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

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.