OBJECTIVES: The success and longevity of total knee arthroplasty (TKA) is dependent upon many factors, including accurate alignment of prosthesis and restoration of the mechanical axis of the lower limb. Computer assisted surgery (CAS) could lead to better functional outcomes by enabling more precise component positioning and mechanical alignment versus conventional techniques. A systematic review was conducted to investigate the economic and humanistic burden of CAS compared with conventional methods in patients undergoing TKA.

METHODS: Electronic databases and reference lists were interrogated in February 2019 to identify studies reporting cost/resource use outcomes (including duration of surgery, operating room time, registration time, hospital length of stay [LOS]) and quality of life (QoL)/patient-reported outcome (PRO) data associated with CAS-TKA. Eligible studies were extracted and quality assessed using established methods.

RESULTS: A total of 86 relevant studies were identified (cost/resource use, N=55 studies; QoL/PRO, N=63 studies). In general, CAS-TKA was associated with higher upfront technology costs and additional computed tomography (CT) or magnetic resonance imaging (MRI) scans compared with conventional TKA. However, patients undergoing CAS-TKA typically had a shorter hospital LOS (N=9/19 studies) compared with patients undergoing conventional TKA. Few data were reported regarding registration time, operating room time, number of instrument trays required, or indirect costs. Functional outcomes were assessed using a variety of validated PRO tools. CAS was associated with comparable or improved functional outcome compared with conventional surgery over the short- and medium-term, with statistically significant improvements reported with CAS in 9 of 24 studies (follow up time ranged from 6 months to 10 years).

CONCLUSIONS: Despite higher upfront technology costs, CAS-TKA has been shown to potentially reduce costs through shorter inpatient stays. Further adequately powered studies employing longitudinal data collection with validated tools are certainly warranted to quantify the long-term societal costs and functional outcomes associated with CAS-TKA.