Robotic shoulder surgery enters ASCs, paving way for broader adoption

Editor's Note

Surgeons are performing robotic shoulder replacements in ambulatory surgery centers (ASCs) for the first time, signaling a significant shift in the trajectory of outpatient total joint arthroplasty. According to Outpatient Surgery Magazine May 7, the world’s first robotic total shoulder replacement outside of a hospital took place on March 10 at Constitution Surgery Center East in Waterford, Connecticut, using a new mobile robotic system designed specifically for ASC use.

The outlet reports this milestone builds on the strong momentum already seen in outpatient total knees and hips. Between 2018 and 2022, the percentage of orthopedic surgeons performing total knee replacements in outpatient settings jumped from 47% to 88%, and hip replacements rose from 47% to 87%, according to AAOS data cited in the article. Key drivers include compact robotic platforms that can be wheeled between ORs and increasing patient demand, which Mayo Clinic research links to rising Google search trends over the last decade.

The new shoulder-capable robot, developed with input from Ammar Anbari, MD, offers a major assist to surgeons with lower shoulder replacement volumes. “Shoulders can be very intimidating,” Dr Anbari told the outlet, citing visibility challenges and component placement precision. He emphasized the robot’s role in helping ensure consistent accuracy regardless of experience level. The article notes that existing robotic systems used for knees and hips can be upgraded to include the shoulder application.

While this innovation may improve surgical consistency, the article also acknowledges unresolved questions about clinical outcomes. A study presented at the 2024 AAOS Annual Meeting found no significant reduction in revision surgeries among robotic versus traditional knee procedures.

On the business side, cost and operational demands are steep. The article states a shoulder-capable robot runs close to $1 million, with upgrades from knee/hip-only systems averaging $250,000. Constitution Surgery Center East, which operates in partnership with Hartford HealthCare, uses two robots and is adding a fifth OR to accommodate the extra time and space required. Facilities must also ensure payer contracts support higher implant and equipment costs or risk operating at a loss.

The outlet concludes that patients are actively seeking robotic options, and volume is likely to grow—but facilities must enter with eyes open, backed by solid return-on-investment calculations and reimbursement strategies.