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MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and
Ryan Wai Keong Loke1, Yao Hui Lim2, Yang Kai Chan2
1Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, NUHS Tower Block, Singapore.
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.
