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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 dem-onstrated a significant advantage in osteotomy time (6.03±2.35 vs. 8.06±2.73 min, P<0.001). Both groups exhibited sub-stantial 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 standard-ized 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 effi-ciency 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.