Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 May 16;20(1):466.
doi: 10.1186/s13018-025-05866-1.

MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and meta-analysis

Ryan Wai Keong Loke  1 , Yao Hui Lim  2 , Yang Kai Chan  2 , Barry Wei Loong Tan  3
Affiliations
Meta-Analysis

MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and meta-analysis

Ryan Wai Keong Loke et al. J Orthop Surg Res. .

Abstract

Background: Total Hip Arthroplasty (THA) is the gold standard for treating end-stage hip osteoarthritis. Robotic-assisted systems, particularly the MAKO system, have been introduced to enhance reproducibility and safety. However, meta-analyses comparing MAKO-assisted THAs (MAKO-THA) to conventional methods are lacking, and previous reviews often aggregate various indications, introducing heterogeneity.

Methods: A random-effects meta-analysis was conducted on comparative studies between MAKO robotic-arm-assisted and conventional THAs in patients undergoing THA for solely hip osteoarthritis. Clinical outcomes (Harris Hip Scores [HHS], Forgotten Joint Scores [FJS], and Oxford Hip Scores [OHS]), radiographic parameters (implant positioning accuracy), leg-length-discrepancy, surgical duration, and complications were evaluated.

Results: 20 comparative studies were included. MAKO-assisted THAs resulted in higher postoperative HHS (MAKO-THA: 89.1, 95%CI: 86.4-91.7; C-THA: 87.0, 95%CI: 83.8-90.1), FJS (MAKO-THA: 84.7, 95%CI: 79.9-89.6; C-THA: 74.9, 95%CI: 64.0-95.7), and OHS (MAKO-THA: 89.1, 95%CI: 86.4-91.7; C-THA: 87.0, 95%CI: 83.8-90.1). FJS and OHS improvements were significantly greater compared to conventional THA (HHS WMD 2.2 [95%CI: -0.3-4.7, p = 0.09; FJS WMD: 8.7 [95%CI: 2.7-14.8], p = 0.005; OHS WMD: 1.5 [95% CI: 0.1-2.8], p = 0.03). MAKO-THA resulted in 94.7% and 90.3% of implants positioned within Lewinnek-and-Callanan zones, respectively, compared to 65.8% and 57.1% in conventional THA. MAKO-THA had longer mean surgical durations and lower postoperative leg-length discrepancy, but not significantly (Surgical Duration WMD: 3.5 [95%CI: -2.5-9.5], p = 0.3; Leg Length Discrepancy WMD: -0.2 [95%CI: -0.7-0.4], p = 0.6). Complication rates were low and non-significant (MAKO-THA: 3.0% [95%CI: 1.2-7.4]; C-THA: 3.5% [95% CI: 1.2-10.1), p = 0.3).

Conclusion: MAKO robotic-arm-assisted THA significantly improves Forgotten Joint Scores, Oxford Hip Scores and reproducibility in implant positioning without compromising on surgical duration and complication rates.

Protocol registration: CRD42024542794.

Keywords: Arthroplasty; Hip osteoarthritis; Meta-analysis; Orthopaedic surgery; Total hip arthroplasty.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: All authors provided critical conceptual input, interpreted the data analysis, read and approved the final draft of the manuscript have accessed and verified the data. were responsible for the decision to submit the manuscript. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA Schema
Fig. 2
Fig. 2
Forest Plot of Harris Hip Scores
Fig. 3
Fig. 3
Harris hip scores. Oxford Hip Scores (OHS). MAKO-assisted THAs resulted in significantly improved postoperative Oxford Hip Scores (MAKO-THA Mean: 89.1, 95%CI: 86.4–91.7; C-THA Mean: 87.0, 95%CI: 83.8–90.1; OHS WMD: 1.45 [95% CI: 0.11–2.78], p = 0.03)
Fig. 4
Fig. 4
Oxford hip scores. Forgotten Joint Scores (FJS). MAKO-assisted THAs resulted in significantly improved postoperative Forgotten Joint Scores (MAKO-THA Mean: 84.7, 95% CI: 79.9–89.6; C-THA Mean: 74.9, 95%CI: 64.0-95.7; FJS WMD: 8.72 [95% CI: 2.68–14.77], p = 0.005)
Fig. 5
Fig. 5
Forgotten joint scores
Fig. 6
Fig. 6
(a) Implant Positioning within Lewinnek “Safe Zones”. (b) Implant Positioning within Callanan “Safe Zone”
Fig. 7
Fig. 7
Surgical duration. Leg-Length Discrepancy(LLD). MAKO-THA also had lower postoperative leg-length discrepancy (MAKO-THA Mean: 2.72, [95%CI: 1.48–3.96]; C-THA Mean: 3.0, [95%CI: 1.2–4.8]), but not to a significant degree (WMD: -0.16, 95%CI: -0.72–0.4, p = 0.57). (Fig. 8)
Fig. 8
Fig. 8
Leg-length discrepancy. Complication Rates. Our study comprised both medical and surgical complications. Medical complications included superficial or deep infections, postoperative pneumonia, deep vein thrombosis or pulmonary embolism, anaemia and myocardial infarctions. Surgical complications included dislocations, prosthesis loosening, periprosthetic fractures or delayed wound healing. Complication rates were low (MAKO-THA Mean: 3.0% [95%CI: 1.18–7.37]; C-THA Mean: 3.5%, 1.2–10.1 and non-significant (p = 0.3) between both groups. Importantly, the rates of prosthetic dislocations were low and non-significant between both groups (MAKO-THA Mean: 1.3% [95% CI: 0.7–2.3%]; C-THA Mean: 0.7% [95%CI: 0.4–1.4%]; P-Value: 0.2). (Fig. 9)
Fig. 9
Fig. 9
Complications
See this image and copyright information in PMC

References

    1. Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW. What safe zone?? The vast majority of dislocated THAs are within the Lewinnek safe zone? for acetabular component position. Clin Orthop Relat Res. 2016;474(2):386–91. PMID: 26150264; PMCID: PMC4709312. - PMC - PubMed
    1. Alessio-Mazzola M, Colombo P, Barducci N, Ghezzi E, Zagra L, Caldora P, et al. Direct anterior approach with conventional instruments versus robotic posterolateral approach in elective total hip replacement for primary osteoarthritis: a case-control study. J Orthop Traumatol. 2024;25(1):9. 10.1186/s10195-024-00753-7. PMID: 38381320; PMCID: PMC10881946. - PMC - PubMed
    1. Banchetti R, Burco N, Sciulli L, Vicentini R. Comparison of conventional versus robotic-assisted total hip arthroplasty using the Mako system: an Italian retrospective study. J Arthritis. 2018;7:1–4.
    1. Bargar WL, Bauer A, Börner M. Primary and revision total hip replacement using the Robodoc system. Clin Orthop Relat Res. 1998;(354):82–91. - PubMed
    1. Beard DJ, Harris K, Dawson J, Doll H, Murray DW, Carr AJ, et al. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery. J Clin Epidemiol. 2015;68(1):73–9. 10.1016/j.jclinepi.2014.08.009. Epub 2014 Oct 31. PMID: 25441700; PMCID: PMC4270450. - PMC - PubMed

MeSH terms

LinkOut - more resources