Daniel Sullivan, 81, had shoulder arthritis for decades before deciding on shoulder replacement surgery. At Duke Health, he underwent a procedure that used a new and innovative handheld robotic tool, and both he and his health care team are delighted by the outcome. “I would recommend anybody go to Duke,” he said.
Deciding on Shoulder Replacement Surgery
About 20 years ago, Sullivan, who lives in Chapel Hill, began experiencing arthritic pain in his shoulder. Periodic cortisone injections at Duke Sports Medicine would help for months or years, but gradually became less effective. In February 2026, he and his doctor, Duke Health orthopaedic surgeon Christopher S. Klifto, MD, decided that the time was right for shoulder replacement surgery. A retired Duke Health radiologist, Sullivan knew he would be in good hands at Duke.
A New Procedure
Dr. Klifto suggested a robotic surgery platform that had just became available. While robotic-assisted replacement of larger joints, such as the hip, have been performed for decades, robotic shoulder replacements were rare because the shoulder space is so small. Dr. Klifto could perform Sullivan’s replacement using a handheld robotic device that allows him to operate in smaller spaces. Sullivan was game.
“At six weeks of recovery, you’d think it’d been one year.” – Christopher S. Klifto, MD
How Handheld Robotic Surgery Leads to Enhanced Safety and Precision
First, the surgical team uses a CT scan to create a detailed 3D digital plan that maps exactly which parts of the shoulder need to be removed and where the implants will be placed. In the operating room, small tracking pins are secured directly to the bones, giving the robotic system fixed reference points it can follow precisely throughout the procedure. “Since the implants are placed under robotic guidance, we’re less likely to place the components in a suboptimal position, which is a common reason for shoulder revision surgery,” explained Dr. Klifto.
The surgeon then uses a handheld robotic cutting tool. The system sends precise position information to the handpiece more than 300 times per second. When the surgeon is working within the planned area, the cutting tool operates normally. If the tool reaches or exceeds the defined virtual boundary, the system stops the cutting action. The surgeon remains in full control of the procedure; the robotics act as a precise, real-time guardrail.
Supercharged Recovery
Sullivan anticipated pain from the surgery, but was surprised by how minimal it was. “I took some Tylenol, but that’s all I needed,” he said. His clinic visits provided more positive surprises. “When I went in for my six-week post-surgery check, the orthopedic resident came into the room and asked me to raise my arms as far as I could. He seemed to be speechless for a moment and then quietly said ‘wow!’” Sullivan’s surgeon echoes that sentiment. “At six weeks of recovery, you’d think it’d been one year,” Dr. Klifto said.
A Team-Based Effort
Since Sullivan’s surgery, Dr. Klifto and his team have performed more than 60 handheld robotic shoulder replacement surgeries. He credits his team with the outcomes his patients experience. “From the clinic office team, to the scrub technologists and the nurses to the pre-op and post-op staff, to the fellows and residents, to the physical therapists—this is 100% a team effort,” he said.
“A Much More Precise Procedure” — And a Better Outcome
Meanwhile, Sullivan continues to reap gains from the surgery, returning to such hobbies as house projects, weightlifting, and playing piano and organ. He’s fascinated by the technology behind the surgery and maintains a lively email correspondence with Dr. Klifto about it. “I had enough knowledge about CT scans and image processing and robotics to suspect that this was going to be a much more precise procedure,” he said. “That turned out to be the case, and I'm really delighted about it.”
