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This paper reviews the literature on robotic-assisted TKA (RA-TKA) and public procurement policies in India, arguing for increased adoption of RA-TKA in public sector hospitals to improve outcomes and patient satisfaction. The review analyzes the cost-benefit of Capital Expenditure (CapEx) and Operational Expenditure (OpEx) procurement models, highlighting the potential for improved implant placement, alignment, and early outcomes with RA-TKA. The authors suggest that OpEx models, such as "Robotics as a Service," offer a more feasible approach for public hospitals to access RA-TKA technology.
OpEx procurement models for RA-TKA, such as "Robotics as a Service," can enable public hospitals to overcome prohibitive upfront costs and improve TKA outcomes, addressing the technological gap with private providers.
Total knee arthroplasty (TKA) remains a cornerstone in the management of end-stage knee arthritis, providing significant pain relief and restoration of function. However, patient dissatisfaction persists in up to 10% of cases after primary TKA and 7.3% even following an uncomplicated procedure. Robotic-assisted TKA (RA-TKA) provides an opportunity to further improve outcomes, but public sector adoption in India encounters unique economic and policy barriers. A comprehensive review of global and Indian literature on RA-TKA and public procurement policies – including General Financial Rules and Ministry of Health and Family Welfare guidelines – was undertaken. Capital Expenditure (CapEx) and Operational Expenditure (OpEx) procurement models were analyzed using cost–benefit perspectives and published clinical, economic, and systems evidence. Public hospital demand for TKA is rapidly increasing, but advanced computer navigation and robotic systems are absent in most public centers. Evidence links RA-TKA with improved implant placement precision, joint alignment, early clinical and radiographic outcomes, and patient satisfaction. The surgeon learning curve is moderate and does not negatively impact patient results. International adoption of RA-TKA is accelerating, with India seeing a substantial rise in installation and usage. Upfront costs pose the main barrier to public sector rollout, but OpEx procurement – such as “Robotics as a Service” – offers operational flexibility, budget relief, and adaptable technology lifecycles. Indian experience across public and private sectors demonstrates this feasibility. Expanding RA-TKA in public hospitals can close the technological gap with private providers and meet rising patient expectations. Compared to CapEx, the OpEx model avoids prohibitive up-front costs, mitigates risks of obsolescence and vendor lock-in, and ensures access to high-quality care as technology evolves. Public hospitals are thus empowered to deliver state-of-the-art arthroplasty sustainably and efficiently.
