Comparative analysis of HURWA versus MAKO robotic-assisted TKA: a prospective cohort study of surgical accuracy and clinical outcomes

BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an advanced surgical technique. However, direct comparisons between Chinese and American robotic systems are limited. OBJECTIVE: Exploratory comparison of surgical accuracy and short-term clinical outcomes between Chinese HURWA and American MAKO robotic systems in total knee arthroplasty. METHODS: A prospective exploratory cohort study was conducted from September 2023 to January 2024. Eighty-five patients were assigned to undergo RA-TKA with either the HURWA system (n = 43) or the MAKO system (n = 42) based on the sequential clinical introduction of the systems. The primary outcomes were radiographic accuracy, including the restoration of the mechanical axis within ± 3°. Secondary outcomes encompassed surgical efficiency metrics and patient-reported clinical scores (WOMAC, HSS, VAS) assessed preoperatively and at one-year postoperatively. RESULTS: All included patients have completed surgery and follow-up.The two systems achieved a comparable and high proportion of mechanical axis restoration within ± 3° (HURWA: 86.05% vs. MAKO: 90.48%). The HURWA system demonstrated a significant advantage in osteotomy time (6.03 ± 2.35 vs. 8.06 ± 2.73 min, P < 0.001). Both groups exhibited substantial and comparable improvements in all clinical outcome scores at the one-year follow-up. The HURWA system, as an open-platform design, offered flexibility in prosthesis selection, while the MAKO system demonstrated a highly standardized workflow. CONCLUSION: This exploratory comparison indicates that the HURWA system achieves favorable and comparable one-year clinical outcomes and radiographic alignment to the MAKO system in TKA, with distinct advantages in osteotomy efficiency and implant flexibility. These preliminary findings support the clinical potential of HURWA as a viable option, though definitive conclusions regarding its equivalence require validation through larger, long-term studies.