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Cohort studyKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026

Equivalent accuracy of image-based and imageless robotic platforms in achieving planned femoral rotation in primary total knee arthroplasty: A CT-based study.

Fabio Mancino, Ignacio Fernandez, David A Parker, Brett A Fritsch

SurgeryCohort study

Image-based and imageless robotic platforms show equivalent accuracy in total knee arthroplasty.

Equivalent accuracy of image-based and imageless robotic platforms in achieving planned femoral rotation in primary total knee arthroplasty: A CT-based study.

Fabio Mancino … Brett A Fritsch

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026

Background

Robotic-assisted total knee arthroplasty (total knee arthroplasty) is increasingly adopted worldwide, yet comparative data on the rotational accuracy of image-based and imageless platforms remain limited.

Purpose

The aim of this study was to compare the accuracy of image-based and imageless robotic platforms in achieving planned femoral rotation in primary total knee arthroplasty.

Methods

This single-surgeon retrospective cohort study included patients undergoing image-based and imageless robotic-assisted total knee arthroplasty for primary osteoarthritis.

n = 79, image

Results

this range confirms both robotic methods are equally accurate in thigh bone rotation

imageless

1.3°

image-based

1.2°

More results

The mean rotational error was 1.3 ± 1.0° for imageless and 1.2 ± 1.2° for image-based total knee arthroplasty (p = 0.346; effect size -0.09).

Analysis of covariance demonstrated a small adjusted difference of 0.51° (p = 0.045), with minimal explained variance (adjusted R 2 = 0.01).

More results

Intra-observer reliability was excellent (intraclass correlation coefficient [ICC] 0.91), while inter-observer reliability was good (ICC 0.82).

No differences were observed in patient-reported outcomes, except lower pain scores in the image-based group at 12 months.

“

Conclusion · 1 of 2

Image-based and imageless robotic platforms demonstrated equivalent accuracy in achieving planned femoral rotation in primary total knee arthroplasty. Any observed differences were not clinically meaningful.

Conclusion · 2 of 2

LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.

Post

Equivalent accuracy of image-based and imageless robotic platforms in achieving planned femoral rotation in primary total knee arthroplasty: A CT-based study.

Image-based and imageless robotic platforms show equivalent accuracy in total knee arthroplasty.

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