ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
Functional alignment achieves a more balanced total knee arthroplasty than either mechanical alignment or kinematic alignment prior to soft tissue releases.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 3 of them syntheses that pooled it.
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Who cites it
60 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Functional alignment in robotic total knee arthroplasty provides favourable outcomes and minimal early revisions: A systematic review and meta-analysis.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Pooled it
- Learning curve of robotic-assisted total knee arthroplasty: a literature review.Journal of robotic surgery · 2025Pooled it
- Functional alignment in robotic-assisted total knee arthroplasty: a systematic review.Archives of orthopaedic and trauma surgery · 2024Pooled it
- Coronal plane alignment of the knee (CPAK) phenotypes and their relationship with gap patterns in robotic-assisted total knee arthroplasty: a clinical trial.Orthopadie (Heidelberg, Germany) · 2026Trial
- EPMEDBOT robotic-assisted total knee arthroplasty amplifies the advantage of intraoperative dynamic gap balance and alignment monitoring - a prospective randomized controlled and single center study.Journal of orthopaedic surgery and research · 2025Trial
- Functional alignment is associated with increased incidence of pre-balance, reduced soft-tissue release, and post-operative pain compared to mechanical alignment in patients undergoing simultaneous bilateral robotic-assisted TKA.Journal of robotic surgery · 2023Trial
- [A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2023Trial
- Joint line obliquity change was associated with femoral and tibial resection patterns and smaller final flexion imbalance after robot-assisted total knee arthroplasty.Journal of experimental orthopaedics · 2026Article
- Kinematic Alignment in Total Knee Arthroplasty: Unresolved Challenges and Barriers to Overcome for Universal Application.Clinics in orthopedic surgery · 2026Review
- A Comparison of Medial and Lateral Ligament Balance in Functional Versus Simulated Mechanical Alignment in Total Knee Arthroplasty Across CPAK Phenotypes: A Single-Center Study.Journal of clinical medicine · 2026Article
- Radiographic Evaluation of Distal Femoral Sagittal Morphology Following Imageless Robotic-Assisted Total Knee Arthroplasty Using Functional Alignment.Journal of clinical medicine · 2026Article
- Influence of total knee arthroplasty on coronal plane phenotypes and associated clinical outcomes: a CPAK-based comparison between mechanical and functional alignment.Journal of robotic surgery · 2026Article
- Asia-Pacific expert consensus on robotic-assisted hip and knee arthroplasty.Arthroplasty (London, England) · 2026Review
- Bridging postural biomechanics and knee arthroplasty success.Arthroplasty (London, England) · 2026Review
- Final intraoperative gaps commonly exceed resection-based reference gaps during sequential balancing in imageless robot-assisted total knee arthroplasty.Journal of experimental orthopaedics · 2026Article
- Robot-Assisted TKA for Varus Knees: Post Hoc Exploratory Analysis of Alignment Strategy and Deformity Severity.Journal of clinical medicine · 2026Article
- Comparison of the Reliability and Gap Differences Between Using the Varus-Valgus Stress Technique and Paddles Technique in Pre-Resection Balancing Phase of Robotic-Assisted Total Knee Arthroplasty.Arthroplasty today · 2026Article
- Radiographic Accuracy and Consistency of Implant Placement Using the ROSALife (Basel, Switzerland) · 2026Article
- A minimal-incision and minimal-soft-tissue-injury (MISI) technique for robot-assisted total knee arthroplasty: a preliminary report.Journal of orthopaedic surgery and research · 2026Article
- Comparable outcomes and early revision rates between restricted and unrestricted functional knee positioning in robotic-assisted total knee arthroplasty for varus deformities ≥10°.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
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3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTotal knee arthroplasty with functional alignment uses pre-resection balancing to determine component position within the soft tissue envelope to achieve balance and restoration of native joint obliquity. The purpose of this study was to assess the balance achievable with a mechanical axis alignment and kinematic axis alignment plan, and the subsequent balance achievable after adjustment of the component position to functional alignment.
methodsA prospective cohort of 300 knees undergoing cruciate retaining total knee arthroplasty were included in this study. Of these, 130 were initially planned with mechanical alignment (MA) and 170 with kinematic alignment (KA). Maximal stressed virtual gaps were collected using an optical tracking software system. The gaps were measured medially and laterally in flexion and extension. Following assessment of balance, implant position was adjusted to balance the soft tissues in functional alignment (FA) and the maximal gaps reassessed. Gaps were considered to be balanced when within 2 mm of equality. Incidence of balance within each cohort was compared to independent samples proportions test.
resultsFunctional alignment obtained significantly better balance in extension, medially and overall than both MA and KA alignment without soft tissue release (p < 0.001). Overall balance was observed in 97% of FA knees, 73% of KA knees and in 55% of MA knees. The difference between KA and MA was also significant (p = 0.002). Whilst there was no difference observed in balanced achieved or limb alignment when FA was planned with either MA or KA, the joint line obliquity was maintained with an initial KA plan.
conclusionFunctional alignment more consistently achieves a balanced total knee arthroplasty than either mechanical alignment or kinematic alignment prior to undertaking soft tissue release. Utilising an individualised KA plan allows FA to best achieve the stated goals of maintaining joint line plane and obliquity. LEVEL OF EVIDENCE: Level III: retrospective cohort study.
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