Smart technology in surgery includes a suite of technologies all aiming at improving the patient’s care journey and the surgeon’s procedural efficiency and success. It encompasses artificial intelligence (AI), robotics, augmented reality (AR), 3D printing, implants with embedded sensors, and much more to improve precision and outcomes.

AI analyzes large datasets to help with diagnosis, plan procedures, and offer real-time decision support. It can predict patient risks like complications or adverse events, as well as optimize surgical instrument movements. Robotic systems boost a surgeon’s precision and control to enable complex procedures with a minimally invasive approach.

AR overlays crucial information like medical scans or anatomical structure onto the real world through devices like headsets so surgeons can visualize and locate specific areas with accuracy during a procedures. 3D printing is used to create patient-specific surgical models, guides, and custom implants matched to an individual’s anatomy.

Smart surgical instruments are also part of the team. The advanced tools are equipped with sensors and microchips to provide real-time data and feedback to the surgeon—examples include smart scalpels that can detect tissue types and help prevent damage to healthy tissue.

Telemedicine allows for remote consultations and even remote surgery, which can help bridge geographical gaps in access to specialized surgical expertise. Digital twins create a virtual replica of the patient so surgeons can simulate and plan a procedure beforehand, including testing different techniques, predicting outcomes, and spotting possible complications before the surgery takes place. 

Many of these tools are used to enhance orthopedic surgery already, but challenges still remain.

“Orthopedic surgery continues to face persistent unmet needs—ranging from patient dissatisfaction in knee procedures and infection risk, to variability in surgeon experience, surgeon fatigue, and workflow complexity,” said Janardhan (JR) Ramachandran, president of Global Robotics and Enabling Technologies at DePuy Synthes. “These issues drive variability in both care and cost across the system. The next wave of ‘smart’ technology must be purpose-built to address these pain points and support more consistent, efficient, and patient-centered care.”

Several smart technologies are gaining traction in the operating room. Robotic-assisted systems are intended to assist with precision, and artificial intelligence (AI)-enabled planning tools help with procedure planning based on patient anatomy. Navigation platforms also provide real-time feedback to support intraoperative decision making.

“Smart technologies—encompassing augmented reality (AR), artificial intelligence (AI), patient-specific smart instrumentation, and connected data ecosystems—are shifting the focus from hardware to software-driven precision,” said David Conley, VP of product management and marketing at Medacta USA. “The industry is seeing a clear move toward image navigation, reduced footprint solutions, and cost-per-case efficiency compared to legacy robotic systems.”

Today, use of surgical guidance and robotics in orthopedic procedures is growing enormously because of the recognition of their capabilities and benefits. Patients across the world are also living longer, staying active, and looking for orthopedic procedures at a younger age. Hospital facilities expect more clinical value from their enabling technologies to drive surgeon and staff satisfaction, as well as a single footprint to drive more ROI and facility efficiencies.

“Instead of bulky platforms requiring extensive capital investment and space for utilization, the trend is toward scalable, software-based technologies that provide actionable insights to the surgeon without disrupting workflow,” said Conley. “Integration of intraoperative feedback, cloud-based planning, and machine learning algorithms is enabling more personalized, reproducible procedures while lowering the barrier to adoption in hospitals and outpatient surgery centers.”

All of these smart technologies coalesce into one goal: to match the shift toward personalized orthopedics where the principles of precision medicine are brought into joint surgery.

“This means integrating multisource data across the patient journey, using advanced 3D tools to classify patients and guide decisions, and moving beyond alignment to consider soft tissue balance,” said Laurent Angibaud, senior VP of Advanced Surgical Technologies for Advita Ortho (which acquired assets from Exactech). “Personalization now extends into the perioperative stage as well, with prehabilitation, rehabilitation, and even nutrition playing a role. The exponential growth in data makes AI essential, serving as a surgical assistant that helps aggregate and interpret information for truly patient-specific planning. By keeping the patient at the center of every decision, this digital transformation has the potential to enhance compassionate care and strengthen collaboration across the entire care ecosystem.”

For example, Stryker’s Mako SmartRobotics is a robotic-arm-assisted system that helps orthopedic surgeons perform joint replacements and other surgeries with more precision. The system leverages a 3D CT-based model of the patient’s anatomy to create a personalized surgical plan, which is used by the surgeon to guide the robotic arm during the procedure.

“Across the established Mako applications we have seen multiple studies demonstrating improved patient outcomes,”^1-3 said Keith Evans, VP & GM of Mako Enabling Technologies at Stryker. “Additionally, studies have shown meaningful benefits for the surgeon such as reduced mental and physical demand⁴ and potential reduction in harmful intraoperative radiation.⁵ We believe all of this is why they continue to ask for more applications and indications for orthopaedic robotic assistance and guidance.”

Mako’s 3D CT-based planning lets surgeons see more of their patients’ unique anatomy, create a personalized surgical plan and identify desired implant size, orientation, and alignment before surgery. Surgeons can modify their plans intraoperatively, and Mako’s AccuStop haptic technology helps execute their plans for total hip, total knee, and partial knee replacement patients.

