- Type
- Major joint arthroplasty
- Anaesthesia
- General + regional block
- Hospital stay
- 1 night
- Sling
- 1 week
- Recovery to driving
- ~2 weeks
- Final outcome
- 9–12 months
What it is, in plain language.
A “robotic” shoulder replacement is not a robot performing surgery. It is a planned, computer-controlled guidance system that helps the surgeon position the implant exactly where the pre-operative plan says it should be. The technology is best understood as a millimetre-accurate ruler, drawn on your shoulder before the operation begins.
The procedure itself is a reverse total shoulder replacement — the worn or torn shoulder is replaced with a reversed ball-and-socket construct that allows the deltoid to lift the arm without a functioning rotator cuff. The robotic element refers to the way the socket (glenoid) side is prepared. In conventional surgery, the surgeon judges glenoid position using direct vision and a set of standard guides; with Mako, that judgment is augmented by a 3D plan derived from your CT scan and a haptic-guided burr that physically cannot remove bone outside the planned volume.
Why the Mako shoulder is a reverse-only platform.
The Mako shoulder application is currently approved and used for reverse total shoulder replacement only. Anatomic total shoulder replacement continues to be performed with conventional instrumentation.
The reverse construct is more demanding on baseplate position than an anatomic replacement; small errors in version, inclination or lateralisation translate directly into scapular notching, early loosening or limited active elevation. That is the problem the Mako platform was designed to address.
Why the glenoid matters more than the ball.
The single most technically demanding component of a reverse shoulder replacement is the glenoid baseplate (the fixation on the scapula side). The glenoid is small, often worn unevenly by years of arthritis or cuff-deficiency, and located at the back of a deep surgical field. Even a few degrees of error in glenoid version (rotation) or inclination (tilt) can shorten implant survival and worsen function.
Australian National Joint Replacement Registry data identify glenoid-side complications as a leading reason for revision of shoulder replacement.1 Accurate baseplate position is therefore a key technical goal in reverse shoulder arthroplasty. CT-based planning and haptic-guided robotic burring are used to help close the gap between intended and achieved implant position.
How the procedure is performed.
1. CT scan and 3D planning
In the weeks before surgery, you undergo a high-resolution CT scan of the shoulder. The dataset is converted into a patient-specific 3D model of your scapula and humerus. Dr Coory uses dedicated software to plan baseplate size, glenoid version, inclination, lateralisation, fixation, and the precise volume of bone to be removed — to the millimetre — before you ever reach theatre. You will be able to see this plan at your pre-operative consultation.
2. Anaesthesia and approach
The operation is performed under general anaesthesia. An interscalene regional block is placed by the anaesthetist to provide excellent pain relief for the first 12–18 hours after surgery. A deltopectoral incision — about 10 cm in length, along the front of the shoulder — is used to access the joint. This approach preserves the deltoid muscle, which is essential for elevation in a reverse construct.
3. Haptic-guided glenoid burring
The humeral head is removed and the glenoid is exposed. Your anatomy is registered to the pre-operative CT plan. A high-speed burr is then mounted on the robotic arm, and the system enforces a three-dimensional haptic boundary around the planned volume of glenoid bone. Inside that volume the burr cuts freely; the instant it reaches the planned edge, the arm pushes back and the burr cannot advance.
4. Implantation
The reverse baseplate is implanted into the prepared glenoid. The glenosphere is locked on. The humeral side is prepared, the tray and chosen liner inserted, and the construct is trialled, tensioned and reduced. Stability and tension are checked through a full range. The wound is closed in layers with a buried subcuticular suture and an external dressing.
The operation typically takes between 90 and 120 minutes.
Who is a candidate.
Most patients being considered for a reverse total shoulder replacement can be planned robotically. The technology is particularly valuable where:
- Glenoid anatomy is abnormal — significant glenoid retroversion (B2 / B3 wear pattern), posterior bone loss, or congenital dysplasia.
- Bone stock is limited — small, worn or fragile glenoids, where the margin for error is smallest.
- Revision surgery is planned — where prior surgery has altered the anatomy.
- Reverse arthroplasty is being performed — baseplate position is critical to long-term survival.
Robotic assistance is not a substitute for surgical experience. Dr Coory will discuss your individual anatomy at consultation and confirm whether robotic planning will materially improve your specific case.
Where it is performed.
Mako robotic-assisted reverse total shoulder replacement is performed at Buderim Private Hospital, Sunshine Coast University Private Hospital, and the new Maroochy Private Hospital in Maroochydore. Typical inpatient stay is one night. All three hospitals are fully equipped for shoulder arthroplasty including the relevant imaging, the Mako platform, and inpatient physiotherapy. The operating hospital is chosen at the consultation based on the operation, the patient, and what is most convenient.
Recovery timeline.
Dr Coory uses an accelerated post-operative protocol for Mako robotic-assisted reverse shoulder arthroplasty — one night in hospital and one week in a sling, with early active-assisted motion under the supervision of your treating physiotherapist.
Day 0–1 (in hospital)
- Regional block lasting 12–18 hours.
- Pendulum exercises and passive range of motion under the inpatient physiotherapist.
