The first surgical robots were enormous, expensive and impractical. They belonged to a period when computers still felt like specialized machinery: powerful, promising and largely inaccessible outside institutions with the money, staff and patience to operate them.
Ugo Ihekweazu, MD, chief of adult hip and knee reconstructive surgery with Houston-based Fondren Orthopedic Group at Texas Orthopedic Hospital believes, robotic joint replacement is beginning to leave that era behind.
The hardware has improved. Platforms have become more precise and easier to use. Some no longer require a preoperative CT scan. Systems that were once available only to large academic centers are moving into community hospitals and surgery centers. But the most consequential change may be what happens after the robot becomes ordinary.
“Over time, we’re going to be talking less about robots and more about intelligent surgery,” Dr. Ihekweazu told Becker’s.
The next generation of robotic joint replacement, he said, will be driven less by larger machines or new mechanical features than by software capable of learning from the enormous volume of information produced during surgery.
The robot will not replace the surgeon, but it will increasingly reveal how the surgeon can perform better.
That shift carries significant implications for hospital and ASC leaders. Many organizations have evaluated robotic platforms through a relatively narrow lens: Will the machine attract patients? Will surgeons use it? Will greater precision translate into better outcomes?
Dr. Ihekweazu believes those questions remain important. They are no longer enough. The real value of robotics may lie in whether it can standardize care across surgeons, make complex outpatient procedures more feasible, reduce physical demands in the operating room and turn surgical data into better decisions across an entire joint replacement program.
The robot is a visible investment, yet the intelligence around it may determine whether the investment pays off.
From specialized machine to everyday tool
Dr. Ihekweazu was the first surgeon to perform a partial knee replacement using the imageless Velys robotic platform. Unlike image-based systems, it does not require the patient to undergo a CT scan before surgery. That removes a planning step for the practice and eliminates concerns about whether the scan was ordered, completed and performed using the correct protocol.
For Dr. Ihekweazu, the milestone represented more than the arrival of another device. It reflected robotics’ progression from a specialized and cumbersome technology toward something more accessible.
He compares the evolution to that of the computer. Early computers were large machines confined to governments, research institutions and industrial operations. They eventually became tools used everywhere, by nearly everyone, without the user spending much time thinking about the hardware.
Robotic surgery is moving along a similar path. The earliest systems demonstrated what might be possible. Image-based platforms later brought a higher level of planning and precision. Imageless systems are beginning to reduce the preparation and infrastructure required to use them.
“The Velys platform is a natural step in the right direction of making these devices more accessible and easier to use,” Dr. Ihekweazu said. Future hardware improvements may eliminate some of the pins, arrays and additional steps currently required during robotic procedures. The larger transformation, however, will take place inside the software.
Precision is proven. The final outcome question is not.
Robotics has already demonstrated that it can help surgeons execute a plan with greater precision and reproducibility. The more difficult question is how much that precision changes the patient’s life years later.
“I think there’s a thought that robotics is a panacea,” Dr. Ihekweazu said. “It’s important to be balanced.” Evidence supporting improved alignment and implant positioning is strong, he said. Whether those improvements produce superior long-term results for every patient remains under study.
That distinction matters for executives weighing a seven-figure capital investment. A technically more accurate operation is valuable. It should not automatically be presented as proof of longer implant survival, faster recovery or greater patient satisfaction in every case.
Yet focusing only on long-term clinical outcomes can also understate the technology’s value. Robotics can change how consistently surgery is performed, how surgeons experience the operation and how programs scale quality across physicians with different levels of volume and experience. Those benefits may not appear in a traditional implant alignment study. They can still shape the economics and durability of a joint replacement program.
Robotics does not eliminate the surgeon’s work
Dr. Ihekweazu and his colleagues recently examined surgeon workload during robotic and manual knee replacement using a validated assessment tool. The findings challenged another common assumption: that robotic surgery simply makes the operation easier.
“Robotics didn’t necessarily reduce overall workload,” he said. “It changed the type of work surgeons are doing.” Physical demand decreased. Task complexity and distractions increased.
The robot may reduce some of the manual strain involved in executing bone cuts, but it also introduces planning screens, registration steps, data interpretation and additional equipment into the procedure. The technology transfers part of the workload from the surgeon’s body to the surgeon’s attention.
Experience changes that equation. Surgeons who used robotics routinely reported lower workload than those who used it only occasionally, Dr. Ihekweazu said. The finding suggests that implementation and repetition may be as important as the platform itself.
A hospital cannot buy a robot, perform a small number of cases and assume it has created an effective robotic program. Surgeons need enough volume to become fluent. Operating room teams must understand the workflow. Equipment placement, setup and troubleshooting have to become routine.
Without that infrastructure, the technology intended to make surgery more reproducible can introduce new sources of complexity. The purchase is only the first step.
