Hip Replacement Robot: ROBODOC, Mako and ABB

The hip replacement robot was one of the first robots to work inside a human operating room, and in 2026 people are asking again what it is worth. A large British registry study published by The BMJ at the end of September found that robotic hips did not lower the overall early risk of repeat surgery. This post follows the hip from Themistocles Gluck's ivory ball and John Charnley's low friction arthroplasty to ROBODOC and Mako, looks at what the new evidence says, and asks where ABB robots could fit. For now that is in the factories that make the implants.

An X-ray of a pelvis with a total hip replacement in one hip joint. Photo: Mikael Häggström / Wikimedia Commons (CC0)

How surgeons rebuilt hips by hand, from ivory balls to Wrightington

The earliest recorded attempts at hip replacement were made in Germany in 1891, when Themistocles Gluck used ivory for the head of the femur and fixed it with nickel plated screws. In 1938 Philip Wiles in London fitted a stainless steel hip held with bolts. Austin Moore implanted a cobalt chrome prototype in 1940, and a commercial Austin Moore prosthesis followed in 1952. Surgeons shaped the bone and fitted each of these by hand and by eye, with chisels and reamers, judging the angles as they went.

A McKee-Farrar metal on metal hip prosthesis, photographed in 1975. Photo: John Marton, National Archives and Records Administration via Wikimedia Commons (public domain)

The modern hip owes most to Sir John Charnley at Wrightington Hospital in Lancashire. In 1962 he settled on a design that is still the template today: a one piece stainless steel stem and head, a cup of high molecular weight polyethylene, and bone cement made of polymethylmethacrylate to fix both parts to the bone. He called it low friction arthroplasty because the small head turned easily in the plastic cup. Infection worried him too, so he designed clean air enclosures and ventilated exhaust suits for the surgical team.

A ventilated surgical exhaust suit designed by Sir John Charnley, on display at the Thackray Museum of Medicine in Leeds. Photo: Museumjack / Wikimedia Commons (CC BY 4.0)

Robots reached the hip thirty years later. ROBODOC grew out of a feasibility study with IBM and the University of California, Davis, led by Sacramento surgeon William Bargar and veterinarian Howard "Hap" Paul, and it was tested on dogs first. On 7 November 1992 it machined the femur of a 64 year old man at Sutter General Hospital in Sacramento, the first time a robot was used on a human hip. The operation took almost six hours. Mako Surgical received FDA clearance for its hip application in 2010, and Stryker bought the company in 2013.

The entrance to Wrightington Hospital in Lancashire, where Charnley developed his hip, in 2019. Photo: Lewis Clarke / Wikimedia Commons (CC BY-SA 2.0)

What the 2026 hip robot evidence shows

On 30 September 2026 The BMJ published two studies from Queen Mary University of London, the University of Oxford and the University of Bristol, based on the National Joint Registry for 2018 to 2024. They covered 666,283 total hip replacements, of which 10,203 were robotic, about 1.5 percent. Robotic hips had no lower overall early risk of repeat surgery and no difference in mortality. They did have fewer revisions linked to implant malpositioning, which is the problem the robot is built to prevent. The authors point out that the studies are observational, and functional results from the RACER trials are still to come.

Different types of hip prosthesis on display in the Wellcome Medicine Gallery at the Science Museum in London, 2022. Photo: FE2656BA / Wikimedia Commons (CC BY-SA 4.0)

Hospitals keep buying. According to the study team, a robotic system costs around £1 million to introduce and adds £1,000 to £2,500 per procedure. In early October Stryker launched its Mako 4 system in India, Princeton Community Hospital in West Virginia announced its 3,000th robotic joint replacement, and Indiana Regional Medical Center reported 1,000 Mako operations. Lead author Hasan Mohammad said new technology "should deliver meaningful benefit for patients and represent good value for a publicly funded health service." So far the extra precision has not shown up in the repeat surgery numbers.

An X-ray of a hip replaced with cementless implants, 16 days after surgery. Photo: KimvdLinde / Wikimedia Commons (CC BY-SA 3.0)

ABB does not make a surgical robot, so its place in the hip story is on the factory side. A hip implant is a stem, a ball and a cup, and each has to be machined, ground and polished to tight tolerances. The new generation IRB 1200, launched in 2025, is a compact arm for machine tending and small parts, and the GoFa CRB 15000 cobot loads parts into machine tools next to people. Using these arms on implant lines is only a possibility, since no such ABB project has been announced. Our post on the knee replacement robot asks the same question for knees.

The new generation ABB IRB 1200 with its OmniCore controller and FlexPendant, launched in 2025. Photo: ABB

Where robotic hip surgery goes next, in theatres and factories

Surgeons now need proof that the precision pays off. Robots place the cup and stem more accurately, and the registry suggests this cuts revisions for malpositioning, a fault that can lead to dislocation. Whether that adds up to fewer repeat operations over ten or twenty years will take longer follow up. Cost is the other open problem. Robotic hips were only about one in seventy UK operations in the study period, and a health service has to decide whether a seven figure machine pays off before that answer arrives.

An ABB GoFa cobot loading parts into a machine at a small factory. Photo: ABB

In factories, more hip operations mean more stems, heads and cups to finish. Grinding cells such as Teqram's EasyGrinder, which uses an ABB IRB 6700 to pick, grind and stack steel parts at Ancofer, show a robot taking over a dirty manual finishing job. A smaller ABB arm doing the same on implants is only a possibility today, and ABB does not sell such a cell. Cells like this are usually built and tested first in RobotStudio, so every path can be checked before any metal is cut.

The EasyGrinder robot at Ancofer picks steel parts from pallets, grinds them and stacks them again. Photo: ABB

For patients, Charnley's basic design still does most of the work. A robot can help the surgeon put the implant where the plan says, and the surgeon's own experience still matters a great deal. Recovery happens at home with walking and exercise, where rehabilitation robots may play a larger part than the arm in the theatre. How fast robotic hips spread will depend on their price, on training for surgical teams and on long term data that will take years to collect.

An X-ray of a dislocated hip prosthesis, the ball out of its cup. Photo: Bill Rhodes / Wikimedia Commons (CC BY 2.0)

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