Christen Bernhard, Tanner Lars, Ettinger Max, Bonnin Michel P, Koch Peter P, Calliess Tilman
Articon Spezialpraxis für Gelenkchirurgie, Salem-Spital, 3013 Berne, Switzerland.
Department of Automotive Engineering, Bern University of Applied Science, Campus Biel, 2502 Biel, Switzerland.
J Pers Med. 2022 Jan 30;12(2):184. doi: 10.3390/jpm12020184.
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.
为提高手术精度并减少并发症，一些计算机辅助技术，如导航和机器人技术，已被引入全膝关节置换术（TKA）。然而，这些技术常因成本增加和相关工作量加大而受到批评；不过，缺乏对比数据。本研究的目的是评估用于植入TKA的四种当前计算机辅助技术在术中工作流程及相关围手术期成本概况方面的差异，以便与传统器械进行比较。对于成本分析，与传统TKA相比，计算了额外的术前成像和器械、增加的手术室（OR）和规划时间，以及设备技术支持和处置的费用，涉及（1）标准计算机导航、（2）患者特异性器械（PSI）、（3）基于图像的机器人辅助和（4）无图像机器人辅助。由一名独立观察员审查了使用这些技术的四个专家中心的工作流程。总成本计算基于瑞士每年125例TKA的单位量。计算机导航导致手术时间增加14分钟（+23%），总体额外成本为650美元。PSI技术节省了5分钟（8%）的OR时间，但产生了1520美元的成像和处置费用。基于图像的机器人系统是最昂贵的技术；总体额外成本为2600美元，主要来自技术支持、处置、CT扫描以及OR时间增加14分钟。无图像机器人辅助导致OR时间增加最多，平均增加25分钟（+42%）。总体计算额外成本为1530美元。与传统技术相比，本研究中的每种辅助技术都增加了TKA的总成本，与成本相关的最重要变量是技术支持和额外的一次性用品。这些技术所需的更长手术时间和额外手术托盘对总成本的影响较小。这种对比成本分析为未来计算这些技术的实际成本以及每种技术的后续投资回报率提供了有价值的信息。