The value question hospital leaders are missing
Hospital and ASC leaders often begin robotic evaluations with familiar questions. Will it improve market share? Will patients ask for it? Will it differentiate the organization? Will clinical outcomes improve enough to justify the cost?
Dr. Ihekweazu encourages leaders to widen the analysis. Can the platform standardize results across surgeons? Can it improve efficiency after the learning curve? Can it support outpatient growth? Can it strengthen recruitment and education? What data will it produce, and can that information be used to improve quality over time?
“Those are questions that aren’t routinely discussed in these meetings,” he said. “They’re incredibly important to the viability of an arthroplasty program in the long run.”
Surgeon performance also belongs in the value calculation. A forthcoming study involving Dr. Ihekweazu and his colleagues suggests lower-volume surgeons using robotic platforms may be able to achieve intraoperative results that more closely approximate those of experienced, high-volume surgeons.
If that finding is sustained, it could become one of robotics’ most consequential advantages. A health system cannot place a nationally recognized specialist in every operating room. It can invest in tools that make high-quality execution more consistent across its network.
That does not erase differences in judgment, training or technical ability. It may reduce some of the variation created by them. For systems acquiring practices and expanding joint replacement into multiple hospitals and ASCs, consistency can be more valuable than novelty.
The robot is not driving outpatient joint replacement
Robotics is often credited with accelerating the migration of hip and knee replacement into ASCs. Dr. Ihekweazu believes that gives the technology too much credit. Outpatient joint replacement became possible primarily because of advances in anesthesia, multimodal pain management, rapid recovery protocols and patient selection.
“The robotics are not the reason we’re seeing more outpatient joint replacement,” he said. The technology can complement the shift. Robotic platforms allow surgeons to execute procedures consistently and may help them tackle more complicated cases with fewer resources.
Dr. Ihekweazu pointed to conversion arthroplasty, in which a patient who previously underwent fracture fixation or ligament reconstruction later needs a joint replacement. Traditional surgery may require the surgeon to remove plates, screws or other hardware before placing the new implant. That can lengthen the case, increase tissue disruption and require additional equipment.
With robotic planning, surgeons may be able to position the joint replacement around retained hardware rather than removing all of it. A more complex case can then be performed using resources closer to those required for a primary joint replacement. That capability could allow additional patients to receive care in lower-cost outpatient environments.
Still, Dr. Ihekweazu cautioned against treating the robot as the defining element of a successful outpatient program.
“At the end of the day, patient selection and great multidisciplinary care are so much more important than whether there’s a robot in the operating room,” he said.
The machine cannot compensate for choosing the wrong patient, inadequate pain control or weak discharge planning. It can make a strong program more capable. It cannot create one by itself.
The next platform may be the data
Every robotic procedure generates information. The system records anatomy, implant positioning, alignment decisions, surgical adjustments and elements of the surgeon’s workflow.
Today, much of that information is used primarily to guide the individual operation. Dr. Ihekweazu expects future software to compare those decisions across thousands of cases and connect them with recovery, complications, patient experience and long-term outcomes.
The robot could then become more than an execution tool. It could become a learning system. A surgeon might see how patients with similar anatomy responded to different alignment strategies. A health system could identify variation across facilities. A program could understand which workflows reduce operating time without compromising quality.
Instead of merely confirming that an implant was placed where the surgeon intended, the technology could help answer a more valuable question: Was that plan the right one for this patient?
“The robot isn’t going to replace the surgeon anytime soon,” Dr. Ihekweazu said. “But it’s giving us better information so we can make better decisions for our patients.”
That distinction is central to his vision. AI should not remove the physician from joint replacement. It should remove repetitive work, surface relevant evidence and allow the surgeon to devote more attention to judgment and patient care.
The goal is not autonomous surgery. It is a better-informed surgeon.
Beyond the alignment report
For much of robotics’ development, success has been measured through technical outputs: alignment, implant positioning and the accuracy of bone preparation. The next stage will require a broader scorecard.
Hospitals taking on greater accountability for surgical episodes need to understand the entire journey: operating room efficiency, surgeon workload, patient experience, recovery, complications and resource use after discharge.
Robotics will increasingly be judged by how it contributes to that full episode. A platform that produces a perfectly aligned implant but adds significant operative time, workflow disruption and cost may not deliver the same value as one that supports consistency across several surgeons and enables appropriate cases to move into an ASC.
The most advanced robot may not be the platform with the most visible hardware. It may be the one that disappears most effectively into the care model.
“I don’t think the question anymore is whether robotics has a role in joint replacement,” Dr. Ihekweazu said. “It definitely does. The question is how we maximize the value that it brings.”
That question moves the conversation beyond whether a hospital owns a robot. It asks whether the organization has built the data infrastructure, surgeon experience and clinical model required to make the robot matter.
The next era of robotic surgery will not be won by the health systems with the most machines. It will be won by those that learn the most from them.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.