Robotic-assisted technology is poised to reshape how orthopedic cases move into ASCs, particularly as precision tools expand beyond hips and knees and into more complex procedures such as shoulder replacements.
Robotics adoption is already strong in knees: use in total knee arthroplasty increased sixfold between 2017 and 2023, according to the American Joint Replacement Registry’s 2023 report.
In early February, Providence-based Ortho Rhode Island began offering Mako SmartRobotics for reverse shoulder replacements at the Ortho RI Surgery Center, becoming the first in the state to do so. For Michael Bradley, MD, president and CEO of Ortho Rhode Island, robotics are less a question of “if” and more a question of how they fit the ASC environment.
“Precision technologies in general, which probably range from navigation to robotic-assisted to autonomous robotics, all of those things give us more information than we had when we were doing these procedures on our own,” Dr. Bradley told Becker’s.
For Ortho Rhode Island, bringing robotics into the ASC wasn’t a branding decision, it was an economics-and-throughput decision. Dr. Bradley said the organization tracks cost, time and margin by procedure, allowing it to evaluate new technology on a “margin per minute” basis.
That added data is already changing certain joint procedures. In hip surgery, for example, surgeons can dial in leg length and offset directly in computer-guided systems, getting within a millimeter or two, he said.
However, shoulder surgery has not yet reached the same level of technological maturity, in part because of scale as there are far more total knee replacements, for example. Still, Dr. Bradley sees the trajectory as inevitable.
“We know they’re not going away,” he said of robotic systems. “Do they need to be right-sized from a price and cost structure? Probably. But we know they’re not going away.”
For ASCs, that economic equation may be the defining issue. Robotic systems bring major capital costs, service contracts and training requirements. As value-based pressures intensify and more joint replacements migrate outpatient, ASCs will need to weigh the clinical benefits of precision technology against sustainable cost structures.
Dr. Bradley also framed robotics as a site-of-service strategy. With higher-acuity cases continuing to move from hospitals to ASCs, he said those patients often skew “more active” and “younger,” and his team didn’t want hospital-only technology to pull appropriate cases out of the outpatient setting.
“We really have said we want to do the best operation we can at the ASC,” he said, adding that the organization aims to match the technology footprint across settings when the ASC site of service is appropriate.
At the same time, Dr. Bradley expects innovation to keep accelerating.
“Just like everything else that’s happening with data and things, the doubling time for the knowledge is getting shorter and shorter,” Dr. Bradley said.
For now, Dr. Bradley sees robotics in shoulder surgery as “a fantastic starting point” and expects continued development from companies such as Stryker and its Mako platform.
