Authors' objectives: To assess the effectiveness, safety and cost-effectiveness of robotic arm-assisted surgery in total hip, total knee and unicompartmental knee arthroplasty.

Authors' results and conclusions: Aside from good alignments and rates of placing acetabular component within safe zone seen in robotic surgery, the Global offset (GO) discrepancy was higher in mTHA compared to RA-THA, and it was shown that a GO reduction of more than 5 mm is associated with less abductor muscle strength and decreased functional results after THA. Robotic UKA scored higher on the Knee Society Score (KSS) and the Knee Society Function (KSF). Over a 90-day period, robotic UKA was also found to improve postoperative pain and reduce time to straight leg raise, as well as decrease physiotherapy sessions. Robotic-assisted arthroplasty is generally safe and have fewer complications attributed to surgical technique as compared to use of the technology. The results of the economic evaluations indicated that equipment purchases, start-ups, and maintenance are of high cost. However, evidence have shown that robotic arthroplasties will improve long-term implant survival rate, resulting in lower costs for future revisions. Long-term data is needed to fully determine the cost-effectiveness of newer robotic systems.

Authors' recommendations: Robotic arm assisted surgeries (hip and knee) have benefits as it improves component position and alignment. Robotic-assisted UKA also improves clinical outcomes and implant survivorship by reducing revision rates. However, learning curve associated with new technology, and most importantly the added cost in purchasing, maintenance along it’s consumables are the potential limitations of robotic arthroplasty. Hence, long term outcomes comparing with conventional techniques are required to further ascertain the effectiveness, safety and cost effectiveness of its use in Malaysia.

Authors' methods: Literature search was done to search for published articles assessing the effectiveness, safety and cost-effectiveness of robotic arm-assisted total hip, total knee and unicompartmental knee arthroplasty. The following electronic databases were searched via, OVID: MEDLINE (1946 to present), EBM Reviews-Cochrane Database of Systematic Reviews (2005 to September 2022), EBM Reviews–Cochrane Clinical Answers (September 2021), EBM Reviews–Database of Abstracts of Review of Effects (1st Quarter 2016), EBM Reviews–Health Technology Assessment (4th Quarter 2016), NHS economic evaluation database (1st Quarter 2016), PubMed and INAHTA database. The last search was done on 9th September 2022.

Authors' identified further research: -

Project Status: Completed

Year Published: 2022

URL for published report: https://www.moh.gov.my/index.php/database_stores/store_view_page/30/400

Requestor: Decision-making committee

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)