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March 18, 2026/Orthopaedics/Upper Extremity

Robot-Assisted Shoulder Arthroplasty: A Photo Essay

Increasing precision to conserve bone and protect soft tissue

Surgeon at a computer planning robot-assisted surgery

The incidence of shoulder arthroplasty in the U.S. has increased exponentially over the last two decades. By 2030 the number of primary procedures is expected to approach 370,000 annually.

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Supporting this growth has been the advent of reverse shoulder replacement as an alternative to anatomic replacement, and the expansion of implant options and navigation systems. The tools available for shoulder arthroplasty now include robotic systems, similar to those prevalent in hip and knee arthroplasty.

“Robotic surgery is uniquely suited for shoulder replacement because of the scarcity of bone and the importance of soft tissue relative to hip or knee arthroplasty,” says Vahid Entezari, MD, MMSc, a shoulder and elbow surgeon at Cleveland Clinic. “Millimeters matter in shoulder surgery, so the precision offered by robotic systems is especially valuable. In addition, the shoulder is the most unstable joint in the body. It relies greatly on muscles like the rotator cuff and other soft tissues for stabilization. Robot assistance can help minimize disruption to those soft tissues.”

In 2025 Cleveland Clinic began offering robot-assisted shoulder arthroplasty. This photo essay illustrates details of our first procedure.

A surgeon talks to a patient in a hospital bed — Dr. Entezari meets with the patient prior to surgery. The primary reason patients pursue shoulder replacement is arthritic pain combined with a progressive loss of function. The pain and dysfunction can impact every aspect of daily life: driving, personal care, work responsibilities, sleep. For many, it threatens their independence and ability to participate in the activities that define their quality of life.

Computer screen showing planning for a robot-assisted surgery — Preoperative planning uses the patient’s CT scan to determine optimal implant size and component positioning. The robotic platform helps execute the plan with millimeter accuracy and single-degree precision. Emerging evidence and clinical experience suggest that implant positioning and restoration of native anatomy are closely associated with postoperative range of motion, function and implant longevity.

Surgeon's hand holding the robotic arm — The array attached to the robotic arm contains reflective markers that interface with an optical camera system, allowing real-time tracking of the robotic arm throughout the procedure. At the beginning of the case, Dr. Entezari moves the robotic arm through a guided path to help calibrate it.

Three surgeons performing shoulder surgery — Dr. Entezari (center) registers key bony landmarks using a handheld probe and optical tracking camera. This registration aligns the virtual plan with the patient’s actual anatomy, enabling the robotic arm to execute bone preparation precisely.

Surgical tech preparing instruments in an operating room — A surgical technologist prepares instruments that will connect to the robotic arm. These cutting tools will prepare the glenoid to receive a reverse shoulder arthroplasty baseplate. Currently robotic platforms are available only for reverse shoulder arthroplasty, although applications for anatomic shoulder arthroplasty are being developed.

A surgeon performs shoulder surgery in an operating room — The robot is positioned near the patient so it can reach the surgical field. Dr. Entezari uses a high-speed bur mounted on the robotic arm to prepare the glenoid. Although Dr. Entezari’s hand moves the bur, the robot uses haptic feedback to warn if he strays from the surgical plan, helping conserve bone and protect soft tissue.

Drill removing a portion of the shoulder joint during surgery — The high-speed bur (attached to the robotic arm) removes a portion of the glenoid. Tracking arrays sense the movement of the robotic arm relative to the scapula and help maintain highly precise bone preparation.

Three surgeons performing shoulder surgery in an operating room — Fellow Brett Haislup, MD, (left) and resident Lauren Grobaty, MD, (right) assist Dr. Entezari (center) in inserting the implant and reducing the prosthetic shoulder joint. While robot-assisted shoulder arthroplasty is still in its infancy, longer term data from robot-assisted hip and knee arthroplasty indicate that increased surgical precision results in fewer outliers, shorter hospital stays and less postoperative pain.

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