{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:16:50Z","timestamp":1791825410055,"version":"4.3.4"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Robotic-assisted total knee arthroplasty has been adopted to enhance surgical precision, yet contemporary national evidence on clinical and economic outcomes remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare in-hospital complications, length of stay, and hospital charges between robotic-assisted and conventional total knee arthroplasty using recent nationwide data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Nationwide Inpatient Sample from 2016\u20132022. Adult elective primary knee arthroplasty admissions were identified; cases with revision procedures or documented coronavirus disease were excluded. Robotic-assisted and conventional procedures were compared after 1:1 propensity score matching on demographics, hospital factors, and comorbidities and year of admission (two cohorts of 173,565 patients each). Outcomes included length of stay, total hospital charges, and major in-hospital complications. Two-sided tests were used with a significance threshold of 0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The proportion of robotic-assisted procedures increased from 0.7% in 2016 to 14.9% in 2022. After matching, robotic-assisted surgery was associated with a shorter mean length of stay (1.9 vs 2.7 days; p\u2009&lt;\u20090.001) and lower rates of several complications. When expressed as relative risks (RR) (risk in conventional TKA divided by risk in robotic-assisted TKA), transfusion (RR 3.7), pneumonia (RR 3.0), pulmonary embolism (RR 2.6), prolonged ventilation (RR 2.1), and deep vein thrombosis (RR 1.8) were all higher in the conventional group (all p\u2009&lt;\u20090.01). Acute kidney injury was marginally more frequent with robotic assistance (relative risk 0.9; p\u2009=\u20090.03). Mean hospital charges were higher for robotic-assisted procedures (US$70,758 vs US$62,618; p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a large, contemporary national cohort, robotic-assisted total knee arthroplasty was associated with fewer in-hospital complications and shorter hospital stays than conventional surgery, while incurring higher hospital charges. These findings support a potential safety advantage for robotic assistance during the index admission and motivate further study of longer-term clinical and economic outcomes. Levels of Evidence: LEVEL III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346031","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T17:24:14Z","timestamp":1776878654000},"page":"e0346031","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["In-hospital outcomes and hospital charges after robotic-assisted versus conventional total knee arthroplasty: A 2016\u20132022 Nationwide Inpatient Sample study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1538-5347","authenticated-orcid":true,"given":"David","family":"Maman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaniv","family":"Steinfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaron","family":"Berkovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"pone.0346031.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/j.artd.2022.03.004","article-title":"Epidemiology of revision total knee arthroplasty in the United States, 2012 to 2019","volume":"15","author":"A Upfill-Brown","year":"2022","journal-title":"Arthroplast Today"},{"issue":"1","key":"pone.0346031.ref002","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1186\/s13018-021-02767-x","article-title":"Revision arthroplasty after unicompartimental knee arthroplasty","volume":"16","author":"N Walter","year":"2021","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"pone.0346031.ref003","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1055\/s-0038-1641729","article-title":"Robotic-Arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques","volume":"32","author":"EL Hampp","year":"2019","journal-title":"J Knee Surg"},{"issue":"1","key":"pone.0346031.ref004","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1186\/s13063-022-06494-4","article-title":"A prospective randomised controlled trial of mechanical axis with soft tissue release balancing vs functional alignment with bony resection balancing in total knee replacement-a study using Stryker Mako robotic arm-assisted technology","volume":"23","author":"SW Young","year":"2022","journal-title":"Trials"},{"issue":"8","key":"pone.0346031.ref005","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1007\/s00167-021-06464-4","article-title":"Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: A systematic review and meta-analysis","volume":"30","author":"J Zhang","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"pone.0346031.ref006","article-title":"Robotic total knee arthroplasty vs conventional total knee arthroplasty: A nationwide database study","volume":"6","author":"SA Ofa","year":"2020","journal-title":"Arthroplast Today"},{"key":"pone.0346031.ref007","first-page":"409","article-title":"Robotic-Arm assisted total knee arthroplasty more accurately restored the posterior condylar offset ratio and the insall-salvati index compared to the manual technique; A cohort-matched study","volume":"34","author":"AA Sultan","year":"2019","journal-title":"Surg Technol Int"},{"issue":"3","key":"pone.0346031.ref008","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s12178-020-09625-z","article-title":"Robots in the operating room during hip and knee arthroplasty","volume":"13","author":"PL Sousa","year":"2020","journal-title":"Curr Rev Musculoskelet Med"},{"key":"pone.0346031.ref009","year":"2019"},{"issue":"8","key":"pone.0346031.ref010","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1056\/NEJMp1006602","article-title":"New