Sports lovers sidelined by pain can get their swing back with a level of precision that even master surgeons can’t reach with traditional methods, thanks to a new robotic-assisted shoulder replacement technique available at the Jupiter Medical Center Anderson Family Orthopedic and Spine Center of Excellence.
In October 2025, board-certified orthopedic surgeon Dr. Brian W. Hill, who specializes in complex shoulder conditions, became one of only nine surgeons nationwide offering the Stryker Mako SmartRobotics reverse shoulder replacement.
Hill, of Palm Beach Orthopedic Institute, performs all his complex arthroplasty (joint replacement) surgeries and all robotic surgeries at the Johnny and Terry Gray Surgical Institute at JMC. From October 2025 to May 2026, he performed nearly 70 Mako reverse shoulder replacements. He has also trained two JMC shoulder surgeons, who are qualified to perform the procedure.
“Lots of patients have gotten their knees or hips done with robotic assistance, and that’s really paved the way,” Hill says. “They are seeking out robotic-assisted surgery, specifically robotic-assisted shoulder surgery.”
While the use of the Mako SmartRobotics is expanding across the country, Hill says JMC is the only hospital in Southeast Florida (and one of only four in the state) offering the procedure. JMC was also selected as one of three centers nationwide to be the first to get software upgrades this past summer before a formal rollout, and Dr. Brian Hill was the first surgeon in the world to utilize the most updated robotic arm and software to assist with the shoulder replacement surgery.
Unlike “anatomical” shoulder replacement—during which a new ball and socket are implanted in their original location—a “reverse” shoulder replacement switches the location of the implants, allowing the deltoid muscle to do the work of a damaged rotator cuff.
Hill says 70 to 80 percent of all shoulder replacements are in the form of reverse replacement nowadays. Currently, Mako is only available for reverse arthroplasty, but Stryker will soon offer it for anatomical replacements as well. “Some people don’t require the reverse, but if you have a deficient rotator cuff or bad arthritis with complex deformity, then the reverse shoulder replacement may likely be the best option,” he says.
Before patients enter the operating room, Hill strives to understand their goals and expectations—and whether they are realistic. “Is this going to give them the best chance to get back to golf, pickleball, swimming, or whatever activity they like to do?” he asks. “What is somewhat unique here in Jupiter and Palm Beach County, we have a very active, older
population that is still out doing lots of activities. Making sure that we can meet those needs is critical.”
About six years ago, computerized tomography (CT) scans replaced X-rays to create more accurate surgical plans. “But we were still taking those two-dimensional plans and trying to identify landmarks and put the implants in the correct position,” Hill says.
More recently, a study came out that showed six master surgeons from across the United States—who had completed thousands of shoulder replacements—were still slightly off in manual placement 25 percent of the time in a bone model. “When they used a robotic-assisted arm, it was [off] zero percent of the time,” Hill says, explaining that a small shift in location can affect a patient’s post-recovery range of motion. “If we have the capabilities to put the implant the exactly planned spot every single time that we plan it, we should be utilizing those tools.”
In the operating room, the surgeon uses Mako’s probe to touch different points on the shoulder. “Then the robotic arm and the software know this is exactly lined up with that preoperative CT scan, and these points are the patient’s precise anatomy,” Hill says.
What sets Mako apart, Hill says, is its haptic feedback with patented virtual boundaries that ensure just the right amount of bone is removed for the implant. “Other robotic systems are basically glorified navigation, where it will give you the route, but you can veer off. What Mako does is, even if I try to push my hand too far to the right, take away too much bone, the system will not allow you to due to the haptic feedback and virtual boundary.”
Robotic-assisted surgery cannot yet be used to revise existing shoulder implants. But Hill is happy with the outcomes Mako has provided for patients with arthritis, irreparable rotator cuff tears, and even some proximal humerus (top of the upper arm bone) fractures.
Mako’s greater precision allows for less bone removal, potentially less soft tissue trauma, and a smaller incision, which can decrease postoperative pain and offer a faster recovery. Hill has been able to trim a month off the time his patients have traditionally been required to wear a sling after surgery. He used to order it for a six-week period, but now most of the patients are out of the sling after two weeks, he reports.
The hope is that in five years, the robotic software will be able to predict which implant position will have the best rate of success based on each patient’s CT scan, age, and physical build. “That’s long-term data, but it’s exponentially growing, just like AI,” Hill says. “We’re getting better with information; we’re getting better with technology.”