When patients hear the phrase “robot-assisted surgery,” many imagine that the surgeon steps aside and the machine does everything. In reality, this is a misconception.
In shoulder joint arthroplasty using the MAKO SmartRobotics™ system, it is not an autonomous “robot surgeon”, but a tool that helps the surgeon implement their own decisions more precisely.
The procedure is performed by a human. The robot merely prevents deviation from a pre-planned trajectory.
The shoulder joint is particularly sensitive to inaccuracies. It is highly mobile and anatomically variable, and even a few degrees of deviation can result in a compromised outcome. This is why robotic assistance in shoulder arthroplasty has practical value beyond just technological appeal.
(A general understanding of the MAKO concept is detailed in the article “MAKO Stryker Robotic Shoulder Arthroplasty: A New Era in Orthopedics.”)
What MAKO Really Is — Without Marketing Hype
If you strip away the promotional language, the MAKO system is a combination of three components: preoperative CT planning, real-time navigation, and a robotic arm with haptic feedback.
The key idea is simple:
First, the surgeon plans the operation in detail, then the system ensures that the plan is executed exactly, rather than relying on approximate “feel-based” execution.
Step 1: CT and Planning
Work begins long before the operating room. CT allows visualization of structures that are often “out of view” during surgery.
CT provides information on:
the true shape of the glenoid fossa
the degree of deformity
asymmetry that cannot be accurately assessed visually
At this stage, the surgeon sets the orientation of components, insertion depth, and angles.
These are not abstract parameters—they are concrete decisions tailored to the patient’s anatomy.
Sometimes it is only at the planning stage that it becomes clear the case is complex. In such cases, precise instrumentation is no longer optional; it becomes necessary.
Anatomy Registration: Where Everything Comes Together
During surgery, the system must match the CT model to the patient’s actual bone position. This is done via anatomy registration.
Technically, the process seems routine, but it is crucial.
After registration, the surgeon is not working “blindly” but sees the real position of the instrument relative to the planned trajectory on the screen.
At this point, the operation stops being intuitive and becomes measurable.
Haptic Feedback: The Key Feature of MAKO
Most technical errors occur during resection—not due to lack of experience, but because of complex anatomy and misleading landmarks.
Haptic feedback creates a physical constraint: the instrument literally cannot move beyond the planned limits.
This is especially valuable:
with significant glenoid deformities
after trauma
in revision cases
The robot does not completely eliminate errors, but it significantly reduces the likelihood of unintended movement. This is noticeable even during initial procedures.
Result Control Instead of “Feel”
After preparing the bone bed, the system displays the actual parameters: angles, depth, and centering.
Decisions are made not by “looks straight,” but based on specific measured values.
If something does not match the plan, it is immediately visible, not after the surgery is completed.
Why It Matters Especially for the Shoulder
The shoulder joint is less forgiving of errors than other joints. Incorrect orientation of the glenoid component can lead to pain, instability, limited motion, and accelerated implant wear.
Robotic technology does not automatically make the operation perfect.
But it creates conditions in which precision becomes reproducible, not random.
(For the impact of this approach on recovery and prognosis, see the article “Advantages of Robotic Shoulder Arthroplasty: Accuracy, Recovery, Prognosis.”)
Prospects for Implementation in Russia
It is worth noting the situation in Russia. According to professional and industry sources, the implementation of MAKO robotic shoulder arthroplasty is planned for 2026.
This primarily concerns major orthopedic centers that already have experience with robotic systems in knee and hip replacement.
Typically, such technologies go through team training and protocol adaptation. Therefore, mass adoption should not be expected immediately. However, the very fact of planning implementation indicates serious interest in this field.
MAKO SmartRobotics™ is not a replacement for the surgeon and not just a trendy technological gadget.
It is a tool that allows shoulder arthroplasty to be performed more confidently and with greater control, especially in situations where the cost of an error is measured in millimeters.
For the shoulder joint, this is of critical importance.