technology and health care costs--the case of robot-assisted surgery","volume":"363","author":"GI Barbash","year":"2010","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0346031.ref011","article-title":"Robotic total knee arthroplasty vs conventional total knee arthroplasty: A nationwide database study","volume":"6","author":"SA Ofa","year":"2020","journal-title":"Arthroplast Today"},{"issue":"8","key":"pone.0346031.ref012","doi-asserted-by":"crossref","first-page":"2496","DOI":"10.1016\/j.arth.2018.03.042","article-title":"Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: A prospective cohort study and validation of a new classification system","volume":"33","author":"B Kayani","year":"2018","journal-title":"J Arthroplasty"},{"issue":"3","key":"pone.0346031.ref013","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1007\/s00167-022-07031-1","article-title":"Complications and downsides of the robotic total knee arthroplasty: A systematic review","volume":"31","author":"C Nogalo","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"pone.0346031.ref014","first-page":"441","article-title":"Robotic-Arm assisted total knee arthroplasty demonstrated soft tissue protection","volume":"30","author":"A Khlopas","year":"2017","journal-title":"Surg Technol Int"},{"issue":"21","key":"pone.0346031.ref015","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.2106\/JBJS.22.00167","article-title":"Inflammatory Response in Robotic-Arm-Assisted Versus Conventional Jig-Based TKA and the Correlation with Early Functional Outcomes","volume":"104","author":"A Fontalis","year":"2022","journal-title":"Journal of Bone and Joint Surgery"},{"issue":"5","key":"pone.0346031.ref016","doi-asserted-by":"crossref","first-page":"345","DOI":"10.2106\/JBJS.22.00675","article-title":"Perioperative essential amino acid supplementation facilitates quadriceps muscle strength and volume recovery after TKA: A double-blinded randomized controlled trial","volume":"105","author":"H Ueyama","year":"2023","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"pone.0346031.ref017","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1007\/s00167-022-07227-5","article-title":"Functional alignment with robotic\u2011arm assisted total knee arthroplasty demonstrated better patient-reported outcomes than mechanical alignment with manual total knee arthroplasty","volume":"31","author":"BS Choi","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"pone.0346031.ref018","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1002\/ksa.12120","article-title":"Functional alignment maximises advantages of robotic arm-assisted total knee arthroplasty with better patient-reported outcomes compared to mechanical alignment","volume":"32","author":"JH Lee","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"7","key":"pone.0346031.ref019","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1007\/s00464-018-6507-3","article-title":"The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample","volume":"33","author":"Z Khorgami","year":"2019","journal-title":"Surg Endosc"},{"issue":"5","key":"pone.0346031.ref020","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2217\/cer-2018-0136","article-title":"A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty","volume":"8","author":"CL Cool","year":"2019","journal-title":"J Comp Eff Res"},{"issue":"6","key":"pone.0346031.ref021","doi-asserted-by":"crossref","DOI":"10.1002\/rcs.2311","article-title":"Robotic surgery costs: Revealing the real villains","volume":"17","author":"YM Rodrigues Martins","year":"2021","journal-title":"Int J Med Robot"},{"issue":"8","key":"pone.0346031.ref022","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1007\/s00167-022-07035-x","article-title":"Artificial intelligence and robotics in TKA surgery: Promising options for improved outcomes?","volume":"30","author":"R von Eisenhart-Rothe","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"12","key":"pone.0346031.ref023","doi-asserted-by":"crossref","first-page":"5453","DOI":"10.1007\/s00167-023-07578-7","article-title":"Robotic-arm assisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten-joint scores compared with conventional manual total knee arthroplasty at five-year follow-up","volume":"31","author":"B Kayani","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"1","key":"pone.0346031.ref024","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1302\/0301-620X.98B1.36314","article-title":"Total knee arthroplasty with an oxidised zirconium femoral component: Ten-year survivorship analysis","author":"I Ahmed","year":"2016","journal-title":"Bone Joint J"},{"key":"pone.0346031.ref025","article-title":"Medical registries: Continued attempts for robust quality data","volume":"5","author":"HI Pass","year":"2010","journal-title":"J Thorac Oncol"},{"key":"pone.0346031.ref026","unstructured":"Weiss AJ, Elixhauser A. Trends in operating-room procedures in US hospitals, 2001-2011: Statistical Brief #171. 2014."},{"issue":"4","key":"pone.0346031.ref027","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/j.arth.2022.10.044","article-title":"Reasons and risk factors for failed same-day discharge after primary total knee arthroplasty","volume":"38","author":"TS Shen","year":"2023","journal-title":"J Arthroplasty"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346031","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T17:24:18Z","timestamp":1776878658000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346031"}},"subtitle":[],"editor":[{"given":"Emil George","family":"Haritinian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":27,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0346031","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]}}}