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Patient Education / Hip

Robotic-Assisted Total Hip Replacement (Mako): Precision Planning for Your New Hip

Hip

A successful hip replacement depends on getting the details right — the angle of the new socket, the length of your leg, and the overall balance of the joint. Dr. MacNeille performs hip replacement with the Mako robotic-arm system to plan and execute these details with a level of precision that is difficult to achieve by hand alone.

How Does Mako Work?

Before surgery, you get a CT scan of your hip. This creates a detailed 3D model of your unique anatomy, which Dr. MacNeille uses to plan the exact size and position of your implants before ever making an incision.

During surgery, the robotic arm acts like a highly accurate guide:

  • It tracks your hip's position in real time
  • It helps prepare the bone precisely along the plan
  • It keeps instruments within the planned boundaries

The robot never operates on its own — Dr. MacNeille performs the surgery, using the robot the way a builder uses a level and laser guide.

The Stryker Mako robotic arm system fitted with its total hip replacement attachment.
The Mako robotic arm with its total hip attachment.

Why Does Accuracy Matter?

The angle of the hip socket (the "cup") affects dislocation risk, implant wear, and how natural the hip feels. A 2021 study in Scientific Reports by Hayashi and colleagues measured cup position after Mako robotic hip replacement and found the final position matched the plan within about 2 degrees on average — a remarkable level of accuracy.

Research comparing techniques points the same direction. A 2024 study in Technology and Health Care by Incesoy and colleagues found that CT-based Mako assistance placed the cup significantly more accurately than conventional freehand technique. And a 2017 study in Surgical Technology International by Illgen and colleagues, following patients for a minimum of two years, reported improved accuracy and fewer dislocations with robotic assistance compared with manual hip replacement.

Benefits Patients Care About

  • Lower dislocation risk. Precise cup position, combined with computer modeling of your hip's motion, helps the new joint stay stable. A 2024 multicenter study in Hip International by LaValva, Westrich, and colleagues showed that the system's "virtual range of motion" tool lets surgeons fine-tune implant position during surgery to avoid impingement.
  • Leg length restoration. The CT-based plan measures your leg length to the millimeter, helping avoid the feeling of one leg being longer than the other — one of the most common concerns after hip replacement.
  • A plan personalized to you. No two pelvises are alike. The 3D plan accounts for your bone shape and spine-pelvis relationship.

Robotics Plus a Muscle-Sparing Approach

Dr. MacNeille pairs Mako robotic assistance with the direct superior approach, a minimally invasive technique that protects the IT band and key stabilizing muscles. The combination is designed for accuracy on the inside and a gentler recovery on the outside — most patients walk the day of surgery, and most do not need traditional hip precautions.

References

  • Hayashi S, et al. Accuracy of cup position following robot-assisted total hip arthroplasty may be associated with surgical approach and pelvic tilt. Scientific Reports. 2021.
  • Incesoy MA, Yildiz F, Pulatkan MA, et al. CT-based, robotic-arm assisted total hip arthroplasty (Mako) through anterior approach provides improved cup placement accuracy. Technology and Health Care. 2024.
  • Illgen RL, Bukowski BR, Abiola R, Anderson P, Chughtai M, Khlopas A, Mont MA. Robotic-Assisted Total Hip Arthroplasty: Outcomes at Minimum Two-Year Follow-Up. Surgical Technology International. 2017.
  • LaValva SM, Westrich GH, et al. A multicentre prospective assessment of robotic assisted total hip arthroplasty with virtual range of motion on intraoperative implant positioning. Hip International. 2024.

This article is for general education and is not a substitute for medical advice.

Watch: see it for yourself

Mako SmartRobotics (Stryker)Stryker's official overview of Mako SmartRobotics for hip and knee replacement.
Mako Total Hip — how it worksStryker's animation of Mako robotic-arm assisted total hip replacement.

Recovery videos courtesy of Dr. Lige Kaplan, whose patients underwent the same minimally invasive techniques Dr. MacNeille uses. Robotics videos from Stryker and partner hospitals. We will be adding videos of our own patients over time. Browse the full video library →

Ready to talk about your hip or knee? Request an appointment and our team will contact you within 1–2 business days.