Systematic Review Finds Robotic Knee Replacement Lacks Consistent Economic Advantage

A comprehensive systematic review evaluating robotic-assisted total knee arthroplasty against conventional surgical techniques has found no consistent economic advantage favoring the robotic approach. Rather than demonstrating uniform financial benefits or universal cost penalties, the available evidence indicates that the economic profile of robotic technology remains highly variable across different surgical environments and analytical models.

The primary objective of the review was to directly compare the economic and healthcare resource utilization outcomes associated with robotic-assisted total knee arthroplasty (R-TKA) versus conventional total knee arthroplasty (C-TKA).

To evaluate the comparative literature, the authors executed a structured search strategy adhering to the PRISMA 2020 guidelines on October 10, 2026. Systematic queries were conducted across major biomedical and health economic databases, including PubMed/MEDLINE, Scopus, EBSCOhost, and the NHS Economic Evaluation Database (NHS EED). The initial electronic queries retrieved 174 records from PubMed, 208 from Scopus, and 199 from EBSCOhost, whereas the search within the NHS Economic Evaluation Database yielded no eligible publications meeting the review criteria.

Studies identified through the database searches were screened to select investigations that directly compared R-TKA and C-TKA while reporting explicit economic endpoints. The investigators evaluated direct and total costs, hospital costs and charges, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), length of hospital stay, healthcare resource utilization, and complication- and revision-related costs. Methodological quality was assessed using the 10-item Drummond checklist.

Because the included evaluations displayed substantial clinical, institutional, and methodological heterogeneity, the researchers conducted a qualitative synthesis without performing a quantitative meta-analysis. The reported economic outcomes for robotic-assisted surgery varied considerably depending on the study setting. Certain included analyses reported higher surgical or hospital costs directly associated with R-TKA procedures, while other investigations demonstrated comparable costs between the two surgical approaches or identified overall expenditure savings across the complete episode-of-care.

Formal cost-effectiveness findings based on quality-adjusted life years and incremental cost-effectiveness ratios similarly diverged among the analyzed studies. The authors observed that ICER and QALY calculations yielded different conclusions depending on the specific national healthcare system examined and the duration of postoperative follow-up. Economic viability was further influenced by hospital surgical volume, the baseline acquisition and maintenance costs of the robotic platforms, and the time horizon chosen for economic modeling.

In their final appraisal, the authors concluded that current published evidence fails to show a clear and consistent economic superiority for robotic-assisted knee replacement compared to conventional surgery. Although robotic procedures often incur higher upfront capital and procedural expenditures, potential reductions in downstream healthcare utilization and longer-term clinical complications may offset initial investments in selected clinical settings. Further high-quality comparative economic studies are needed to clarify the long-term economic outcomes of R-TKA.

Subject of Research: Economic and healthcare resource utilization outcomes of robotic-assisted versus conventional total knee arthroplasty

Article Title: Economic value of robotic-assisted versus conventional total knee arthroplasty: a systematic review of costs, cost-effectiveness, and healthcare resource utilization

Article References: Yazar, C., & Tantekin, M. F. (2026). Economic value of robotic-assisted versus conventional total knee arthroplasty: a systematic review of costs, cost-effectiveness, and healthcare resource utilization. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-026-10734-y

Image Credits: AI Generated

DOI: 10.1186/s12891-026-10734-y

Keywords: robotic-assisted total knee arthroplasty, conventional total knee arthroplasty, systematic review, cost-effectiveness analysis, healthcare resource utilization, incremental cost-effectiveness ratio, quality-adjusted life years, hospital costs, orthopedic surgery, surgical volume, Drummond checklist, PRISMA 2020, episode-of-care costs, health economics, length of hospital stay, surgical robotics