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Joint replacement

Robotic hip replacement Gold Coast

Dr Jason Tsung uses the Stryker Mako robotic-arm system for hip replacement, and has done so since 2016. The robot doesn't perform the surgery. Dr Tsung does. It is a guidance tool that helps him position your new hip accurately, working from a plan built around your own anatomy.

Written and reviewed by Dr Jason Tsung, FRACS (Orth) · Last reviewed June 2026

What robotic-assisted hip replacement involves

Robotic-assisted hip replacement is a conventional hip replacement carried out with the help of a robotic-arm system, with the surgeon in control at every step. What changes is the planning and the accuracy of implant placement, not the implant itself or the general operation, which is covered on the hip replacement page.

It works from a low-dose CT scan taken a week or two before surgery. The scan becomes a 3D model of your hip, and the size and position of the socket and stem are planned onto that model before the day. In theatre, Dr Tsung registers your pelvis and femur to the plan, prepares the socket within boundaries the system holds him to, and checks the cup position, leg length and offset against the plan before the final implant goes in. The step-by-step detail of how the Mako system works is on the robotic-assisted joint replacement page.

Accurate cup positioning and the safe zone

The position of the socket, or cup, is one of the things that most affects how a hip replacement behaves. Surgeons aim to place the cup within a range of angles, often called the safe zone, that balances the risk of the hip dislocating against wear of the bearing. A cup placed outside that range is linked to a higher chance of dislocation, edge-loading and faster wear.

This is where robotic assistance has its best-established benefit. Planning the cup from a CT model and preparing it within the robot's boundaries places it in the safe zone more often than freehand technique. In one review the socket reached the target position in around 95 per cent of robotic cases, compared with roughly two thirds using conventional instruments.¹ A 2025 meta-analysis of 38 studies and 10,055 patients found robotic assistance gave more accurate cup placement and a lower rate of complications, while noting it did not produce better patient-reported scores.² Precision is the proven benefit. Whether it changes how the hip feels is less certain.

Leg length and offset

Two other measurements shape how a new hip works: leg length, and offset, which is how far the hip sits out from the pelvis and sets the tension in the muscles around it. Getting them right helps with a level gait and a stable hip; getting them wrong is a common reason for a limp or a sense that the legs are uneven. The CT plan measures both, and studies report that robotic assistance restores leg length and offset more accurately on X-ray than manual technique.³,⁴ It's worth being straight about the limit of that. One study found that even when the measured leg length was more even, patients did not necessarily notice a difference.⁵ Better numbers on a scan don't always translate into something you feel.

Combined with the direct superior approach

Robotic planning can be combined with the minimally invasive direct superior approach that Dr Tsung uses for many hip replacements. The two address different things. The robotic step is about where the implant goes; the direct superior approach is a muscle-sparing way of reaching the hip that leaves the iliotibial band and a deep muscle at the back of the hip intact. They're complementary, not alternatives.

What the evidence shows

The evidence for robotic hip replacement is consistent.

Positioning accuracy: well established. Robotic assistance places the cup, and restores leg length and offset, more accurately than freehand surgery. This is supported by meta-analyses.¹,²,³

Dislocation and complications: not clearly different. Some large observational studies report fewer dislocations with robotic assistance or fluoroscopic guidance,⁶ and some meta-analyses report fewer complications with robotic assistance.² Across the wider literature, though, robotic surgery hasn't been shown to reliably lower dislocation or revision rates compared with well-performed conventional surgery.⁷

Function and recovery: no proven advantage. Better placement on a scan hasn't translated into clearly better patient-reported function or a faster recovery. Trials following patients for one to three years have generally found the two groups end up much the same.²,⁸

Implant longevity: not shown to differ. Reviews have not shown that robotic assistance reliably lowers revision risk or improves implant survivorship compared with well-performed conventional surgery.⁷ Australian registry data show low ten-year revision rates for total hip replacement overall, with around 95 per cent of hip replacements still working at ten years.¹⁰

Is robotic assistance right for your hip?

Robotic precision is likely to matter most where the anatomy is demanding: a shallow or dysplastic socket, a hip changed by previous surgery, or a hip at higher risk of dislocation. For a straightforward hip, a well-performed conventional replacement is already an excellent operation, and the robotic plan mainly adds confidence around implant position. A complex or badly deformed hip may still be better served by a standard approach. Dr Tsung will look at your X-rays and your CT plan and tell you whether robotic assistance is likely to add anything in your case.

Risks and trade-offs

Robotic assistance doesn't remove the risks that come with any hip replacement, among them infection, blood clots, dislocation, a difference in leg length and the small chance of further surgery. A few trade-offs are specific to the robotic approach. It adds a CT scan beforehand, which involves a small amount of extra radiation, and it tends to add a little to the time in theatre, on the order of ten minutes once a surgeon is past the early learning curve.⁹ Dr Tsung has used the Mako system since 2016. The robot supports his judgement; it doesn't replace it. Whether robotic-assisted surgery suits your hip is something to talk through at your consultation.

Common questions

Is robotic hip replacement more accurate?

