Sixty patients with varus deformity knee osteoarthritis were randomized to receive a kinematically-aligned total knee arthroplasty using an accelerometer-based portable navigation system (iASSIST; n=30) or a conventional, image-free navigation system (OrthoPilot; n=30) for tibial bone resection. The outcomes of interest included tibial component angle, posterior slope angle, number of alignment outliers, hip-knee-ankle angle, range of motion in flexion and extension, and the 2011 Knee Society Score (KSS) sub-scores for objective knee indicators, satisfaction, expectations, and functional activity. Radiographic evaluations were performed at 1 month follow-up, and clinical outcomes were assessed at 1 year follow-up. Results revealed no significant differences in all outcomes between the two navigation systems (p>0.05 for all).