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

This systematic review aimed to compare the economic and healthcare resource utilization outcomes of robotic-assisted total knee arthroplasty (R-TKA) and conventional total knee arthroplasty (C-TKA). This systematic review was conducted in accordance with the PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed/MEDLINE, Scopus, EBSCOhost, and the NHS Economic Evaluation Database (NHS EED) on October 10, 2026. The searches identified 174 records in PubMed, 208 in Scopus, and 199 in EBSCOhost, while no eligible studies were identified through NHS EED. Studies comparing R-TKA and C-TKA and reporting economic outcomes were 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 were examined. Methodological quality was assessed using the 10-item Drummond checklist. Due to heterogeneity among the included studies, a qualitative synthesis was performed without meta-analysis. The economic outcomes of R-TKA varied across studies. Some studies reported higher surgical or hospital costs associated with R-TKA, whereas others demonstrated comparable costs or savings in overall episode-of-care expenditures. Cost-effectiveness analyses based on QALYs and ICERs yielded different findings across healthcare systems and follow-up periods. Economic results also varied according to surgical volume, robotic technology costs, and the time horizon of the evaluation. Current evidence does not demonstrate a consistent economic advantage of R-TKA over C-TKA. Although robotic-assisted surgery may be associated with higher initial costs, potential savings in subsequent healthcare utilization and longer-term outcomes may offset these expenditures in certain settings. Further high-quality comparative economic studies are needed to clarify the long-term economic outcomes of R-TKA.