# National evidence linking robotic total knee arthroplasty to reduced 90-day readmissions, complications, and readmission costs

## TL;DR

Robotic-assisted total knee replacement leads to fewer readmissions, complications, and lower costs within 90 days compared to traditional methods.

## Contribution

First national analysis showing robotic TKA reduces early complications and readmissions in a large, real-world cohort.

## Key findings

- Robotic TKA had 5.0% readmission rate versus 6.5% for conventional TKA.
- Readmission costs were $66,769 for robotic TKA versus $75,544 for conventional TKA.
- Lower risks of VTE/PE, pneumonia, and prosthesis-related complications with robotic TKA.

## Abstract

To compare 90-day readmissions, complications, and resource use after robotic-assisted versus conventional total knee arthroplasty (TKA) in a contemporary, nationally representative cohort.

Retrospective cohort study using the Nationwide Readmissions Database (NRD) 2020–2022. Primary TKA identified from the PR1 field (ICD-10-PCS). Exclusions included non-elective admissions, revisions, bilateral procedures, age < 18, oncology/fracture/reoperation, COVID-19, and discharges after September. Readmissions within 90 days were categorized (prosthesis/SSI, mechanical/implant, VTE). 1:1 propensity score matching (nearest neighbor, caliper 0.01, no replacement) included demographics, comorbidities, hospital factors, and year.

After matching, 96,982 patients (48,491 per group) were analyzed. Robotic TKA showed lower all-cause 90-day readmission (5.0% vs 6.5%), superior readmission-free survival (log-rank P < 0.001), shorter readmission LOS (4.8 vs 5.6 days), and lower readmission charges ($66,769 vs $75,544), with slightly higher index charges ($78,125 vs $74,090). Risks were lower for VTE/PE, pneumonia, transfusion, postoperative pain, and prosthesis/SSI-related and mechanical readmissions.

In the largest contemporary national analysis, robotic TKA was associated with fewer early complications, lower 90-day readmissions, and reduced readmission resource use compared with conventional TKA.

The online version contains supplementary material available at 10.1186/s42836-026-00373-y.