80 patients scheduled for total knee arthroplasty were randomized to undergo implantation through pinless navigation or with conventional instrumentation. The purpose of this study was to determine whether pinless navigation could reduce outliers (+/-3 degrees from planned alignment) of hip-knee-ankle (HKA) angle, femoral, and tibial alignment without increasing operative time. Radiographs were used to determine outliers, and the length of each surgery was recorded. Results indicated that pinless navigation led to significantly fewer HKA and femoral outliers. However, standard navigation allowed for less revisions and shorter operative times.