One hundred forty-eight patients with end-stage hip diseases were randomized to receive either robot-assisted total hip arthroplasty (RA-THA) (n=74) or manual total hip arthroplasty (MTHA) (n=74). The primary outcome of interest was the accuracy of implant placement, including acetabular and femoral prosthesis positioning. Secondary outcomes included operative time, femoral prosthesis filling rate, leg length discrepancy (LLD), Harris hip score, and visual analogue scale (VAS) score. Outcomes were assessed up to six months postoperatively. Overall, the results revealed that RA-THA resulted in significantly reduced femoral angulation and LLD compared to MTHA. However, operative time was significantly longer in the RA-THA group. The study confirms the accuracy and safety of the RA-THA system, particularly in restoring lower limb length and optimizing femoral prosthesis angulation.