespread adoption of RA-TKA as a routine procedure. However, this study is limited by its retrospective design, reliance on administrative coding which may lead to misclassification, and the unavailability of outpatient data prior to 2018.