Coming to ASCs in 2026: Robotic Total Shoulder Replacements

Robotic Assistance Financial Management Orthopedics

By: Adam Taylor | Managing Editor

Published: 5/7/2025

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Surgery center-friendly mobile systems are normalizing same-day total joints procedures.

When Ammar Anbari, MD, exited one of the four operating rooms at Constitution Surgery Center East in Waterford, Conn., on March 10, it marked the end of a groundbreaking event.

“It was the first robotic total shoulder replacement performed in a facility other than a hospital anywhere on the planet,” says Rob Taylor, RN, BS, IP, CFDAI, the ASC’s clinical director and total joint coordinator.

Consistently gaining steam

Robotic Shoulder
FLOATS ALL BOATS The new robot will really help surgeons who perform only several shoulder replacements a year, but specialists who perform several a week can also benefit.

The procedure is the latest development on a steady upward arc for outpatient robotic total joints, which is increasingly becoming more commonplace. As usual, knee and hip replacements have led the way.

In 2018, 47% of orthopedic surgeons performed total knee arthroplasty in outpatient settings, according to the American Academy of Orthopaedic Surgeons (AAOS). That number grew to 88% in 2022. Similarly, 47% performed outpatient total hip arthroplasty in 2018, a number that rose to 87% in 2022.

The advent of robotic technology in a package small enough to wheel from OR to OR in ASCs, where space is always at a premium, played a role in this growth, as has growing demand among an aging patient population. A Mayo Clinic Arizona study, for example, says patient expectations will continue to rise after their research on 10 years of Google trends showed a significant jump in public interest in robotic total joints from 2011 to 2020. As a result, more surgeons have made robotics part of their arsenal than ever before. By 2030, two of every three total hip arthroplasties will be done robotically, as will one in two total knee arthroplasties, according to results of a Cleveland Clinic study.

Dr. Anbari is part of the research and development for the robot he used for the March 10 procedure at Constitution East. The product is expected to be commercially available to orthopedic surgeons in 2026.

Dr. Anbari says the new robot will be particularly helpful for orthopedic surgeons who perform shoulder replacements infrequently. “An issue with shoulder replacements is that many are done by surgeons who only perform several of them a year, whereas shoulder specialists do 150 to 200 a year,” he says. “Shoulders can be a very intimidating surgery. You can have trouble exposing the socket, opening it up correctly or retracting stuff out of the way. The robot really helps out and makes sure that the prosthesis is going to be put in precisely the right spot every time.”

The main goal of the new robot is to allow surgeons of all skill levels to perform the surgery accurately so the prosthesis will live a long life and allow patients to have the best range of motion afterward. “This application was built to first help less experienced surgeons have superior outcomes that are reproducible but will also help experienced surgeons in the same way,” says Dr. Anbari.

The shoulder application on the robot also has knee and hip programs. Owners of existing versions of robots with knee and hip packages can have the internal shoulder application and external hardware added into it.

How it works

Robotic Shoulder
CAPITAL INVESTMENT A pre-purchase financial analysis to determine whether the seven-figure cost of a shoulder robot is justifiable for a facility is crucial.

The new robot is much needed, says Dr. Anbari, who says the bulk of his revision work is to correct surgeries during which the prosthesis was placed incorrectly or doesn’t fit right. “The robots should be able to fix a lot of these issues and hopefully eliminate them altogether,” he says.

The robot arm aligns the surgeon’s hand so the saw blade, burr or router goes to the exact spot it needs to be, ensuring accurate cuts. “You hold the robot arm like you’re holding a drill,” says Dr. Anbari. “The robot doesn’t let you make a mistake; it won’t let you plunge and make too deep of a cut, so the surgery is much safer.”

The mobile device is about twice as large as popular fluid waste management carts. The wheels lock when it’s time to perform the surgery. Its relatively small size and ability to go from room to room makes it a very ASC-friendly device.

The jury is still out overall on whether robotic surgery is superior to nonrobotic surgery, however. For example, a study by the American Joint Replacement Registry presented at the 2024 AAOS Annual Meeting concluded that robotic assistance did not reduce the amount of revision procedures needed in more than 9,200 patients who underwent total knee replacement surgeries from 2017 to 2020. OSM

BUSINESS DECISIONS
Consider These Factors Before Jumping Into Robotic Total Joints

Constitution Surgery Center East in Waterford, Conn., opened in 2001, moved to a larger location in 2017 and plans to add a fifth operating room this year. The two larger ORs in the multispecialty ASC are where total joints procedures take place.

The first thing to determine is whether you can afford a robot, says Rob Taylor, RN, BS, IP, CFDAI, the facility’s clinical director and total joint coordinator.. They cost about $1M. If you have a robot that is already programmed for knees and hips, an upgrade to include the shoulder package would be around $250,000, he says.

ASCs in partnership with health systems are more likely to be able to afford a robot than an independently owned ASC. “You need a strong surgery center to be able to go out and purchase a robot,” says Mr. Taylor. “You don’t get a small orthopedic practice to pony up and finance a million-dollar piece of equipment.”

That said, owners of a strong single-practice facility would be more likely to agree to such a significant capital investment than a multispecialty center. “It’s one thing if it’s an orthopedic specialty facility, because it’s comparatively easy to get everybody to put their oars in the water and paddle in the same direction,” says Mr. Taylor. “But when you have non-orthopedic partnerships, you need to win over the eye doctors, the spine doctors and the pain doctors to agree to the capital expenditure.”

Constitution Surgery Center East is in a joint venture partnership with Hartford HealthCare, which helped pay for the ASC’s two robots. It started with a single device, but when CMS began reimbursing for total knees and hips at ASCs, more surgeons wanted to use the robot, so a second was needed.

• Check your contracts. Before you commit to signing a check for a pricey robot, your business department should have already researched your payor mix and checked to determine that your fee-for-service agreements with insurance companies include reimbursements for robotic procedures.

Outpatient robotic shoulders is a new enterprise, and implants are significantly more expensive than knee and hip implants, so it’s crucial that your contracts are sufficient to pay for the devices.

Once you know precisely how much you’ll be reimbursed, you’ll be in a better position to negotiate with the robot manufacturer on price. If your average implant reimbursement is half of what the manufacturer wants to charge, a compromise must be reached on implant costs, which can render acceptable levels of reimbursement for other parts of the case irrelevant. “Otherwise, you’re destined for failure if every time you do one of these procedures, you’re losing money on it,” says Mr. Taylor.

• Time and space considerations. In general, robotic procedures tend to take a little longer than traditional joint replacements, so an extra 20 minutes of time is blocked off for each robotics case. That will quickly become an issue if OR time is scarce and surgeons are performing four or five traditional total joint arthroplasties (TJA) a day, because the robotics cases will cut into their time.

That’s one reason why Constitution Surgery Center East is building a fifth OR. The facility’s current TJA cases take place in two ORs that are about 600 square feet, about 100 square feet larger than each of the other two.

“The robots aren’t huge, but you do need additional space,” says Mr. Taylor. “There is also an additional set of instruments that comes with the platform, and the robot company’s technicians are in the room in case the software or any of the configurations need to be adjusted.”

Mr. Taylor thinks facilities’ volumes are bound to grow once they acquire a robot.

“There’s a large amount of money that gets shelled out and you have to be comfortable that you’ll bring in the volume to reach your targeted ROI,” he says.

“Advertising that you have a robot is key,” he adds. “Patients are asking for it. They’re drawn to the smaller incisions and the greater accuracy. And the outcomes speak for themselves.”

—Adam Taylor

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