Robotic Knee Arthroplasty Market (2026-2036)

The robotic knee arthroplasty market covers robotic systems used to prepare bone and position implants in knee replacement surgery, together with the instruments and accessories consumed per procedure, the implants supplied for use with these systems, and the planning software and service contracts sold alongside them, across total, partial and revision knee procedures performed in hospitals, ambulatory surgical centres and specialty orthopaedic clinics. The growth of this market is driven by the unused share of knee replacement procedures not yet performed with robotic assistance, by the movement of knee replacement to lower cost sites of care, by the recurring revenue attached to each procedure, and by implant portfolios tied to specific robotic platforms.

Growth in this market comes from the share of an existing procedure rather than from growth in the procedure itself. Knee replacement is a long established, well counted operation, and The American Joint Replacement Registry reported robotic use in primary total knee arthroplasty approaching 16.1% in the aggregate analysis for 2024, with procedure data captured through 31 March 2025. The remaining share is therefore the size of the opportunity, and the forecast rests on how quickly that share is taken rather than on how many knee replacements are performed.

What the payment system allows sets the pace at which that share can be taken. Under the 2026 Medicare hospital outpatient prospective payment system, total knee arthroplasty under CPT code 27447 is paid USD 13,116, up 2.0% from USD 12,866 in 2025, while the ambulatory surgical centre rate for the same procedure is USD 9,393, up 1.5% from USD 9,255 in 2025. Neither payment carries any separate or additional amount for the use of a robotic system. The purchase of a robotic system therefore has to be justified by throughput, implant mix and length of stay rather than by additional revenue per case, which is why capital cost, footprint and setup time now decide placements more than clinical capability does.

A robotic knee arthroplasty system plans the position of a knee implant from imaging or from measurements taken during the operation, then assists the surgeon in preparing the bone to match that plan. The systems in use differ in whether they require a preoperative scan, in whether the robot is a floor-standing arm, a handheld instrument or a device mounted on the bone itself, and in how much of the cutting the machine performs under surgeon control. None of the systems cleared for sale operates without the surgeon, and the value offered is accuracy of implant position and soft tissue balance rather than the removal of surgical work.

The size of the opportunity is measured by the share of procedures not yet done this way. The American Joint Replacement Registry reported robotic use in primary total knee arthroplasty approaching 16.1% in the aggregate analysis for 2024, with procedure data captured through 31 March 2025. Roughly five in six primary knee replacements in that registry were therefore performed without robotic assistance, and the forecast for this market is a forecast of how quickly that proportion falls. This is a different exercise from forecasting a new procedure, because the number of knee replacements performed is already known and grows slowly with population age.

Payment determines how fast the share can move, and it does not reward the technology directly. Under the 2026 Medicare hospital outpatient prospective payment system, total knee arthroplasty under CPT code 27447 is paid USD 13,116, up 2.0% from USD 12,866 in 2025, while the ambulatory surgical centre rate for the same procedure is USD 9,393, up 1.5% from USD 9,255 in 2025. Neither payment carries any separate or additional amount for the use of a robotic system. A hospital or surgical centre using a robot is paid the same amount as one that does not, so the system has to pay for itself through the number of cases a theatre can complete in a day, the implants the platform brings with it, and any reduction in length of stay or readmission. That calculation is tighter than it appears, because robotic cases have historically taken longer to set up than conventional ones.

A regulatory change now underway moves the procedure towards sites where that calculation is harder still. For 2026 the Centers for Medicare & Medicaid Services removed 285 musculoskeletal procedures from the inpatient-only list, encompassing all procedures in the CPT 27000 series, phased over three years, and added 276 surgical codes to the ambulatory surgical centre covered procedures list, 271 of which were removed from the inpatient-only list. Knee replacement is therefore moving steadily out of the inpatient setting, and the ambulatory rate of USD 9,393 is about 28% below the hospital outpatient rate of USD 13,116 for the same operation. A surgical centre receiving the lower amount has less room for a capital purchase and usually no capital budget of the kind a hospital system holds.

The response from manufacturers has been to make the equipment smaller and cheaper to place rather than more capable. Handheld systems and devices mounted directly on the bone remove the floor-standing arm, the dedicated theatre space and in several cases the preoperative scan, which shortens setup and allows placement in a centre that cannot accommodate a large installation. THINK Surgical, Inc. received FDA 510(k) clearance in 2023 for a miniature robotic system intended for total knee arthroplasty, and systems of this kind are the part of the market aligned with where the procedure is moving.

Commercial models have shifted in the same direction. Rather than selling a system outright, manufacturers increasingly place equipment against a commitment to implant volume, charge a fee for each procedure, or include the system within a wider supply agreement. These arrangements suit a buyer without capital and give the manufacturer a return tied to use, and they are the reason the recurring portion of this market grows faster than the equipment portion.

Autonomy is limited by what regulators have cleared rather than by what has been built. Monogram Technologies received FDA 510(k) clearance in March 2025 for a CT-based, semi-autonomous, artificially intelligence-navigated total knee arthroplasty robotic technology, began a clinical study of a fully autonomous version in July 2025, and was acquired by Zimmer Biomet Holdings, Inc. on 7 October 2025 for USD 4.04 per share in cash together with contingent value rights worth up to USD 12.37 per share through 2030. The fully autonomous version is not cleared. Every system available for sale therefore operates under the control of the surgeon, and claims about autonomous knee surgery describe products in study rather than products on the market. A forecast that assumes autonomous operation within this period would be assuming a clearance that has not been granted.

The acquisition also illustrates how capability is being consolidated. The companies that supply knee implants are the companies acquiring robotic platforms, because the platform determines which implants can be used with it and therefore protects the implant revenue that is several times larger than the equipment revenue. This is why the leading positions in this market are held by orthopaedic implant manufacturers rather than by robotics companies. It also explains why platforms have been bought outright rather than licensed, since a licence would leave the implant choice open to the facility and remove the protection the acquisition is intended to provide.

Two conditions qualify the growth rate in this market. The first is that the payment amounts and site of care rules described here are set by payers and can be revised, and a change in the ambulatory rate or in the phase-in of the inpatient-only list removal would alter the placement economics directly. The second is that the recurring revenue in this market depends on procedures actually performed on installed systems rather than on systems sold, so an installed base that is used for a small share of a surgeon list produces less revenue than the placement count suggests. Utilisation therefore has to be assessed alongside placement numbers when the size of the installed base is translated into revenue, and it varies widely between sites performing the same number of procedures.