Smith+Nephew has completed the first knee and shoulder procedures using its CORI XT handheld robotic platform, while securing US regulatory clearance for an artificial intelligence-supported system intended to assist surgeons during ligament reconstruction.

The medical technology company reported double-digit growth in installations of its existing CORI surgical system during the first half of 2026. Its next-generation CORI XT platform has now been used in initial clinical cases, moving the product from development towards a more consequential test of adoption inside operating theatres.

Separately, the US Food and Drug Administration granted De Novo classification to Smith+Nephew’s TESSA Spatial Surgery System. TESSA combines personalised planning, advanced imaging, navigation, augmented reality, real-time tracking, and accelerated computing, with its first approved application covering femoral anterior cruciate ligament reconstruction in the knee.

The milestones arrived alongside softer commercial performance in parts of the company’s orthopaedics business. Smith+Nephew reduced its forecast for full-year revenue growth from about 6 per cent to about 4 per cent, although it maintained guidance for trading profit, free cash flow, and return on invested capital.

Smaller systems change the adoption equation

Surgical robotics has often been associated with large, expensive installations that require dedicated operating-room space and substantial hospital commitments. A handheld platform changes that physical model, although it does not remove the need for training, technical support, workflow redesign, maintenance, and evidence that the equipment improves procedures.

CORI is intended to help surgeons plan and carry out orthopaedic operations while retaining direct control of the handheld instrument. That differs from systems in which a clinician operates through a large fixed robot, and it may allow hospitals to introduce robotic assistance without rebuilding an operating theatre around the machinery.

However, portability does not guarantee that a system will be used often enough to justify its cost. Hospitals must decide which procedures are suitable, which surgeons will be trained, how operating lists are scheduled, and whether the technology shortens or extends the time required for each case.

Installation figures therefore provide only an early indication of demand. Utilisation, procedure volume, service revenue, surgical outcomes, revision rates, and the time needed for clinical teams to become proficient will offer a clearer measure of whether robotics is becoming routine or remaining concentrated among selected specialists.

The first CORI XT knee and shoulder cases broaden Smith+Nephew’s ambitions beyond a single joint or procedure. Yet moving between applications places additional demands on instruments, software, planning data, and clinical training, particularly where surgeons and hospitals expect one platform to support several parts of an orthopaedic practice.

Spatial systems bring data into surgery

TESSA approaches the operating theatre from another direction by combining tracking and imaging with digital planning and navigation. Rather than automating surgery, the system is intended to organise information around the surgeon and maintain an updated understanding of instruments and anatomy during the procedure.

Its first indication covers reconstruction of the anterior cruciate ligament, where the positioning of tunnels and implants can affect the mechanics of the repaired knee. Real-time tracking and navigation may help make the planned procedure more reproducible, although regulatory classification allows the product to enter the market rather than proving superior outcomes across routine practice.

Smith+Nephew describes TESSA as using AI and accelerated computing, but hospitals will need more specific information about what the algorithms do, which decisions remain with the surgeon, what data are collected, and how the system behaves when tracking or imaging becomes incomplete.

Clinical technology also creates operational dependencies that extend beyond the procedure itself. Software updates, cybersecurity, calibration, equipment availability, network access, data retention, and vendor support can determine whether a system remains usable throughout its expected life.

Where planning data or imaging move between systems, hospitals must establish how patient information is protected and whether outputs can be transferred if they later change suppliers. Proprietary formats may make individual products easier to integrate within one vendor’s portfolio while making the wider clinical estate harder to change.

The commercial context adds urgency because Smith+Nephew is relying on new products to improve its orthopaedics performance. Second-quarter revenue reached $1.60 billion, with underlying growth of 1.6 per cent, while its US orthopaedics operation continued to face weaker hip and knee implant sales.

Chief executive Deepak Nath said: “Orthopaedics is not where we want it to be,” although he expects new product introductions to support faster growth from later in 2026 and into 2027. The company has identified another $50 million of efficiency savings for this year, taking its expected total to about $200 million, as it seeks to protect profitability despite slower revenue growth.

Robotics and AI-supported navigation can strengthen the relationship between an implant manufacturer and a hospital by connecting planning, instruments, software, consumables, and service support. That creates opportunities for recurring revenue, but it can also increase switching costs and make procurement decisions extend well beyond the price of the initial machine.

Smith+Nephew has now crossed several early thresholds: regulatory classification, initial procedures, and growth in installations. The next evidence will need to come from how frequently the systems are used, whether they improve clinical or operational outcomes, and whether hospitals can support them without adding more complexity than they remove.