Robotics in orthopedics is having a moment, but Brian Nwannunu, MD, orthopedic surgeon at Dallas-based Texas Joint Institute, says the biggest misconception is still the simplest one: people assume it runs itself.
In reality, the technology is changing how surgeons plan, how teams operate and how patients shop for care, but it is not taking the driver’s seat.
“I wish people understood that robotics in orthopedics is a tool,” he said. “I think there’s a misconception that it’s some autonomous structure or machine that’s just there doing its own thing while we’re in the background drinking coffee.”
Dr. Nwannunu’s view is practical: robotics can make great surgeons better, but it still depends entirely on the clinician using it. The promise is not “hands-off surgery.” The promise is a smarter workflow that supports more consistent decision-making.
“We are fully in control,” he said. “We are the ones making the plans. We’re the ones making the decisions. We’re the ones that are using the robot as a tool to be better.”
The generational gap is real — and so is the upside for younger surgeons
Robotics adoption in orthopedics has been uneven, and Dr. Nwannunu said it often tracks with experience level. For surgeons in the early years of practice, he sees robotics as a way to accelerate expertise, closing the gap between new surgeons and colleagues who have lived inside the same procedure for decades.
“It helps us kind of bridge the gap between those that have been doing it for 30 years,” Dr. Nwannunu said.
At the same time, he said it’s understandable why some long-tenured surgeons hesitate. Robotics can feel slower when someone’s already operating at a pace built on muscle memory and repetition.
“If you’re a surgeon that’s done a procedure 30,000 times, you are a robot, right?” Dr. Nwannunu said. “You know you’re not going to be better with the robot. You’re probably going to be slower.”
Robotics shines in the hard cases, not the “slam dunks”
In Dr. Nwannunu’s view, robotics doesn’t fundamentally change everything about joint replacement, it changes the margin for error when a patient’s anatomy isn’t predictable. He described the robot as most valuable when the case is complex, the geometry is abnormal and small deviations can cause big downstream issues.
“I don’t think it helps you on those average, normal, slam-dunk patients,” he said. “It helps you on those outliers, on the people whose anatomy is much different.”
That advantage shows up when a patient brings a history, deformities, prior surgeries, old injuries, the kinds of cases surgeons can’t always rehearse in training labs.
“When you’re in an abnormal situation, the robot’s really precise and able to find this complex geometry and help you know where you are,” Dr. Nwannunu said. “If there’s twisting, if there’s torsion, if there are any bends, things that just aren’t supposed to be there, it’ll alert you so you can make your plan accordingly.”
The operational challenge: cost, space and an extra layer of logistics
For leaders, the biggest barriers are rarely philosophical. They are practical. Robotics adds cost, equipment, people and new variables to a space that is already highly scheduled and highly optimized.
Dr. Nwannunu said hospitals also need to account for the additional specialist support required to run a robotics program smoothly, and that the per-case add-on becomes significant at scale.
“If you look at the, you know, hundreds of thousands of joint replacements … and you add $200 or $300 per case, it can be significant,” he said.
Time is the learning curve — and it compounds fast
Even when robotics is clinically appealing, the time equation can decide whether a team embraces it or resents it. Dr. Nwannunu said surgeons still learning the platform can add meaningful minutes to a case, and those minutes can stretch an entire day into something unsustainable.
“For those that aren’t used to it, it can add 30 minutes to an hour,” he said.
When leaders think about efficiency, he added, robotics adoption has to be mapped not just to a single case, but to a full schedule and a real team working under pressure.
“If you have five or six surgeries a day and you’re adding an hour extra because you’re just trying to troubleshoot this robot, then that’s a long day,” Dr. Nwannunu said. “Instead of leaving at 3 p.m., we’re leaving at nine.”
“You still have to fly the plane”
No matter how advanced the tool becomes, Dr. Nwannunu said the surgeon still has to be able to operate without it. Robots can fail. Cases can shift. Technology can drift. The fallback plan cannot be panic.
“There are times when a robot just doesn’t work,” he said.
He compared robotics to autopilot: helpful, powerful and not something you can rely on blindly.
“As a surgeon, you have to be able to fly the plane, right?” Dr. Nwannunu said. “You can put on autopilot all you want, if there’s some turbulence, if you have to redirect it, if you have to land in some inclement weather … then you still have to fly the plane.”
That’s also why he believes robotics shouldn’t replace foundational training. Not every site has the technology, and not every situation will allow it to work as planned.
“Every hospital system and every hospital hasn’t adopted robots or can’t afford the robot,” he said. “So every surgeon, every trainee should have a site where there is no robot and they have to call a manual hip or knee replacement.”
Precision becomes measurable — not just something you “feel”
Robotics doesn’t only change how surgeons cut bone or place implants. Dr. Nwannunu said it changes what you can measure in real time, especially in knee replacement, where balance and motion can affect patient outcomes.
“And that is what I think you cannot mimic anywhere else,” he said.
In manual procedures, he said, the surgeon’s judgment still matters, but robotics introduces a more exact language for what “good” looks like inside the joint.
“After you put the implants in as a manual person, you can say, ‘Oh, it feels good. It feels nice,’” he said. “But robots take things down to a millimeter, down to a degree.”
A robotics-ready team is bigger than one surgeon
Behind every robotics program is a team built to support it. Dr. Nwannunu described a robotics-ready setup as a full ecosystem: the surgical core, anesthesia support, a robot specialist and the device rep who ensures the equipment and implants are there and functional.
“That’s the core team always, no matter where you go,” he said.
Beyond that, the difference-maker is the specialized roles that keep the robot integrated into the case rather than disrupting it.
“We have all of that team together working synergistically. That’s a robotics ready team.”
Patients are asking for the robot — and systems are adapting
One of the strongest forces pushing robotics forward, he said, is not surgeons. It’s patients. Orthopedic patients are more informed than ever, and they are increasingly direct about what they want.
“They also come in asking for the robot,” Dr. Nwannunu said. “And patients will come in specifically and say: ‘Hey, do you do the robot? I want the robot.’”
That behavior is part of a broader consumer shift in healthcare, where choice, convenience and transparency shape volume. In Dr. Nwannunu’s view, systems that don’t adapt may lose more than market share , they may lose relevance.
“If you don’t have that option, you’re gonna lose patients,” he said. “And ultimately, healthcare systems are still a business, so if you lose patients, you lose revenue.”
The next wave is coming — but leaders should be cautious
Autonomous robotics isn’t here yet in orthopedic surgery, Dr. Nwannunu said, but the early signals are already on the horizon. He called it a space to watch closely, especially because even today’s systems can behave unpredictably.
“As of now, there are no fully autonomous robots in orthopedic surgery, but there are prototypes,” he said. “It still isn’t fully out yet, but there are prototypes out there.”
He sees the potential for robotics to expand access in rural areas and across borders, but he also wants the profession to move deliberately as autonomy evolves.
“I just hope that we as an orthopedist society really cross our t’s and dot our i’s and make sure that the robot is doing what it needs to do,” Dr. Nwannunu said. “But I do think there’s a benefit to it, so it’s something for people to keep an eye on.”
For 2026, his message is less about hype and more about readiness: robotics can elevate outcomes and strengthen consistency, but only if health systems build the staffing, training and operational discipline to support it, and only if surgeons remain, unmistakably, the ones in control.
