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Differences between image-based and imageless robotics for total knee arthroplasty - an overview.

Hannes Vermue1,2, Cécile Batailler2, Sébastien Lustig2

  • 1Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Journal of Orthopaedics
|October 15, 2025
PubMed
Summary

Robot-assisted total knee arthroplasty (TKA) offers enhanced precision. Image-based systems may provide superior accuracy, while imageless systems reduce costs and radiation, though both show similar coronal alignment. Long-term outcomes require further study.

Keywords:
Computer-assistedImage-basedImagelessRobot-assistedRoboticsTotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Robotics in Medicine
  • Biomechanical Engineering

Background:

  • Robot-assisted total knee arthroplasty (TKA) improves implant positioning.
  • Significant differences exist between image-based and imageless robotic systems.
  • These differences impact accuracy, workflow, and clinical outcomes.

Purpose of the Study:

  • To provide a structured comparison of image-based and imageless robotic systems for TKA.
  • To analyze key differences relevant to surgeons.
  • To review coordinate system accuracy, landmark identification, resection precision, and clinical implications.

Main Methods:

  • Review of current concepts comparing image-based and imageless robotic TKA systems.
  • Analysis of data on coordinate system accuracy, landmark registration, and resection precision.
  • Evaluation of clinical implications, including radiation exposure and patellofemoral tracking.

Main Results:

  • Image-based systems may offer superior accuracy in defining coordinate systems (e.g., rotational axes) but are more costly and complex.
  • Imageless systems reduce costs and radiation exposure but may have higher inaccuracy in coordinate system definition.
  • Both systems show similar coronal plane alignment error; image-based systems may offer better tibial slope precision. Evidence on long-term outcomes is limited.

Conclusions:

  • Both image-based and imageless robotic systems enhance implant positioning in TKA compared to conventional methods.
  • Image-based systems may offer advantages in specific accuracy metrics, while imageless systems provide cost and radiation benefits.
  • Further research is needed to establish definitive mid- and long-term clinical outcome advantages over conventional TKA.