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机器人辅助全髋关节和膝关节置换术:经济影响和工作流程效率。

Robotic total hip and knee arthroplasty: economic impact and workflow efficiency.

作者信息

Jevnikar Benjamin E, Khan Shujaa T, Emara Ahmed K, Elmenawi Khaled A, Deren Matthew, Piuzzi Nicolas S

机构信息

Department of Orthopedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, A4144195, USA.

出版信息

J Robot Surg. 2025 Sep 8;19(1):578. doi: 10.1007/s11701-025-02698-3.

Abstract

Robotic-assisted total joint arthroplasty (RA-TJA) is projected to account for 70% of all arthroplasties by 2030, yet its economic value and operational efficiency have yet to be thoroughly synthesized. While early literature emphasized technical precision, evolving payment models and implementation costs have shifted focus toward cost-effectiveness and workflow integration. To evaluate the economic and institutional viability of RA-TJA by synthesizing available evidence on capital costs, perioperative expenses, learning curves, throughput, and long-term adoption trends. This review also considers market competition, global uptake, and the need for standardized outcomes reporting. A narrative literature review of published cost analyses, real-world efficiency studies, and policy-relevant frameworks was conducted. Literature addressing per-case cost variability, bundled payments, and implementation strategies was analyzed. Emerging economic models and global diffusion patterns were incorporated to contextualize long-term feasibility. Robotic platforms consistently incur higher upfront and perioperative costs than manual or navigated arthroplasty. However, in both high- and low-volume institutions, these costs may be offset by reduced complications, shorter hospital stays, and improved discharge metrics. Efficiency gains are amplified through procedural clustering and experienced teams. Adoption is accelerating globally, facilitated by leasing models and market competition, yet value remains highly dependent on institutional context. A lack of standardized outcome reporting and platform heterogeneity limits cross-study comparisons. Ongoing, long-term, multicenter randomized trials are expected to address these evidence gaps. Robotic assistance can improve the efficiency and precision of arthroplasty procedures, with the potential for substantial cost-effectiveness when optimized. Institutions adopting this technology can expect improved outcomes by leveraging local surgical volume and infrastructure. Wider integration will be facilitated by robust long-term data, standardized outcome metrics, and continuous innovation that aligns with value-based care models.

摘要

预计到2030年,机器人辅助全关节置换术(RA-TJA)将占所有关节置换术的70%,但其经济价值和运营效率尚未得到全面综合评估。早期文献强调技术精度,而不断演变的支付模式和实施成本已将重点转向成本效益和工作流程整合。通过综合关于资本成本、围手术期费用、学习曲线、吞吐量和长期采用趋势的现有证据,评估RA-TJA的经济和机构可行性。本综述还考虑了市场竞争、全球采用情况以及标准化结果报告的必要性。对已发表的成本分析、真实世界效率研究和政策相关框架进行了叙述性文献综述。分析了涉及每例成本变异性、捆绑支付和实施策略的文献。纳入新兴经济模型和全球传播模式,以将长期可行性置于背景之中。机器人平台始终比手动或导航关节置换术产生更高的前期和围手术期成本。然而,在高容量和低容量机构中,这些成本可能会因并发症减少、住院时间缩短和出院指标改善而得到抵消。通过程序聚类和经验丰富的团队,效率提升得以放大。在租赁模式和市场竞争的推动下,全球范围内的采用正在加速,但价值仍高度依赖于机构背景。缺乏标准化的结果报告和平台异质性限制了跨研究比较。正在进行的长期多中心随机试验有望填补这些证据空白。机器人辅助可以提高关节置换手术的效率和精度,优化后有可能实现显著的成本效益。采用这项技术的机构可以通过利用当地手术量和基础设施来期待更好的结果。强大的长期数据、标准化的结果指标以及与基于价值的护理模式相一致的持续创新将促进更广泛的整合。

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