Robotic Shoulder Replacement (Mako SmartRobotics™)

What is Mako robotic-arm assisted shoulder replacement?

The Mako SmartRobotics™ system, developed by Stryker, is a robotic-arm assisted surgical platform that combines three-dimensional CT-based pre-operative planning with real-time robotic guidance during surgery. It has been extensively used for hip and knee arthroplasty, with strong evidence for improved implant positioning and long-term outcomes. Its introduction to shoulder surgery represents the next frontier for this proven technology.

The system does not replace the surgeon — it augments their precision. Dr Chia controls the robotic arm throughout the procedure; the system provides real-time feedback and physical boundaries that keep every cut and placement within the pre-planned parameters. The result is a degree of accuracy that would be difficult to achieve consistently by hand alone.

How it works: the three-stage process

1. Pre-operative 3D CT planning — a CT scan of the patient’s shoulder is taken before surgery and used to create a precise three-dimensional virtual model of their unique anatomy. Dr Chia uses this model to plan the exact size, position, and orientation of the implant components before entering the operating theatre. Every element of the surgical plan — implant type, depth, angle, and alignment — is determined in advance from the patient’s own anatomy.

2. Real-time robotic guidance during surgery — once in theatre, the Mako system continuously tracks the position of the patient’s shoulder bones in three dimensions. As Dr Chia works, the system compares the real-time position to the pre-operative plan and guides the robotic arm accordingly. If any movement would deviate from the planned boundaries, the system provides haptic (physical) feedback — a resistance that prevents the surgeon from cutting outside the defined safe zone.

3. Accurate implant positioning and soft tissue protection — the combination of pre-operative planning and real-time guidance allows the implant to be seated in precisely the planned position, protecting healthy bone and surrounding soft tissue. The glenoid (socket) component in particular — historically the most technically challenging part of shoulder replacement — benefits significantly from this level of precision.

Potential benefits of robotic-arm assisted shoulder replacement

The Mako system has been used in millions of hip and knee procedures worldwide, with strong evidence supporting improved positioning accuracy. Its application to shoulder surgery is newer, and long-term shoulder-specific data continues to accumulate. The potential benefits — consistent with the evidence from hip and knee use and with Dr Chia’s direct experience from performing NSW’s first case — include:

• Greater implant positioning accuracy — the CT-guided planning and robotic guidance ensure the glenoid and humeral components are placed in the pre-planned position with a level of consistency that exceeds conventional manual technique
• Improved joint stability and function — accurately positioned implants restore normal joint mechanics, contributing to better range of motion and functional outcomes
• Protection of healthy bone and soft tissue — the haptic boundary system prevents inadvertent cuts or contact outside the planned zone, protecting surrounding structures
• Reduced post-operative pain — precise surgery with minimal unplanned tissue disruption is associated with less post-operative inflammation and pain • Faster, more confident recovery — patients who experience less post-operative pain and whose joint mechanics are immediately well-restored tend to progress through rehabilitation more quickly
• Potentially longer implant longevity — accurately positioned implants distribute load more evenly across the joint surfaces, reducing wear rates and the risk of premature loosening

Who is suitable for robotic shoulder replacement?

The Mako system is currently only used for reverse shoulder replacement. The indications for surgery are the same as for conventional shoulder replacement — the robot assists with the execution of the surgery, not the decision to proceed.

Conditions treated with Mako robotic shoulder replacement

• Glenohumeral osteoarthritis — the most common indication. End-stage arthritic degeneration of the shoulder joint that has not responded to conservative management.
• Rotator cuff tear arthropathy — severe shoulder arthritis developing from a large, long-standing rotator cuff tear. Managed with reverse shoulder replacement.
• Fracture — complex proximal humerus fractures (3- and 4- part, head split, fracture dislocations) where tuberosity healing is unreliable.
• Rheumatoid arthritis — inflammatory arthritis causing progressive shoulder joint destruction.
• Post-traumatic arthritis — arthritis developing after previous shoulder fracture, dislocation, or surgery.
• Avascular necrosis of the humeral head — bone death from disrupted blood supply, causing collapse of the humeral head.
• Failed conventional shoulder replacement — revision arthroplasty where the Mako’s 3D planning can be particularly valuable in characterising residual bone stock and planning component positioning.

