Robot-assisted shoulder arthroplasty.

Robotic assistance has demonstrated to provide value in the field of hip and knee arthroplasty. As a result, it is becoming increasingly popular. On the contrary, robot-assisted shoulder arthroplasty is in its infancy. The various commercially available robots for arthroplasty applications are quite different regarding the features they provide. For shoulder arthroplasty, the Rosa system is already available to selected users, and the Mako system will be available soon. Rosa is considered a collaborative robot that positions cutting guides and reamers as a combined effort between the robot and the surgeon; once the desired position of the guide or reamer is achieved, the robot enters static mode, and the surgeon performs the humerus osteotomy or reams the glenoid in collaboration with the robot; currently, augment preparation is not provided. Mako provides an effector end that prepares bone and uses haptic boundaries to avoid error; details on the Mako shoulder application have not been released. The main theoretical benefits of robot-assisted shoulder arthroplasty include accuracy and precision, data acquisition, and with certain robots, the promise to avoid soft-tissue injury with haptic boundaries, prepare a bone through minimally invasive or cuff-preserving exposures, and the potential for motion assessment and soft-tissue balance. The disadvantages include cost, a certain learning curve, complications related to array insertion, potential for cognitive bias, need for a larger operating room space, and the potential for malfunction. Although adoption is likely to happen in many centers, cost and space constrains may favor alternative technologies, such as mixed reality navigation, especially in ambulatory surgery centers.