It seems as if every orthopedic device company is getting involved in robot-assisted surgery — rolling out robots to assist surgeons operating on the knee, hip, shoulder or spine.

Two events in recent years especially signaled that robots were coming into their own in the space: Stryker Corp. spent $1.7 billion for Mako Surgical Corp. to sell robotic systems to aid knee and hip replacement surgeries, and Medtronic PLC acquired Mazor Robotics for $1.7 billion so that it could expand into the robot-assisted spine surgery space.

Now all of the other big ortho device companies have either launched or are preparing to launch their own robots.

“Even if not necessarily proven to be better medicine, you can’t afford not to have an answer to robotics,” SVB Leerink analyst Richard Newitter recently told Medical Design & Outsourcing. “There’s a strategy now where having a robot is better than not having a robot.”

Here are seven companies seeking to make a difference in the space:

1. Stryker: Mako

More than five years after buying Mako Surgical, Stryker has already placed more than 650 Mako robots around the world, with more than 76,900 knee and hip replacement procedures performed in 2018 and double-digit growth in installations expected in 2019. After acquiring Mako in 2013, Stryker launched a total hip replacement tool in 2015 and a total knee arthroplasty application in 2017.

2. Medtronic: Mazor X Stealth

Medtronic officials think robot-assisted surgery could prove a game changer in the spine surgery space. The company late last year closed on its purchase of Mazor Robotics and its robot-assisted spine surgery platform. A month later, Medtronic launched its Mazor X Stealth robotic-assisted spinal surgical platform in the U.S. The Mazor X Stealth combines robotic guidance system technology from the Mazor acquisition with Medtronic’s StealthStation surgical navigation technology.

3. Johnson & Johnson’s DePuy Synthes: Orthotaxy

DePuy Synthes last year bought Paris-based Orthotaxy, which is expected to launch an ortho-surgery robot in 2020. At the American Academy of Orthopedic Surgeons conference in March, a prototype on display was reportedly the size of a shoebox, attaching to an operating table.

“There are no blocks required. There’s no pinning required. We saw this as what the world actually needs. This is bed-mounted. It’s not a huge device that sits on the floor,” said Liam Rowley, vice president of research and development for knees at DePuy.

4. Zimmer Biomet: Rosa

Zimmer Biomet’s Rosa robot-assisted total knee surgery platform won 510(k) clearance for knees in January and for spine in March. The Rosa system includes 2D X-ray and 3D pre-operative planning tools, allowing surgeons to conduct virtual procedures ahead of the actual surgeries, according to the company.

Rosa also provides real-time intraoperative data on soft tissue and bone anatomy. Zimmer Biomet acquired the initial Rosa technology in 2016 through its roughly $132 million purchase of French robot-assisted surgery firm Medtech.

5. Smith & Nephew: Navio

Smith & Nephew spent $275 million in 2016 to acquire Minnesota-based Blue Belt Technologies and its handheld Navio system. The London-based medical device company added a total knee arthroplasty application to Navio in 2017.

It has acquired further technology for Navio through its acquisition of Brainlab‘s orthopedic joint reconstruction business — a deal that closed yesterday. Smith & Nephew plans to install Brainlab’s hip software onto its currently-in-development Navio 7.0 software. A Navio 7.0 release is expected during the second half of the year.

6. Globus Medical: ExcelsiusGPS

Globus Medical announced late last year that it had installed its ExcelsiusGPS robotic guidance and navigation system in several European countries, reporting numerous open and minimally invasive spine procedures performed with the robot assistance. CEO Dave Demski in prepared remarks last month touted impressive level of surgeon adoption in accounts with the ExcelsiusGPS system.

7. NuVasive: Pulse

The U.S. Food and Drug Administration cleared NuVaSive’s Pulse integrated navigation platform as a spinal surgical automation platform in 2018, with a system launch expected soon.

When NuVasive in April announced the U.S. launch of its X360 system for lateral single-position surgery, it noted that the system could be integrated with Pulse so that surgeons could perform multiple procedures from the lateral position. NuVasive describes Pulse as an open imaging platform; it includes enhanced integration with Siemens’ 3D mobile C-arm, the Cios Spin.