Access to robot-assisted total knee arthroplasty varies significantly by race/ethnicity

Background: Racial/ethnic disparities in access to total knee arthroplasty (TKA) have been extensively demonstrated. Over the past several years, there has been a rapid increase in the utilization of robot-assisted TKA (RA-TKA). Therefore, this study sought to determine whether previously established racial/ethnic disparities extend to access to RA-TKA relative to conventional TKA.

Methods: Patients who underwent TKA from 1 January 2022 to 31 December 2022 were identified in the National Surgical Quality Improvement Program database. Patients were stratified by whether they underwent RA-TKA. Multivariable logistic regressions, controlling for demographics and comorbidities significantly different on univariate analysis, were constructed to determine whether race/ethnicity was associated with likelihood of undergoing RA-TKA relative to conventional TKA.

Results: Of the 47,898 patients who underwent TKA in 2022, 8560 (17.9%) underwent RA-TKA. On multivariable analysis, Black, Hispanic, Asian, and all other races were significantly less likely than white patients to undergo RA-TKA relative to conventional TKA (OR 0.65, 95% CI 0.59-0.70, P < 0.001; OR 0.70, 95% CI 0.64-0.77, P < 0.001; OR 0.65, 95% CI 0.55-0.76, P < 0.001; OR 0.78, 95% CI 0.66-0.92, P = 0.003, respectively).

Conclusions: The results of this study demonstrate that non-white race is associated with a significantly lower likelihood of undergoing RA-TKA relative to conventional TKA. Importantly, this reduced access to RA-TKA may represent a broader disparity in access to emerging technologies and modern care. Future work should endeavor to identify drivers of this disparity to better understand minority access to emerging technologies in TKA.