April 24, 2026
5 min read
Key takeaways:
- Robotics and AI learning modules are increasingly being utilized in orthopedics.
- Surgeons must adapt to utilizing these new technologies to improve their decision-making processes.
With the recent growth in utilization of robotic tools and AI learning modules in orthopedic practices around the country, surgeons must now adapt to a new status quo in the OR.
According to Joseph P. Iannotti, MD, PhD, professor of orthopedic surgery at Cleveland Clinic Lerner College of Medicine, utilization of these technologies will only increase in the future, with more emphasis on computer vision and shared decision-making.
“At some point, an AI module will say, ‘I have analyzed 10,000 of these procedures already. I suggest that this is the right next step for this patient,’” Iannotti told Healio. “It is similar to the situation when a resident or trainee asks an attending surgeon why did you do that, and an experienced surgeon says, ‘I just know, and because I have done this so many times, I know the next step.’ That is where shared decision-making is going to evolve, and it will be in the next 5 years.”
Healio spoke with Iannotti about the role of robotics in the future of orthopedics, and how physicians can use these new technologies in their shared decision-making processes.
Healio: What role will robotics play in the future of orthopedics?
Iannotti: In the next 10 years, robotics will increase in utilization, particularly if surgical speed and workflows become more efficient and the cost of goods become substantially less. The accuracy is good, that is not a problem. The biggest barriers to broad adoption are cost and speed.
The speed, in part, is related to surgical navigation, which is slow right now compared with what it could be in the next several years. By and large, most commercialized systems use infrared cameras. These track markers that are put into the bone, so the tracker software knows where the bone is relative to the marker in 3D space. A big factor limiting wide adoption is the speed by which surgeons can put the pins in the bone for the trackers, then do the surface mapping to collect all that digital data. When a routine primary knee replacement takes 20 minutes to put in the implant by an experienced surgeon and you then add another 5 or 10 minutes to that procedure, the technology becomes a real number that limits utilization.
The current robots are also big and expensive. These are in the OR for the entirety of the surgery yet used for a fraction of the time. When robots become much smaller, the cost of goods becomes a fraction of the current cost and surgical navigation takes seconds and not minutes for each of the steps. Then you can imagine greater potential for this technology to become more widely used, particularly as primary joint replacement moves from the hospital setting to the ambulatory surgery center.
The second major advance — probably in the next 5 years — is the shift from infrared cameras that require digitizing the surfaces of a bone using a probe to using computer vision where stereoscopic cameras create digital information in seconds without pins or trackers. Then the technology will be more widely used.
Moreover, the digital data from computer vision can be analyzed to create AI learning modules, where the data collected at the time of surgery from thousands of other surgical cases can inform a surgeon on the best options for a current surgery on an individual patient. The future of AI mentors will not necessarily tell the surgeon what they have to do, but it will give information for them to make an informed decision. There are a tremendous number of advancements that will occur in the next 5 or 10 years when you go from current surgical navigation to in-OR computer vision.
Healio: What will eventually bring down the cost of these new technologies?
Iannotti: Some of it occurs because of new technology and economies of scale associated with broader utilization. That happens in every industry. That said, these will not be the only driving factors. I predict there will be different navigation and robotic technology that will lower the cost for certain procedures that do not require a more expensive solution. Typically, one technology may be better suited for some patients, and another robotic technology will be better suited for other patients. This is typically determined after extensive use in real-life clinical situations. It is simple: lower cost tools that are effective for the purpose needed that will drive change.
Healio: How important is it for surgeons to work alongside these new technologies to improve patient care?
Iannotti: In the next 10 years in orthopedics, there will be more shared responsibility between the surgeon, the surgical team and the technology they use for execution of surgery. Today, it is common practice for surgeons to determine with the patient what their best treatment options are. During the surgery, the surgeon is not interfacing with an AI module suggesting what might be the best surgical next step for a particular patient. It is likely that AI mentors in the future will serve this function in the OR. For those AI mentors to be developed, surgeons must interface with those developing the technology to create useful technology.
If you look at the future of AI modules in the OR derived from computer vision, there is going to be more use of the digital data with members of the OR team other than the surgeons. Using AI modules to interface with the OR personnel supporting the surgical procedure will improve OR efficiency and improve patient safety.
At the beginning, surgeons and other caregivers are going to be skeptical because they have never used computers in this way. But, with time, effective utilization of this technology after showing better outcome and greater efficiency will win out. As the AI modules get better and confidence improves, there will be more shared decision-making and then shared execution. There is no reason to assume that robots cannot do some things that humans do now. It has happened in almost every industry, and health care is no exception.
Healio: What are the larger implications for the development of robotics in the field of orthopedics?
Iannotti: We do not know for certain that new technology of computer vision and robotics will improve clinical outcomes. We expect that it will improve decision-making, consistency and the precision of the surgery. All of these areas of outcomes need to be evaluated to define when and if these improvements are realized.
Robotics have not yet been proven to improve patient-reported clinical outcomes after rehabilitation because we are measuring clinical patient-reported outcomes imprecisely — we are asking the wrong questions and measuring the wrong clinical outcomes when it relates to navigation and robotic-assisted surgery.
Many factors influence patient-reported outcomes other than the surgical procedure or the technology used. It is not only the precision of the surgery or the speed of the surgery or the accuracy of which implant is placed that determines patient-reported outcomes. Patient variables, such as comorbidities, pain tolerance and mental health have great impact as well. Many of these patient variables will not be influenced by use of a robot to assist in performing the surgery. To judge the value of this technology, you need to correlate the precision of the surgery with the anatomic outcome as it relates to patient-reported outcomes. These studies have not been done at scale but are likely to be done in the future to justify the cost of this new technology.
For more information:
Joseph P. Iannotti, MD, PhD, wishes to be contacted through newsroom@ccf.org.
Sources/Disclosures
Source:
Healio Interviews
Disclosures:
Iannotti reports receiving royalties from DePuy Synthes and Enovis Surgical Viscus Biologics and VisionAir.; and consulting equity from Bone Solutions, CollaMedics and Redefine Surgery.
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