ArticleJournal of robotic surgery2026
Imageless robotic assistance versus laser-projected mechanical-axis guidance in total knee arthroplasty: a deformity-stratified comparative cohort study.
Article in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Whether imageless robotic assistance provides measurable radiographic differences beyond laser-projected mechanical-axis guidance in total knee arthroplasty (TKA) is unclear. We studied 259 consecutive primary TKAs performed from 2023 to 2025 at a single high-volume practice: 110 manual, 99 laser-projected, and 50 imageless robotic-assisted procedures. The primary outcome was absolute postoperative hip-knee-ankle (HKA) angle error. Secondary outcomes were coronal component error, operative time, and observed patient out-of-pocket (OOP) payments. Pairwise 1:1 propensity-score matching compared laser-projected with manual TKA and robotic-assisted with laser-projected TKA; the latter comparison also used a prespecified high-varus stratum (preoperative varus ≥ 10°). Interaction models adjusted for clinical and coronal phenotype covariates. Mean absolute HKA error was 2.20°, 1.19°, and 0.95° in the manual, laser-projected, and robotic-assisted groups (P < .001). After 1:1 caliper matching, laser-projected TKA had lower HKA error than manual TKA (-1.01°, 95% CI -1.38 to -0.64; P < .001). HKA error did not differ between robotic-assisted and laser-projected TKA in the full cohort (-0.03°, P = .612; caliper sensitivity, -0.05°, P = .541). In high-varus matched pairs (n = 16), robotic-assisted TKA had lower femoral coronal error (-0.86°, Holm P = .019) and mean coronal component error (-0.61°, Holm P = .039), but neither finding persisted in the caliper sensitivity analysis. Robotic-assisted TKA had 14.41 min longer adjusted operative time and higher observed OOP payments (ratio, 1.208; 95% CI, 1.146 to 1.274); the CPI-standardized sensitivity ratio was 1.189. After caliper matching, laser-projected TKA had lower whole-limb alignment error than manual TKA. Whole-limb HKA error did not differ detectably between the two assisted workflows. In the exploratory high-varus subgroup, robotic-assisted TKA had lower femoral and mean coronal component error, but the small matched sample and lack of persistence in the caliper sensitivity analysis warrant cautious interpretation.
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