2026 AAHKS Annual Meeting: Does Imageless Navigation Add Value Beyond CT-Based 3D Planning in Primary THA? An RCT

106 patients undergoing primary uncemented total hip arthroplasty (THA) for osteoarthritis were randomized to receive computed tomography (CT)-based three-dimensional (3D) planning alone (3D-Only; n=56) or 3D planning combined with intraoperative imageless navigation (3D-Nav; n=50). The primary outcome was the absolute deviation between planned and achieved centre of rotation (COR) and component orientation. Secondary outcomes included the proportion of hips meeting predefined radiographic accuracy thresholds and changes in patient-reported outcomes, including the Oxford Hip Score (OHS) and EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L). Outcomes were assessed postoperatively and at 12 months. Overall, the results revealed no significant differences in reconstruction accuracy, component positioning, or patient-reported outcomes between groups. These findings suggested that adding imageless navigation to CT-based 3D planning did not improve early surgical or functional outcomes following primary THA.