{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:58:54Z","timestamp":1785405534602,"version":"3.56.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Robotic\u2010assisted total knee arthroplasty (TKA) is increasingly adopted worldwide, yet comparative data on the rotational accuracy of image\u2010based and imageless platforms remain limited. The aim of this study was to compare the accuracy of image\u2010based and imageless robotic platforms in achieving planned femoral rotation in primary TKA. We hypothesized that the two platforms would be equivalent, with any difference within \u00b11\u00b0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single\u2010surgeon retrospective cohort study included patients undergoing image\u2010based and imageless robotic\u2010assisted TKA for primary osteoarthritis. All patients underwent pre\u2010 and postoperative computed tomography (CT) scans. Native femoral rotation was defined using the transepicondylar axis (TEA)\u2013posterior condylar axis (PCA) angle. Femoral rotation was planned intraoperatively relative to the PCA, and postoperative TEA\u2013PCA was measured on CT. Accuracy was defined as the absolute difference between achieved and intended rotation. Measurements were independently performed by two blinded fellowship\u2010trained knee surgeons. Statistical analysis included two one\u2010sided tests (TOST) equivalence testing and analysis of covariance (ANCOVA). Significance was set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 150 TKAs were included (imageless 79, image\u2010based 71). Patients in the image\u2010based group were younger (67.7 vs. 71.3 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), with no other baseline differences. The mean rotational error was 1.3\u2009\u00b1\u20091.0\u00b0 for imageless and 1.2\u2009\u00b1\u20091.2\u00b0 for image\u2010based TKA (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.346; effect size \u22120.09). Equivalence testing confirmed statistical equivalence, with the 90% confidence interval (\u20130.23 to 0.31) lying within the predefined \u00b11\u00b0 margin (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). ANCOVA demonstrated a small adjusted difference of 0.51\u00b0 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045), with minimal explained variance (adjusted\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.01). Intra\u2010observer reliability was excellent (intraclass correlation coefficient [ICC] 0.91), while inter\u2010observer reliability was good (ICC 0.82). No differences were observed in patient\u2010reported outcomes, except lower pain scores in the image\u2010based group at 12 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Image\u2010based and imageless robotic platforms demonstrated equivalent accuracy in achieving planned femoral rotation in primary TKA. Any observed differences were not clinically meaningful.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective comparative cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70553","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:06:20Z","timestamp":1785402380000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Equivalent accuracy of image\u2010based and imageless robotic platforms in achieving planned femoral rotation in primary total knee arthroplasty: A CT\u2010based study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3080-0052","authenticated-orcid":false,"given":"Fabio","family":"Mancino","sequence":"first","affiliation":[{"name":"Sydney Orthopaedic Research Institute (SORI) The Knee Institute, Landmark Orthopaedics St. Leonards New South Wales Australia"},{"name":"The Orthopaedic Research Foundation of Western Australia (ORFWA) Claremont Western Australia Australia"},{"name":"The University of Western Australia (UWA) Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Sydney Orthopaedic Research Institute (SORI) The Knee Institute, Landmark Orthopaedics St. Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Parker","sequence":"additional","affiliation":[{"name":"Sydney Orthopaedic Research Institute (SORI) The Knee Institute, Landmark Orthopaedics St. Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett A.","family":"Fritsch","sequence":"additional","affiliation":[{"name":"Sydney Orthopaedic Research Institute (SORI) The Knee Institute, Landmark Orthopaedics St. Leonards New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"issue":"2","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"236","DOI":"10.3390\/medicina59020236","article-title":"Robotic\u2010assisted total knee arthroplasty utilizing NAVIO, CORI imageless systems and manual TKA accurately restore femoral rotational alignment and yield satisfactory clinical outcomes: a randomized controlled trial","volume":"59","author":"Adamska O","year":"2023","journal-title":"Medicina"},{"issue":"11","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"4833","DOI":"10.1007\/s00167-023-07523-8","article-title":"Image\u2010free handheld robotic\u2010assisted technology improved the accuracy of implant positioning compared to conventional instrumentation in patients undergoing simultaneous bilateral total knee arthroplasty, without additional benefits in improvement of clinical outcomes","volume":"31","author":"Albelooshi A","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"11","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"3585","DOI":"10.1007\/s00167-020-06283-z","article-title":"MAKO CT\u2010based robotic arm\u2010assisted system is a reliable procedure for total knee arthroplasty: a systematic review","volume":"29","author":"Batailler C","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"2","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.2106\/JBJS.24.00207","article-title":"Achieving better clinical outcomes after total knee arthroplasty in knees with valgus deformity: the role of alignment strategies","volume":"107","author":"Batailler C","year":"2025","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.arth.2011.06.035","article-title":"The \u201cforgotten joint\u201d as the ultimate goal in joint arthroplasty: validation of a new patient\u2010reported outcome measure","volume":"27","author":"Behrend H","year":"2012","journal-title":"J Arthroplasty"},{"issue":"1","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1302\/0301-620X.84B1.0840050","article-title":"Fluoroscopic analysis of the kinematics of deep flexion in total knee arthroplasty. 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