Koper MC, Reijman M, van Es EM, et al. - In this multicenter, single-blinded, randomized, controlled trial, researchers assessed imageless Computer Assisted Surgery (CAS) compared with manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). They assumed that the use of CAS would optimize the femoral component's position and improve PROMs. In total, 122 individuals were randomized, 61 in the CAS group and 61 in the conventional group. No significant differences were found in the accuracy of femoral implant position. The mean difference in the CAS and Conventional group between the postoperative- and preplanned Stem Shaft Angle was − 2.26 and − 1.75 degrees (more varus). Compared with manual implantation, no benefit was observed for the use of CAS in the accuracy of placement of the femoral component in Hip Resurfacing Arthroplasty (HRA). After 1 year follow up, there were no clinical differences in PROMs. This investigation demonstrated no added value and no rationale for the use of CAS in femoral component positioning in HRA.