Who may not be suitable Not every patient requiring shoulder replacement is a candidate for robotic-assisted technique — the assessment is individual and takes into account bone quality, prior surgery, implant availability, and other clinical factors. Dr Chia will advise whether robotic-assisted or conventional arthroplasty is most appropriate for your specific anatomy and diagnosis.

Mako robotic vs conventional shoulder replacement — what is the difference for the patient?

From a patient’s perspective, the experience of robotic-assisted shoulder replacement is very similar to conventional shoulder replacement. The key differences are in what happens in the operating theatre and the quality of the surgical output:

Sydney Adventist Hospital — where this procedure is performed

Dr Chia performs Mako robotic shoulder replacement at Sydney Adventist Hospital — known as ‘The San’ — in Wahroonga. The San is one of Sydney’s most respected private hospitals, with a long history of investing in advanced surgical technology and a specialist orthopaedic theatre suite equipped for complex joint arthroplasty.

Sydney Adventist Hospital is also the location where Dr Chia conducted NSW’s first Mako robotic shoulder replacement in April 2026. It is also one of three hospitals where Dr Chia performs surgery — alongside Northern Beaches Hospital (Frenchs Forest) and Wyvern Private Hospital (Terrey Hills). Northern Beaches Hospital holds accreditation as a Centre of Excellence in Orthopaedic Surgery from the Surgical Review Corporation (2024–2027).

What to expect: before, during, and after robotic shoulder replacement

Before surgery

• Specialist consultation with Dr Chia — including a thorough assessment of your shoulder, review of X-rays, and recommendation of whether robotic-assisted or conventional replacement is most appropriate
• CT scan of the shoulder — taken specifically for Mako pre-operative planning; the scan creates the 3D virtual model that Dr Chia uses to plan your implant position before the day of surgery
• Virtual surgical planning review — Dr Chia reviews and finalises the 3D plan, selecting implant sizes and confirming placement parameters
• Pre-operative preparation — as for all shoulder replacement surgery; see the Before Your Surgery page for details

On the day of surgery

• General anaesthesia combined with an interscalene nerve block for post-operative pain control
• The procedure itself is performed through the same approach as conventional shoulder replacement — a deltopectoral incision at the front of the shoulder
• The Mako system is used throughout the bone preparation and component positioning stages, guided by the CT-based pre-operative plan
• Operative time is similar to conventional shoulder replacement: typically 1–2 hours
• Most patients stay in hospital for 1–2 nights

Recovery Recovery from Mako robotic shoulder replacement follows the same staged protocol as conventional shoulder replacement:

Dr Marcus Chia — experience and credentials in shoulder arthroplasty

Robotic-assisted surgery demands a surgeon who is not only familiar with the technology but also has the deep clinical foundation to interpret the 3D planning, make intraoperative judgements, and manage the full complexity of shoulder arthroplasty. Performing NSW’s first case requires both.

• First surgeon to perform Mako robotic shoulder replacement in New South Wales — Sydney Adventist Hospital, April 2026
• Fellowship-trained exclusively in shoulder and elbow surgery — not a generalist
• Advanced training in shoulder arthroplasty through subspecialty fellowships at the Alps Surgery Institute in Annecy, France (under Dr Laurent Lafosse) and Cleveland Clinic, USA (under Dr Joseph Iannotti).
• Performs both total (anatomic) and reverse shoulder replacement with conventional, PSI (patient specific instrumentation) and robotic-assisted technique
• FRACS (Orthopaedics), FAOrthA, MBBS (Hons), BAppSc (Physiotherapy) — University of Sydney
• Sydney Adventist Hospital (Wahroonga) is an SRC-listed centre with a fully equipped joint arthroplasty theatre suite
  
  

Frequently asked questions about Mako robotic shoulder replacement