Cost Consequences of Enabling Technologies in Primary Total Hip Arthroplasty: A Propensity Matched Cohort Study.

Abstract

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. 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. 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). 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.