Economic evaluation of robotic-assisted versus manual total hip arthroplasty: a systematic review of cost and clinical outcomes

Introduction: Total hip arthroplasty (THA) is a widely performed, cost-intensive procedure with growing demand due to an aging population. While manual THA (mTHA) offers reliable outcomes, robotic-arm-assisted THA (RATHA) has emerged as a technologically advanced alternative with potential clinical advantages. However, its economic value remains uncertain due to high capital and maintenance costs. This systematic review aimed to compare the economic and clinical outcomes of RATHA versus mTHA. Methods: A systematic search of MEDLINE, Embase, and Cochrane Library was conducted (1990-May 2024) following PRISMA guidelines. Studies comparing RATHA and mTHA in adult populations were included. Quality was assessed using the Newcastle-Ottawa scale, and data on costs, clinical outcomes, and patient-reported outcome measures (PROMs) were extracted and synthesized. Results: Seven studies (two Markov models, one prospective cohort, and four retrospective analyses) covering over 1.3 million patients were included. RATHA was associated with higher procedural costs but often yielded lower total 90-day care costs due to shorter hospital stays, fewer readmissions, and reduced rehabilitation needs. Cost-utility analyses showed favorable incremental cost-effectiveness ratios (ICERs), particularly in high-volume centers. Clinical outcomes were comparable or slightly better for RATHA, with some evidence of improved PROMs. Conclusion: RATHA may be cost-effective in high-volume settings, with potential for long-term clinical and financial benefits. However, variation in cost methodologies and healthcare models, along with high initial investment, highlights the need for further high-quality studies with standardized economic reporting and patient-centered outcomes.