Health Technology Assessment on Robot-Assisted Knee Arthroplasty for Knee Osteoarthritis

Condition Description – Knee osteoarthritis is a degenerative joint disease that leads to pain, stiffness, and loss of function. In British Columbia and Canada, knee osteoarthritis is a leading cause of disability, with knee arthroplasty (knee replacement surgery) being a common intervention for end-stage cases. Patients with severe osteoarthritis who do not respond to conservative treatments may be considered for total or partial knee replacement surgery. 

Current treatment options – Conventional knee arthroplasty is a treatment for patients with severe knee osteoarthritis in British Columbia. The procedure involves removing damaged joint surfaces and replacing them with prosthetic components. The procedure is performed manually by orthopedic surgeons.  

Description of the Assessed Technology(ies) - Robot-assisted knee arthroplasty is a surgical approach that utilizes robotic systems to assist in the precise alignment and positioning of knee implants. The technology is used in operating rooms and aims to improve surgical accuracy by providing real-time feedback and enhancing preoperative planning.

Health Technology Assessment Committee’s Findings: 

After review of the HTA, the Health Technology Assessment Committee found that robot-assisted knee arthroplasty does not demonstrate a significant clinical advantage over conventional knee arthroplasty and:

• Available clinical evidence does not indicate a significant difference in overall clinical effectiveness when compared to traditional knee arthroplasty.
• Limited evidence suggests that robot-assisted knee arthroplasty may improve implant alignment in both unicompartmental and total knee replacement procedures.
• There is variability in implant selection across different hospitals in BC, and standardization is not currently in place.
• Some surgeons have expressed strong preference for robotic systems which may affect recruitment and retention.

The use of robot-assisted technologies would be expected to significantly increase costs compared to conventional surgery. Given that use of implants varies widely across hospital sites in British Columbia, a centralized plan coordinated among all regional health authorities would be beneficial if considering a robotic system and associated implants. It will be at the discretion of each health authority to assess the value of potential benefits in comparison to the additional implementation cost of robot-assisted knee arthroplasty.