Can the ASC Model Support the Computer-assisted Surgical Services Patients Expect?

In the U.S., the number of joint-replacement procedures continues to rise. There are over a million joint replacements performed each year, and this figure is expected to exceed 4 million annually by 2030.1   Orthopedics is one of the largest and most profitable service lines in most hospitals, with total joint replacements accounting for a large revenue share. However, this moneymaker is moving from inpatient to outpatient. According to Sg2, in 2020, 32 percent of total joint replacements were performed as an outpatient, and this number is expected to rise to 51 percent by 2026 as joint surgeries continue to move to ASCs.2

Advancements in 2023 hip & knee replacement technology have facilitated the transfer of joint replacement to an outpatient surgery and play an increasingly large role as patients make health care related decisions. For example, in a 2021 survey involving 588 participants, 69 percent of respondents believed robotic-assisted orthopedic surgery resulted in fewer complications and better results, 59 percent expected less pain, and 62 percent predicted a speedier recovery than with traditional manual procedures. Furthermore, 49 percent said they would prefer a low-volume surgeon who use these technologies over a high-volume surgeon who uses conventional manual methods.3 As a result, ASCs are caught between rising patient demand for surgical technologies in their orthopedic procedures and the challenge of making it financially feasible.

The expense of investing in robotics and computer-assisted surgery (CAS) systems and the necessary supplies and services to perform technology-enhanced joint replacement surgery is a major obstacle to overcome. These costs are quite substantial and do not align with the ASC’s cost-saving business model. A robot can cost upward of $1 million, with an additional $100,000 in annual servicing charges. Operating expenses are quoted at more than $1,200 per case, with extensive preoperative imaging adding $1,500-2,000 in cost. Reimbursement for joint replacement does not always include an extra charge for CAS usage4 and is expected to continue to decline in all surgical settings.

Total square footage restrictions for waiting rooms, recovery rooms, sterile processing departments, and operating rooms are common in ASCs, and large console technologies can be difficult to implement due to these space constraints. Furthermore, many ASCs lack the resources to sterilize the numerous trays of equipment required for total joint replacements that computer navigation systems reduce. ASCs typically only have one or two sterilizers on-site, which requires advance planning to overcome scheduling hurdles.2

Single-use surgical technologies, such as OrthAlign handheld navigation, can overcome these cost, space, and sterilization restrictions and meet the demand for surgical technologies that patients seek. OrthAlign delivers accurate, individualized alignment to any patient with a single, disposable handpiece that can be used across implant platforms and surgical philosophies. The user-friendly design and interface provide streamlined workflows to reduce OR times and support multiple ORs concurrently without the investment, equipment, or pre-operative imaging required by many computer-assisted surgical systems.

ASCs have positioned themselves to deliver high-quality, cost-effective care. The technology-assisted services they offer must adhere to the same value-based paradigm. To meet patient expectations and protect their market share, outpatient surgical centers that don’t see the ROI in large CAS systems will need to turn to options better suited for the ASC environment. OrthAlign navigation does not have the same cost, space, and sterilization requirements as the original robotic technology, allowing ASCs to benefit from the competitive edge that robotic-assisted technology delivers without the high initial investment.

Additionally, ASCs that act and invest in advanced surgical technologies differentiate themselves from other options and stay competitive in this growing 2023 market of orthopaedic tools. OrthAlign technology delivers the accuracy that surgeons expect, the efficiency and value that ASCs seek, and the technology that patients demand.



  1. Etkin, Caryn D., and Bryan D. Springer. “The American joint replacement registry—the first 5 years.” Arthroplasty today 3.2 (2017): 67-69.
  2. DeCook, C. A. (2019). Outpatient joint arthroplasty: Transitioning to the ambulatory surgery center. The Journal of Arthroplasty, 34(7S), S48–S50.
  3. Nicholas R. Pagani, MD, et al. “Online Crowdsourcing to Explore Public Perceptions of Robotic-Assisted Orthopedic Surgery.” Journal of Arthroplasty. 36(6), 1887-1894. E3, JUNE 01, 2021
  4. Wang, D. S. (2020, November 30). Will robots take their place in orthopedics? Morningstar.Com.