ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
Kinematic alignment fails to achieve balancing in 50% of varus knees and resects more bone compared to functional alignment.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 22 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- What Are the Optimal Sagittal Alignments in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.Orthopaedic surgery · 2026Pooled it
- Functional alignment in robotic-assisted total knee arthroplasty: a systematic review.Archives of orthopaedic and trauma surgery · 2024Pooled it
- Association between abnormal native tibial torsion and poorer clinical outcomes following robotic-assisted total knee arthroplasty: follow-up of at least two years.Journal of robotic surgery · 2026Article
- The three-pillar concept for functional knee positioning in robotic total knee arthroplasty.Journal of experimental orthopaedics · 2026Review
- Alignment and/or ligament balancing? Towards truly personalized total knee arthroplasty-A narrative review.Journal of experimental orthopaedics · 2026Review
- Robotic Total Knee Replacement: Single-Centre, Prospective, Non-Randomised Comparative Study Comparing Restricted Kinematic Alignment Combined with a Load Sensor Versus Functional Alignment.Journal of clinical medicine · 2026Article
- Alignment Philosophies in Total Knee Arthroplasty: A Comprehensive Narrative Review.Arthroplasty today · 2026Article
- Are current total knee arthroplasty implants tested and approved for personalised alignment?Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Comparable outcomes between cruciate-retaining and posterior-stabilized implants following functionally aligned robotic-assisted total knee arthroplasty for varus knee osteoarthritis.Journal of robotic surgery · 2025Article
- Femoral component rotational alignment in robotic-assisted total knee arthroplasty with functional knee positioning varies across knee phenotypes without affecting clinical outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Observational
- The impact of soft tissue release on radiological and clinical outcomes in functional alignment robot-assisted total knee arthroplasty.Journal of orthopaedic surgery and research · 2025Article
- Femur rotational alignment in total knee arthroplasty: Delphi consensus statements from European knee society (EKS).Archives of orthopaedic and trauma surgery · 2025Article
- Functional Alignment Achieved a More Balanced Knee After Robotic Arm-Assisted Total Knee Arthroplasty than Modified Kinematic Alignment.Journal of clinical medicine · 2025Article
- Article
- Outcomes following functionally aligned total knee arthroplasty in severe varus deformity.Journal of clinical orthopaedics and trauma · 2025Article
- Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review.Journal of clinical medicine · 2024Review
- Functional alignment in total knee arthroplasty best achieves balanced gaps and minimal bone resections: an analysis comparing mechanical, kinematic and functional alignment strategies.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Coronal alignment in total knee arthroplasty: a review.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2023Review
- How does the use of quantified gap-balancing affect component positioning and limb alignment in robotic total knee arthroplasty using functional alignment philosophy? A comparison of two robotic platforms.International orthopaedics · 2023Article
- Pre-Planning the Surgical Target for Optimal Implant Positioning in Robotic-Assisted Total Knee Arthroplasty.Bioengineering (Basel, Switzerland) · 2023Article
Corrections and comments
- Erratum issued
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeEvidence is emerging that tibio-femoral compartmental balancing is related to clinical outcomes after total knee arthroplasty (TKA). The purpose of this study was to assess if kinematic alignment (KA) delivered a balanced knee in flexion and extension after TKA on varus deformity, compared to functional alignment (FA).
methodsThis single-centre retrospective cohort study assessed 110 consecutive TKAs performed with an image-based robotic system for pre-operative varus deformity. The ligament balancing in the medial and lateral femorotibial compartments was assessed intra-operatively with a robotic system to evaluate if a KA plan would deliver a balanced knee. Balance was considered achieved if tibio-femoral compartments (medial/lateral) were equal to or less than 1.5 mm, or if the estimated final gap position more than 2 mm from the global implant thickness (17 mm). Implant positioning was modified within limits previously defined for a FA philosophy to achieve balancing. Resection thickness and implant positioning were compared with the KA plan and after the FA adjustments; and also, between the patients with a final balanced knee in extension and at 90° of flexion.
resultsA total of 102 patients were eligible for final analysis. Mean age was 67.3 ± 8.2 years, average BMI was 29.1 ± 5.2 kg/m
conclusionKA failed to deliver a balanced TKA in more than 50% of cases, especially regarding the flexion gap. Consideration of soft tissue laxity led to significantly less bone resection, with more externally rotated femoral component and more varus tibial component.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.