Economic evaluation of robotic-assisted versus manual unicompartmental knee arthroplasty: a systematic review of Markov models and clinical studies.

BACKGROUND

This systematic review aimed to compare the cost-effectiveness of robotic-assisted unicompartmental knee arthroplasty (rUKA) with manual UKA (mUKA) for patients who have isolated unicompartmental knee osteoarthritis (OA).

METHODS

A systematic review was conducted following PRISMA guidelines, searching databases including PubMed, Scopus, Embase, and Web of Science up to January 2025. Studies comparing the cost-effectiveness of rUKA and mUKA, including cohort studies, case-control studies, clinical trials, and Markov models, were eligible for inclusion in this study. There were no restrictions. Independent reviewers conducted the screening, data extraction, and quality assessment of the studies, and any resolved conflicts were discussed and referred to the corresponding reviewer for resolution. The National Institute of Health (NIH) tools were utilized for quality assessment of the cohort studies and RCTs. Qualitative synthesis was performed due to methodological heterogeneity. Also, the protocol of this study was registered prospectively on the PROSPERO with registration number CRD420250645008.

RESULTS

Eight studies, including four Markov and four non-Markov from the US and UK, were included in the study. The rUKA procedure showed higher initial costs but improved quality-adjusted life years (QALYs) and lower revision rates compared to mUKA. Incremental cost-effectiveness ratios (ICERs) ranged from £1,238 (approximately $1672) to $47,180 per QALY, consistently below country-specific thresholds, indicating cost-effectiveness, particularly in high-volume centers. Long-term follow-up further supported rUKA, with notable cost savings.

CONCLUSIONS

Despite higher upfront costs, rUKA appears to be cost-effective compared to mUKA, driven by reduced revisions and enhanced outcomes, especially in high-volume settings and over extended follow-up periods.