- Sling fitted; discharge home usually the next morning.
Week 1 (sling phase)
- Sling worn for one week post-operatively.
- Pendulum and passive range of motion daily.
- No driving, no lifting.
Weeks 1–6
- Sling discontinued at the end of the first week.
- Active-assisted range of motion under your treating physiotherapist.
- Active range progressing from weeks 2–4.
- Driving resumed at approximately 2 weeks once off opioid analgesia.
- Light desk work from week 1–2 if comfortable.
Weeks 6–12
- Strengthening commences under physiotherapist supervision.
- Return to most light daily activities.
- Light manual work resumed in this window.
Month 3–6
- Return to most manual work and recreational activity.
Month 6–12
- Return to overhead sport and heavier lifting (selectively).
- Final outcome usually reached at 12 months.
Risks and complications.
Shoulder replacement is a safe and reproducible operation, but it is major surgery and carries a defined risk profile. Dr Coory will discuss the relevant risks for your specific case at consultation. The most important to be aware of are:
- Infection — uncommon (approximately 1%) but serious. Modern antibiotic regimens and theatre protocols minimise this risk.
- Dislocation — uncommon, particularly with attention to soft-tissue balance.
- Nerve injury — the axillary nerve is the most relevant; injury is rare and usually transient.
- Periprosthetic fracture — uncommon, more likely in osteoporotic bone.
- Component loosening or wear — long-term considerations addressed by accurate component position and good bone quality.
- Stiffness — partially under the surgeon's control, partially the patient's responsibility through rehabilitation.
- Anaesthetic and medical complications — assessed and minimised through the pre-admission process.
What the evidence says.
The published evidence suggests that computer assistance is associated with more accurate and reproducible glenoid position.23 We are hopeful this will reduce outliers. Long-term outcome studies are still maturing, as is true of any newer technology. The Australian National Joint Replacement Registry continues to track shoulder arthroplasty outcomes prospectively, and Dr Coory submits every shoulder replacement he performs to that registry.
Dr Coory presented on this topic at the Stryker Shoulder Masters Sydney 2026 faculty meeting.
Rehab protocol
A written, procedure-specific rehabilitation protocol is provided to your physiotherapist on the day of surgery. View the recovery roadmap for the full five-phase journey, or visit For Physiotherapists to request protocols directly.
Frequently asked questions.
What does “robotic” mean in a shoulder replacement?
The Mako shoulder platform uses CT-based 3D planning and a haptic-guided robotic arm. A high-speed burr is mounted on the arm, and the robot enforces a 3D haptic boundary around the planned volume of glenoid bone. The surgeon does the cutting; the haptic constraint is designed to keep bone removal within the planned volume. This is different from earlier robotic systems that constrained a central guide pin.
Is the Mako used for anatomic shoulder replacement?
No. The Mako shoulder application is currently approved and used for reverse total shoulder replacement only. Anatomic total shoulder replacement continues to be performed with conventional instrumentation, which has decades of refinement behind it.
How does robotic reverse shoulder replacement compare with conventional?
The accuracy of glenoid baseplate position with CT-based planning and haptic-guided burring is more reproducible than with conventional instrumentation in published studies. Whether that translates into longer-term differences in implant survivorship is the subject of ongoing research. The technology is most useful in shoulders with deformed or worn glenoid anatomy.
Am I a candidate for Mako robotic reverse shoulder replacement?
Most patients being considered for reverse total shoulder replacement — for cuff tear arthropathy, irreparable rotator cuff disease, complex proximal humerus fracture, or osteoarthritis with cuff deficiency — can be planned robotically. Candidacy depends on bone stock, glenoid wear pattern, soft-tissue quality and overall health. Dr Coory will assess your suitability at the consultation.
How long does a reverse shoulder replacement last?
Australian registry data show implant survivorship of greater than 95% at 10 years for reverse total shoulder replacement. Modern implants in well-positioned glenoid baseplates are expected to last considerably longer than that.
Is robotic shoulder replacement covered by Medicare or private health?
Reverse total shoulder replacement is covered under MBS item numbers and most private health funds at appropriate hospital cover tiers. The robotic-assistance component is performed under the same Medicare item; there is no separate out-of-pocket charge for the robotic technology beyond the standard prosthesis costs. Dr Coory's reception team will provide a written estimate before surgery.
Where is the surgery performed?
Mako robotic-assisted reverse shoulder arthroplasty is performed at Buderim Private Hospital, Sunshine Coast University Private Hospital, and the new Maroochy Private Hospital in Maroochydore. Length of stay is typically one night, with an accelerated protocol that has the sling off at one week and active-assisted physiotherapy beginning immediately.
References.
- Australian Orthopaedic Association National Joint Replacement Registry. Shoulder Arthroplasty Annual Report. Adelaide: AOA; 2024. Available from: aoanjrr.sahmri.com.
- Verborgt O, et al. Computer-assisted and patient-specific guidance in shoulder arthroplasty: a systematic review of accuracy. J Shoulder Elbow Surg. 2020;29(7):1481–1492.
- Puzzitiello RN, et al. Robotic-assisted versus conventional total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2025. PubMed 39863156.