Stryker introduced its fourth-generation Mako system at this year’s American Academy of Orthopaedic Surgeons (AAOS) annual meeting. Mako Spine and Mako Shoulder were the latest to join the SmartRobotics suite of applications.

“Mako 4 is our fourth-generation Mako system that delivers more—more capabilities and more applications—and is designed to offer a premium clinical and operational experience when compared to manual surgery across Mako Total Hip, Total Knee, Partial Knee, and Spine,” said Lauren Venekas, VP global marketing, Mako Global and EU Sales Strategy, Mako Enabling Technologies, Stryker. “Mako 4 also integrates Stryker’s fourth-generation Q Guidance System, which is built on over 20 years of experience developing guidance technologies.”

The company’s Q Guidance System launched for spine applications in 2022. It combines new optical tracking options via a redesigned camera with sophisticated Spine Guidance Software algorithms for expanded surgical planning and navigation capability. The Q Guidance System and software together offer a planning and intraoperative guidance system for open or percutaneous computer-assisted surgery.

“The Q Guidance System features full-spectrum active and passive hybrid optical tracking via a redesigned, state-of-the-art camera. Its sophisticated processing algorithms aim to enable enhanced surgical planning, navigation, and robotic capabilities,” said Evans.

In 2023, the technology earned FDA clearance for cranial applications. The new cranial application is indicated for any medical condition where use of computer-assisted planning and surgery is appropriate and can be used for intraoperative where a reference to a rigid anatomical structure can be identified. It tracks navigated instruments and shows position and orientation of instruments in patient images.

DePuy Synthes’ VELYS Enabling Tech Solutions is a portfolio of purpose-built technologies that aim to elevate the surgical moment in the OR to support more precise, patient-specific implants. The portfolio of solutions reveals real-time actionable data, generates insights, and automates tasks to allow reproducible results. Through the VELYS community, the knowledge of one surgeon is shared among the learnings of many, creating a collective intelligence.

“Our VELYS Enabling Tech Solutions portfolio brings together technologies designed to support precision, efficiency, and personalization in orthopedic procedures,” said Ramachandran. “Together, these products are designed to work in concert—supporting decision-making and workflow consistency while keeping the surgeon in control.”

These include the VELYS Robotic-Assisted Solution (knee), which is intended to assist surgeons in planning and executing total knee arthroplasty without needing a CT scan to support integration into existing workflows. VELYS Hip Navigation is non-invasive, integrated software for preoperative planning and intraoperative execution and provides real-time templating and intraoperative data to help with component positioning in total hip replacement.

VELYS Active Robotic Assistance (spine) is a next-gen, dual-use robotics and navigation platform for planning and instrumentation of spinal fusion procedures in the cervical, thoracolumbar, and sacroiliac spine. It integrates advanced navigation and robotic assistance to support patient-specific operative decision-making and accommodate surgeon preference.

In July of this year, DePuy Synthes released its VIRTUGUIDE system, an AI-powered, patient-matched solution to support Lapidus procedures. A Lapidus procedure is a type of bunion surgery that helps realign the foot by joining two bones near the arch. VIRTUGUIDE uses pre-operative planning software developed in collaboration with PeekMed to assess each patient’s bunion and make personalized recommendations for the intended correction. It analyzes patient imaging to create a customized surgical plan, paired with 3D-printed, patient-matched guides. 

The system enables a streamlined approach and reduces surgical complexity, the company said. Early users estimated procedural time savings of at least 30 minutes when using the system compared to their previous technique, DePuy Synthes also said.

“Surgeons tell us they don’t want isolated tools—they want connected platforms that link pre-op planning, real-time guidance in the OR, and post-op insights to help track results and improve consistency,” said Ramachandran.

Medacta’s NextAR augmented surgical application is an augmented reality (AR)-based navigation platform that overlays real-time surgical data into the surgeon’s visual field through a lightweight headset. It leverages preoperative 3D planning models and a small intraoperative tracking system that doesn’t need external line-of-sight visibility.

This allows for standard OR instruments to be converted into smart instruments. According to the company, NextAR guides implant placement with accuracy without needing large robotic consoles or mandated surgical workflow instruments. The system relies on smart glasses and compact technical instruments, creating a minimal footprint in the operating room.

“For patients, this translates to greater precision in alignment and implant positioning, which has been linked to improved function, faster recovery, and potentially longer implant longevity,” said Conley. “For surgeons, the benefits include increased control, reduced setup time, and freedom of movement, as well as the ability to adapt intraoperatively based on live feedback—all while keeping costs predictable for hospitals.”

The company’s MySolutions Personalized Ecosystem is a cloud-based digital planning and personalization suite that moves beyond a single procedure. It combines patient imaging, 3D anatomical modeling, implant templating, and surgical planning tools into one platform. Using the ecosystem, surgeons can create a personalized surgical plan tailored to patient anatomy and biomechanics.

