Robotics in Orthopaedics: Exploring Future Possibilities for South Africa

This editorial examines the feasibility and ethical implications of integrating robotic-assisted orthopaedic surgery into South Africa's healthcare system. While such technologies are well-established in high-income settings, enhancing surgical precision, reproducibility and postoperative outcomes, their widespread adoption in resource-limited contexts poses considerable logistical, financial and ethical challenges. The South African health landscape, marked by stark disparities between public and private sectors, provides a unique setting in which to assess whether such innovations should be prioritised over more pressing service delivery needs. The article traces the evolution of surgical robotics and evaluates their role in joint arthroplasty and spinal instrumentation, noting that benefits often rely on specialised training, robust IT infrastructure and high patient volumes, conditions not uniformly met across public hospitals. The editorial proposes a phased, context-sensitive strategy: concentrate robotic capabilities in high-volume public centres, invest in simulation-based training and strengthen digital infrastructure through open standards and data governance frameworks. Training is identified as a critical bottleneck in expanding access to robotic surgery. The piece advocates for national investment in simulation-based training using virtual and augmented reality (AR) platforms to expand skill development in a cost-effective and scalable way. These efforts could reduce dependency on international fellowships and enable the creation of a locally trained workforce. Additionally, successful adoption requires major upgrades in hospital IT systems, interoperability standards and data governance, without which robotic systems risk becoming underutilised and disconnected from broader clinical processes. Ethical principles, such as justice, beneficence, non-maleficence and autonomy, anchor the discussion, guiding recommendations to ensure innovation supports rather than undermining equitable care. The editorial underscores the importance of aligning new technologies with principles of fairness, transparency and sustainability. It cautions against pursuing innovation for its own sake and argues for a balanced approach that ensures technological advancements do not exacerbate existing inequities in care. Alternatives such as image-guided navigation, AR and artificial intelligence-supported planning are explored as more scalable options for resource-constrained settings. A phased and context-sensitive model, emphasising modular technologies, planning tools and digital navigation systems, is recommended as a more viable entry point for surgical digitisation in South Africa. Ultimately, the editorial advocates for a balanced approach, where surgical innovation is aligned with national priorities and serves the broader public good. While robotic orthopaedic surgery remains aspirational for much of South Africa's healthcare system, its potential is not out of reach. With strategic planning, investment in human capital and attention to ethical imperatives, robotics can form part of a broader vision for advancing surgical care-one that integrates innovation with access, and precision with public value.