What is Mako robotic shoulder replacement?

The problem the robot solves.

In a reverse total shoulder replacement, the glenoid baseplate must be positioned accurately in three dimensions — version, inclination and lateral offset — to optimise implant function and longevity. The glenoid is a small, curved piece of bone at the edge of the shoulder blade. In patients with cuff tear arthropathy or advanced osteoarthritis, this bone is often worn, eroded or deformed.

With conventional instrumentation, the surgeon uses guide pins, jigs and freehand technique to prepare the glenoid. This is effective and has decades of clinical track record. However, published studies show that conventional techniques produce measurable variability in baseplate positioning, particularly in glenoids with significant wear or deformity. The Mako system was designed to reduce that variability.

How the Mako system works.

Step 1: CT-based planning.

In the weeks before surgery, a high-resolution CT scan of your shoulder is performed. The scan is processed by the Mako planning software, which builds a patient-specific three-dimensional model of your shoulder blade, glenoid, humerus and remaining bone stock. Dr Coory uses this model to plan the exact size, position, version, inclination and lateral offset of the glenoid baseplate before you arrive at the hospital.

This pre-operative planning step is itself valuable, independent of the robot. The surgeon sees the anatomy in three dimensions, identifies bone defects or erosion patterns, and can simulate different implant positions to find the optimal configuration. The plan is finalised before the operation begins.

Step 2: intra-operative registration.

In the operating theatre, after the surgical approach is made and the glenoid is exposed, the patient's real anatomy is registered to the pre-operative CT model. Small reference points on the bone are matched to the 3D plan. Once registration is confirmed, the system knows exactly where the patient's anatomy is in space relative to the planned baseplate position.

Step 3: haptic-guided burring.

A high-speed burr is mounted on the robotic arm. The Mako system enforces a three-dimensional haptic boundary around the planned volume of glenoid bone to be removed. Haptic means the surgeon feels physical resistance from the robotic arm — like a virtual fence — when the burr reaches the edge of the planned cutting zone. The surgeon guides the burr within the boundary; the robot prevents the burr from cutting beyond it.

This is fundamentally different from earlier robotic systems that constrained a central guide pin. The Mako system constrains the entire cutting volume in three dimensions, without requiring a central pin at all.

Step 4: implantation.

Once the glenoid is prepared, the baseplate is implanted into the precisely prepared bone bed. The glenosphere, humeral tray and liner are assembled, trialled for stability and tension, and the joint is reduced. From this point onward, the operation proceeds as a conventional reverse shoulder replacement — wound closure, nerve block, sling and the beginning of recovery.

Which patients is it used for?

The Mako shoulder application is currently approved for reverse total shoulder replacement only. It is not used for anatomic (standard) shoulder replacement. The glenoid preparation in reverse and anatomic replacements differs fundamentally, and the Mako platform was engineered for the reverse baseplate.

Most patients being considered for reverse shoulder replacement are potential candidates for the robotic-assisted approach. The common indications include:

• Cuff tear arthropathy — arthritis resulting from a longstanding irreparable rotator cuff tear.
• Irreparable rotator cuff tear with glenohumeral arthritis.
• Glenohumeral osteoarthritis with concurrent cuff deficiency.
• Complex proximal humerus fracture where replacement is indicated.

The technology is most valuable where the glenoid anatomy is deformed or worn — precisely the cases where conventional instruments are most challenged. In a straightforward glenoid with normal anatomy, the benefit over conventional technique is smaller. Dr Coory will discuss whether the robotic approach is indicated for your specific shoulder at the consultation.

What the robot does not do.

The Mako is not an autonomous robot. It does not make decisions. It does not cut bone independently. It does not replace the surgeon. The surgeon performs the operation from start to finish — the approach, the soft tissue work, the humeral preparation, the implant assembly, the stability assessment and the closure. The robot constrains the burr during one specific step: the glenoid preparation.

The value of the technology is in its precision for that step, and in the CT-based planning that precedes it. The value of the surgeon is in everything else — the decision to operate, the choice of implant, the soft tissue balancing, the management of complications, and the years of training that inform every intra-operative judgement.

Dr Coory's experience with Mako shoulder.

Dr Coory was the first surgeon on the Sunshine Coast — and the second in Australia — to perform Mako robotic-assisted total shoulder replacement, beginning in August 2025. The procedure is performed at Buderim Private Hospital, Sunshine Coast University Private Hospital in Birtinya, and the new Maroochy Private Hospital in Maroochydore.

As a fellowship-trained shoulder arthroplasty surgeon (Bateman Orthopaedics Advanced Arthroplasty and Trauma Fellowship) and research partner of the University of the Sunshine Coast, Dr Coory has the training and case volume to use the technology critically — applying it where it adds value and advising against it where it does not.

Cost and insurance.

At Dr Coory's practice, Mako robotic-assisted reverse shoulder replacement carries no additional out-of-pocket charge for the robotic technology. It is performed under the same Medicare item number (48918) as conventional reverse total shoulder replacement. The prosthesis is a standard Prostheses List item. For a detailed breakdown, see shoulder replacement cost in Australia or visit the fees page.

Recovery after Mako robotic shoulder replacement.

The recovery protocol after robotic-assisted reverse shoulder replacement is the same as for conventional reverse replacement — and in Dr Coory's practice, it is accelerated compared with traditional timelines:

• Sling: one week (not the traditional four to six weeks).
• Active-assisted range of motion: from week one.
• Driving: approximately two weeks, once off opioid analgesia.
• Light daily activities: four to six weeks.
• Strengthening: from approximately six weeks.
• Final outcome: nine to twelve months.

Implant survivorship for reverse total shoulder replacement exceeds 95% at ten years in the Australian Orthopaedic Association National Joint Replacement Registry.

Frequently asked questions.

What does the Mako robot actually do during shoulder replacement?

The Mako system uses a CT-based 3D plan and a haptic-guided robotic arm. The surgeon mounts a high-speed burr on the arm, and the robot enforces a virtual boundary around the planned cutting zone. The surgeon does the cutting; the robot prevents the burr from exceeding the planned edge.

Is Mako shoulder replacement better than conventional?

Published studies show more accurate baseplate positioning with CT planning and haptic guidance. Whether this translates into longer-term implant survivorship differences is the subject of ongoing research. The technology is most valuable in shoulders with worn or deformed glenoid anatomy.

Which patients are suitable for Mako robotic shoulder replacement?

Most patients being considered for reverse total shoulder replacement can be planned robotically. Common indications include cuff tear arthropathy, irreparable rotator cuff tear with arthritis, osteoarthritis with cuff deficiency, and complex proximal humerus fracture.

Is Mako used for anatomic (standard) shoulder replacement?

No. The Mako shoulder application is currently approved for reverse total shoulder replacement only. Anatomic total shoulder replacement continues to be performed with conventional instrumentation.

Does Mako robotic shoulder replacement cost more?

At Dr Coory's practice, there is no additional out-of-pocket charge for the robotic technology. It is performed under the same Medicare item number as conventional reverse shoulder replacement. See the fees page for details.

Where is Mako robotic shoulder replacement available on the Sunshine Coast?

Dr Coory performs the procedure at Buderim Private Hospital, Sunshine Coast University Private Hospital (Birtinya), and the new Maroochy Private Hospital (Maroochydore). He was the first surgeon on the Sunshine Coast to perform it, beginning in August 2025.