For surgeons, it offers an efficient, data-rich workflow with integration into multiple applications —knee, hip, shoulder, spine—to ensure consistency across specialties. For patients, it allows a personalized surgical approach that can improve functional outcomes, reduce complications, and support enhanced recovery protocols.

The company pointed to AI-driven predictive analytics to guide implant choice, alignment strategy, and risk management tailored to individual patients. It also predicted integration of wearable and sensor data to monitor recovery in real time and feed outcomes into planning algorithms. Expanded AR and mixed reality platforms that merge preoperative imaging with intraoperative anatomy in a digital environment and cloud-connected ecosystems also figured heavily into the future of smart orthopedic technologies.

“Looking ahead, the trajectory of orthopedic innovation is toward greater intelligence, connectivity, and personalization. Ultimately, the goal of these technologies is not only greater surgical accuracy but also a more patient-centric, efficient, and cost-sustainable model of orthopedic care,” said Conley.

Advita Ortho’s GPS system was touted as the first advanced surgical technology to offer a real-time, patient-specific solution in total knee arthroplasty. It has a touch screen in the sterile field to put real-time visual guidance and alignment data at the surgeon’s fingertips.

According to the company, GPS is the world’s first navigation technology available for knee, shoulder, and ankle procedures, with hip currently in development. It lets surgeons virtually simulate surgery for more informed surgical planning and in some markets, integrates unique machine learning algorithms so surgeons have a new level of personalized planning and guidance based on prediction of clinical outcomes.

“The GPS system is built to make surgery smarter and simpler,” said Angibaud. “Leveraging active tracker technology, GPS provides accuracy and precision that improves clinical outcomes, yet it remains time neutral in the OR after a short learning curve. The system is intuitive, compact, and requires no capital investment, removing major costs for hospitals and surgery centers.”

Advita Ortho’s GPS system is part of its Active Intelligence ecosystem, which was released in 2021. GPS is a dynamic ecosystem of enabling technologies and smart solutions to support surgeons both in and out of the operating room. Its planning software, prediction tools, surgical technologies, and engagement opportunities aim to provide data-rich, low-cost solutions to improve outcomes.

“The Active Intelligence ecosystem is designed to add value throughout the care pathway by making orthopedics more personalized, connected and efficient,” said Angibaud. “The goal is to improve clinical outcomes by enabling personalized surgical functionality, while also supporting surgeons with advanced decision support tools that embed clinical insights directly into their workflows. This not only enhances surgeon expertise but also moves us toward a future where patient-specific implant kits become possible. At its core, Active Intelligence is about empowering the care team while keeping the patient at the center of everything we do.”

To gain more insights on smart orthopedic technologies and their manufacture, ODT spoke to Brad Womble, senior director of strategy at Cirtec Medical, a company that designs, develops, and manufactures complex Class II and III medical devices, specializing in active implant systems, interventional devices, and precision components.

What trends are you noticing in “smart” technologies for orthopedic surgery?
There’s a clear shift toward sensor-rich, data-driven orthopedic implants and surgical tools. From Zimmer’s Persona IQ (PIQ) to emerging sensor-enhanced trauma hardware, the industry is rapidly moving toward systems that provide real-time, in vivo data on alignment, load, motion, and early signs of implant wear or infection. This reflects increasing demand from surgeons and health systems to monitor recovery remotely, improve outcomes, and justify value-based care.

We’re also seeing growing interest in embedded diagnostics, wireless telemetry, and adaptive algorithms, especially for spine and joint reconstruction. These trends signal a move beyond traditional mechanics into intelligent, connected systems.

What manufacturing support do you provide for orthopedic OEMs looking to build “smart” orthopedic devices?
We provide full-system integration, bringing together precision components, embedded electronics, sensor systems, and firmware/software under one roof. This includes:
• Design and assembly of sensorized implants and smart surgical tools
• Integration of ASICs, PCBs, and thin-film circuits
• Hermetic sealing and power management for implantable electronics
• Full-stack firmware development and user interface integration
• Expertise in wireless communication (BLE, MICS) and closed-loop control systems

Our vertically integrated model supports OEMs from concept through clinical trials to full commercial scale, offering seamless handoffs between engineering, manufacturing, and regulatory—a critical advantage for complex, cross-functional smart systems.

How has your business evolved to support the demand for these devices?
We have evolved from a component supplier to a full-service partner for finished smart implants and systems. We’ve expanded capabilities to include:
• Full finished goods assembly of smart implants and connected devices
• System-level design spanning mechanical, electrical, firmware, and cloud components
• In-house teams supporting FDA technical submissions and Design History File (DHF) generation
• Expertise in Class II/III regulatory pathways, including PMA and IDE devices

This transformation allows us to serve as a true extension of our customers’ teams, helping them accelerate development while navigating the regulatory and technical complexity of smart orthopedic systems.

References

1. bit.ly/odt1125smartortho
2. bit.ly/odt1125smartortho2
3. bit.ly/odt1125smartortho3
4. bit.ly/odt1125smartortho4
5. bit.ly/odt1125smartortho5