Early adopter surgeon experience with Mako robotic-assisted reverse shoulder arthroplasty: perceived utility,...

As robotic-assisted reverse total shoulder arthroplasty (rTSA) enters an early adoption phase, widespread implementation will be shaped as much by real-world usability and reliability as by the yet to be realized purported clinical benefits of accurate implant positioning. This study sought to characterize early adopter experience with the Mako robotic rTSA system (Stryker, Kalamazoo, MI) among surgeons participating in the platform's limited release.

A cross-sectional survey was distributed to 15 Mako rTSA limited-release surgeons from North America and Australia, of whom 14 (93%) responded. Perceived utility was assessed with 5 agreement items on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). Workload was assessed using the National Aeronautics and Space Administration Task Load Index domain ratings (0-10) including comparative ratings with non-robotic assisted rTSA (lower/similar/higher). Respondents also reported any robotic-to-non-robotic workflow conversions and reasons.

Perceived utility was strongly favorable for positioning accuracy (median 7; interquartile range [IQR] 7-7), plan fidelity (median 7; IQR 7-7), and reduced likelihood of clinically important outlier placement (median 7; IQR 6-7). All respondents agreed (21%) or strongly agreed (79%) they expect to increase robotic assistance use over the next 12 months. National Aeronautics and Space Administration Task Load Index assessment demonstrated low mental demand (4; IQR 2.3-7), moderate physical demand (5.5; IQR 2.3-6), moderate effort (5.5; IQR 2.2-6.8) and moderate time pressure (temporal demand 5.5; IQR 2.5-7), with high self-rated performance (9.5; IQR 9-10) and minimal frustration (1; IQR 1-2). Compared with non-robotic rTSA, temporal demand was rated higher/much higher by 57% (8/14), physical demand was rated similar by 57% (8/14), and mental demand was rated lower/much lower by 43% (6/14). Temporal demand decreased with increasing robotic experience (Spearman ρ = -0.63; P = .016). Forty-three percent (6/14) experienced at least one workflow conversion, all related to registration errors or coracoid array fixation issues. When asked about current utilization, 50% (7/14) reported performing most (75-100%) of their primary rTSAs using robotic assistance.

Among a limited release cohort of early-adopter surgeons, robotic-assisted rTSA using the Mako system was perceived to improve accuracy and plan fidelity without increasing cognitive workload or frustration. Early implementation was characterized mainly by time pressure that appeared to attenuate with experience, and by rare conversions driven by registration or array fixation issues. These data suggest early real-world feasibility, while highlighting workflow efficiency and reliability as the key barriers to scalability.