{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:09:33Z","timestamp":1779800973191,"version":"3.53.1"},"reference-count":69,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Robotic\u2010arm\u2010assisted surgery is increasingly used in orthopaedics due to its potential clinical benefits. This real\u2010world data analysis evaluated the impact of image\u2010based, robotic\u2010arm\u2010assisted total knee arthroplasty (raTKA) over non\u2010robotic\u2010arm\u2010assisted total knee arthroplasty (nraTKA) on perioperative outcomes in Germany based on a large, multi\u2010hospital administrative dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This observational, cohort study used a large set of pooled administrative data from 91 hospitals from 2018 to 2023. Perioperative outcomes analysed included length of stay (LOS), extended hospitalization, inpatient complications, blood transfusions and intensive care unit (ICU) admission. A two\u2010stage model was conducted: propensity score matching (PSM) to balance various patient characteristics, followed by multi\u2010level regression analysis with hospital\u2010level random intercepts to account for hospital effects. Using this multi\u2010level model specification accounts for hospital\u2010level differences in institutional practices. Significance was set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05, and 95% confidence intervals were consistently reported.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 63,931 TKA cases were included: 11,305 raTKA and 52,626 nraTKA. PSM successfully eliminated baseline differences between groups, with all raTKA matched 1:1 to nraTKA controls. raTKA was associated with a 0.99\u2010day shorter LOS (confidence interval [CI] \u22121.04 to \u22120.93), corresponding to a 14% reduction relative to the median LOS of nraTKA and a significant reduction in the risk of extended hospitalization (2266 vs. 5372 events, odds ratio [OR]\u2009=\u20090.375, CI 0.334\u20130.420). The risk of inpatient complications (93 vs. 186 events, OR\u2009=\u20090.728, CI 0.727\u20130.729), blood transfusions (68 vs. 118 events, OR\u2009=\u20090.435, CI 0.293\u20130.644) and ICU admission (220 vs. 459 events, OR\u2009=\u20090.495, 0.398\u20130.615) were also significantly lower in the raTKA group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this real\u2010world analysis of 63,931 cases from 91 German hospitals, raTKA is associated with clinically and statistically significant improvements in perioperative outcomes compared to non\u2010robotic procedures. These clinical improvements might translate into cost efficiencies that can compensate for extra procedural costs of raTKA; however, the economic impact of raTKA should be examined further, considering also long\u2010term outcomes and their health economic implications. Employing a large real\u2010world data set, closely matched cohorts and explicit adjustment for hospital\u2010level effects, this study isolates associations between raTKA and perioperative outcomes that are not solely attributable to institutional differences between hospitals and thus provides valuable information for policymakers and hospital decision\u2010makers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective comparative, cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70437","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T14:44:20Z","timestamp":1779720260000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduced length of stay and improved perioperative outcomes in robotic\u2010arm\u2010assisted TKA: A real\u2010world evidence study of 63,931 cases from German hospitals"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3370-7064","authenticated-orcid":false,"given":"Lars\u2010Rene","family":"Tuecking","sequence":"first","affiliation":[{"name":"Hannover Medical School, Department of Orthopaedic Surgery Diakovere Annastift Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Ezechieli","sequence":"additional","affiliation":[{"name":"ATOS Fleetinsel Hamburg Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Barkhausen","sequence":"additional","affiliation":[{"name":"University Clinic Bielefeld, Clinic of Orthopaedic Surgery Klinikum Bielefeld Bielefeld Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hendrich","sequence":"additional","affiliation":[{"name":"Orthopaedic Hospital Schloss Werneck Werneck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea Charlotte","family":"Wienholt","sequence":"additional","affiliation":[{"name":"Government Affairs and Market Access Stryker GmbH Duisburg Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Pross","sequence":"additional","affiliation":[{"name":"Government Affairs and Market Access Stryker GmbH Duisburg Deutschland"},{"name":"Department of Health Care Management Technical University of Berlin Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcdiger","family":"von Eisenhart\u2010Rothe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar Technical University of Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Windhagen","sequence":"additional","affiliation":[{"name":"Hannover Medical School, Department of Orthopaedic Surgery Diakovere Annastift Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-024-05231-7"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-023-03798-2"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1735280"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1302\/2633-1462.12.BJO-2019-0004.R1"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2022.06.002"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2022.02.015"},{"key":"e_1_2_13_8_1","unstructured":"Bundesministerium der Justiz Bundesamt f\u00fcr Justiz. 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