JOA - 2026-09-04 - Journal Article
Cost Consequences of Enabling Technologies in Primary Total Hip Arthroplasty: A Propensity Matched Cohort Study.
Williams JL, Gonzalez-Bravo AE, Moriarty JP, Borah B, Taunton MJ, Sierra RJ, Pagnano MW, Abdel MP, Hannon CP
Topics
Key Takeaway
Technology-assisted primary THA costs $1,783 more per episode-of-care than manual THA ($20,038 vs $18,254) with no compensatory reduction in 90-day postoperative costs despite marginally shorter LOS.
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Summary
This propensity-matched institutional registry study compared standardized episode-of-care costs between technology-assisted (handheld navigation, fluoroscopic navigation, image-based robotics) and manual primary THA from 2019–2023. Technology-assisted THA generated higher index hospitalization costs ($17,377 vs $16,814, P<0.001) and higher 90-day postoperative costs ($2,661 vs $1,440, P=0.013), yielding a total episode-of-care cost difference of $1,783. LOS was marginally shorter in the technology-assisted group (1.1 vs 1.2 days, P=0.004), but this did not translate to downstream cost savings, and capital acquisition and service fees were excluded—meaning true cost differential is underestimated.
Key Limitation
Exclusion of capital acquisition and service contract costs means the reported cost differential is a floor estimate, not a true cost comparison, making the economic case against enabling technologies stronger than the data as presented.
Original Abstract
INTRODUCTION
The use of enabling technologies, including handheld navigation, fluoroscopic-assisted navigation, and image-based robotics, in primary total hip arthroplasty (THA) has increased markedly in recent years. Although surgeons and institutions adopt these guidance systems for diverse reasons, their economic impact remains incompletely defined. The present study compared standardized episode-of-care costs for technology-assisted and manual THA, encompassing both index hospitalization and 90-day postoperative expenditures.
METHODS
A retrospective, propensity-matched cohort study was conducted using our institutional total joint registry to compare standardized episode-of-care costs for technology-assisted versus manual primary THA performed between 2019 and 2023. There were 513 technology-assisted THAs matched 1:1 to manual THAs based on age, sex, body mass index, year of surgery, femoral head size/material, surgical approach, and implant construct. Cost outcomes included index hospitalization cost, 90-day postoperative cost, and total episode-of-care cost, calculated using Medicare cost-to-charge ratios and reimbursement rates. Capital acquisition and service fees for enabling technologies were excluded.
RESULTS
Technology-assisted THA was associated with higher index procedure costs ($17,377 versus $16,814; P < 0.001) and higher 90-day postoperative costs ($2,661 versus $1,440; P = 0.013), resulting in greater episode-of-care costs ($20,038 versus $18,255; P < 0.001). Subgroup analyses showed increased costs across all technology types, with handheld navigation and image-based robotics also demonstrating higher total episode-of-care costs. Lengths of stay were slightly reduced in the technology-assisted cohort (1.1 versus 1.2 days; P = 0.004).
CONCLUSION
Technology-assisted THA was associated with modest increases in index and 90-day episode-of-care costs compared with manual techniques. Although lengths of stay were marginally reduced, no compensatory reduction in postoperative costs was observed. While surgeons and hospitals adopt technology for diverse reasons, further evaluation of cost-effectiveness and broader clinical benefits is warranted as the use of enabling technologies expands.