Trial reportKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2026
Imageless and image-based robotic-assisted total knee arthroplasty achieve equivalent radiographic accuracy: A randomised controlled trial.
Trial report in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Robot-assisted total knee arthroplasty and the risk of postoperative infection: a systematic review and meta-analysis.Journal of robotic surgery · 2026Pooled it
- Robotic-assisted total knee arthroplasty: accuracy, clinical outcomes, complications, learning curve and cost-effectiveness: a critical clinical review.Journal of robotic surgery · 2026Review
- Imageless robotic assistance versus laser-projected mechanical-axis guidance in total knee arthroplasty: a deformity-stratified comparative cohort study.Journal of robotic surgery · 2026Article
- Radiographic Evaluation of Distal Femoral Sagittal Morphology Following Imageless Robotic-Assisted Total Knee Arthroplasty Using Functional Alignment.Journal of clinical medicine · 2026Article
- Robotics in revision knee arthroplasty: Solution, support tool or new source of complexity?Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
purposeRobotic-assisted total knee arthroplasty systems offer both image-based and imageless workflows, but their comparative accuracy remains unclear. The robotic surgical assistant (ROSA) system uniquely provides both approaches within a single platform. This study compared radiographic accuracy between image-based and imageless ROSA-assisted total knee arthroplasty (ROSA-TKA).
methodsThis double-blind, randomised controlled trial included patients with primary knee osteoarthritis randomised to imageless (n = 47) versus image-based (n = 48) ROSA-TKA. Primary outcomes assessed the differences between final intraoperative planned measurements (FIPM), robotic-validated measurements (RVM) after bone cuts and postoperative scannogram measurements (PSM) across five radiographic alignment parameters measured at 12 weeks: hip-knee-ankle angle, femoral coronal and sagittal alignment, tibial coronal alignment and tibial slope. Secondary outcomes included functional scores and complications.
resultsBoth techniques demonstrated equivalent radiographic accuracy with no significant differences between groups. Mean differences between FIPM and RVM were ≤1 degree for all parameters, achieving 93.6%-100% accuracy within 2-degree thresholds. No significant differences were observed between imageless and image-based approaches in comparisons of FIPM and RVM with postoperative scanograms. However, these comparisons showed larger differences (1.2-2.5 degrees) and lower accuracy rates (48.9%-87.5% within 2-degree thresholds), with sagittal alignment showing the greatest variation. Functional outcomes improved equally in both groups at 6 and 12 weeks, with comparable registration times and no complications.
conclusionBoth imageless and image-based ROSA-TKA achieved equivalent radiographic accuracy and clinical outcomes. The choice between techniques should be based on practical workflow considerations rather than accuracy concerns, as both approaches deliver comparable precision and excellent safety profiles. CLINICAL
trial registrationThis study was registered in the Thai Clinical Trials Registry (TCTR20240614001). LEVEL OF EVIDENCE: Level I.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.