Yes, in terms of implant position. The socket is placed in the position surgeons aim for, the safe zone, in around 95 per cent of robotic cases, compared with roughly two thirds using conventional instruments, and leg length and offset are restored more accurately on X-ray. What that accuracy has not been shown to do is make the hip last longer, lower the dislocation rate, or change how the hip feels compared with well-performed conventional surgery. Individual results vary.

Will robotic surgery make my legs exactly the same length?

It can't promise that. Robotic planning measures leg length and helps restore it, and studies show more accurate leg length on X-ray. But a small difference in leg length is a recognised part of hip replacement whatever the technique, and one study found that more even measurements didn't always mean patients noticed a difference. Dr Tsung aims to get it as close as the anatomy allows and will explain what's realistic for your hip.

Can robotic planning be combined with a minimally invasive approach?

Yes. Robotic planning can be combined with the minimally invasive direct superior approach that Dr Tsung uses for many hip replacements. The robotic step guides accurate socket positioning, while the direct superior approach is a muscle-sparing way of reaching the hip.

Does robotic hip replacement cost more for the patient?

No. Using the robotic-assisted system does not add to the cost of your surgery. Robotic planning is part of how Dr Tsung performs hip replacement, not a paid extra. Your out-of-pocket cost depends on the procedure and your health fund, and we go through it with you on the fees and health funds page.

Does robotic assistance make hip surgery take longer?

A little. Robotic-assisted hip replacement takes around 45 to 60 minutes on average, about ten minutes longer than conventional surgery once a surgeon is past the early learning curve, and planning requires a CT scan a week or two beforehand, which involves a small amount of additional radiation. The robotic step doesn't remove the risks that come with any joint replacement, such as infection, blood clots and stiffness, and individual results vary.

Book or refer

To see Dr Tsung you’ll need a referral from your GP or another specialist. Call reception on (07) 5676 9930 to book your first appointment, or email hello@sgco.au. New patients can pre-register online before the visit; the form prepares your records and does not book an appointment. For costs, see fees and health funds.

Call (07) 5676 9930Patient forms

References

  1. Loke RWK, Lim YH, Chan YK, Tan BWL. MAKO robotic-assisted compared to conventional total hip arthroplasty for hip osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res. 2025;20(1):466. doi:10.1186/s13018-025-05866-1.
  2. Bensa A, Pagliazzi G, Miele A, Schiavon G, Cuzzolin M, Filardo G. Robotic-assisted total hip arthroplasty provides greater implant placement accuracy and lower complication rates, but not superior clinical results compared to the conventional manual approach: a systematic review and meta-analysis. J Arthroplasty. 2025;40(7):1921–1931. doi:10.1016/j.arth.2024.12.014.
  3. Emara AK, Samuel LT, Acuña AJ, Kuo A, Khlopas A, Kamath AF. Robotic-arm assisted versus manual total hip arthroplasty: systematic review and meta-analysis of radiographic accuracy. Int J Med Robot. 2021;17(6):e2332. doi:10.1002/rcs.2332.
  4. Clement ND, Gaston P, Bell A, Simpson P, Macpherson G, Hamilton DF, Patton JT. Robotic arm-assisted versus manual total hip arthroplasty. Bone Joint Res. 2021;10(1):22–30. doi:10.1302/2046-3758.101.BJR-2020-0161.R1.
  5. Zhang J, Tian H, Shi Z, Wang K, Yang P, Tian R. Can robot-assisted total hip arthroplasty improve the incidence of self-reported leg-length discrepancy? A multicentre, propensity score matching comparative study. J Arthroplasty. 2025;40(9):2353–2362.e2. doi:10.1016/j.arth.2025.02.056.
  6. Di Gangi C, Prinos A, Buehring W, Meere PA, Meftah M, Hepinstall MS. Fewer dislocations after total hip arthroplasty with robotic assistance or fluoroscopic guidance. J Arthroplasty. 2024;39(9S2):S359–S366. doi:10.1016/j.arth.2024.07.002.
  7. Miura T, Yamamoto N, Shiroshita A, Tsuge T, Saitsu A, Yoshitani J, Nakao S, Takami K. Comparison of implant placement accuracy between manual, robot-assisted, computer-navigated, augmented reality navigated, patient-specific instrumentation, and accelerometer navigated total hip arthroplasty: a systematic review and network meta-analysis. JBJS Rev. 2024;12(11). doi:10.2106/JBJS.RVW.24.00120.
  8. Fontalis A, Kayani B, Haddad IC, Donovan C, Tahmassebi J, Haddad FS. Patient-reported outcome measures in conventional total hip arthroplasty versus robotic-arm assisted arthroplasty: a prospective cohort study with minimum 3 years' follow-up. J Arthroplasty. 2023;38(7 Suppl 2):S324–S329. doi:10.1016/j.arth.2023.04.045.
  9. Hecht CJ, Porto JR, Sanghvi PA, Homma Y, Sculco PK, Kamath AF. Contemporary analysis of the learning curve for robotic-assisted total hip arthroplasty emerging technologies. J Robot Surg. 2024;18(1):160. doi:10.1007/s11701-024-01928-4.
  10. Australian Orthopaedic Association National Joint Replacement Registry. Hip, Knee & Shoulder Arthroplasty: 2025 Annual Report. Adelaide: Australian Orthopaedic Association; 2025. Available from: https://aoanjrr.sahmri.com/annual-reports-2025.
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