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Imageless robotic assisted TKA: a systematic review.

Alessandro El Motassime1,2,3, Greta Tanzi Germani1,2,3, Rudy Sangaletti3

  • 1Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito, 8, 00168, Rome, Italy.

Journal of Orthopaedics
|February 24, 2026
PubMed
Summary

Imageless robotic-assisted total knee arthroplasty (RATKA) shows significant improvements in patient function and radiological outcomes. This technology offers a safe and accurate approach to knee replacement surgery with a low complication rate.

Keywords:
ImagefreeImagelessRoboticRobotic TKATotal knee arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Robotics in Medicine
  • Medical Technology

Background:

  • Imageless robotic-assisted total knee arthroplasty (RATKA) is an emerging technology aimed at enhancing surgical precision.
  • It seeks to improve patient outcomes and minimize complications in total knee replacement procedures.

Purpose of the Study:

  • To systematically review the clinical efficacy, safety, and radiological accuracy of imageless RATKA.
  • Evaluate the overall performance and reliability of this surgical approach.

Main Methods:

  • Systematic review adhering to PRISMA guidelines, registered with PROSPERO.
  • Comprehensive literature search across PubMed, Scopus, and Web of Science databases.
  • Quality assessment using Modified Coleman Score, RoB 2, and ROBINS-I tools; descriptive synthesis and meta-analysis.

Main Results:

  • Eight studies with 612 knees were analyzed, showing moderate methodological quality.
  • Significant improvements observed in functional scores: KSS, KSS-F, and KOOS-JR.
  • Low overall complication rate of 2.4%, with surgical site infection as the most frequent adverse event.

Conclusions:

  • Imageless RATKA demonstrates significant functional and radiological benefits.
  • The technology is associated with a low complication rate and acceptable short-term safety.
  • Consistency in patient-reported outcome measures and alignment data supports the accuracy and reliability of imageless systems.