ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Functional alignment in robotic-assisted total knee arthroplasty for valgus deformity achieves safe coronal alignment and excellent short-term outcomes.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
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Who cites it
32 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
- Robotic-assisted total knee arthroplasty for severe fixed valgus deformity: a systematic review of alignment restoration, soft tissue balancing strategies, and clinical outcomes.Journal of robotic surgery · 2026Pooled it
- Precision soft tissue balance in robot-assisted total knee arthroplasty: a bibliometric and visualization analysis of dynamic gap equilibration.Journal of robotic surgery · 2026Pooled it
- Magnitude of intraoperative femoral rotational adjustment from the initial plan is associated with slower early recovery after robotic-assisted functional-alignment TKA.Journal of robotic surgery · 2026Article
- Functional alignment: Defined personalized alignment strategy with promising outcomes and room for improvement.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Unrestricted kinematic alignment on the sagittal plane: Posterior tibial slope and combined flexion do not have boundaries to respect in terms of short-term clinical outcomes and safety.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Proximal Tibial Resection Alone Leads to a Significant Increase in Flexion Gap Size in Tibia-First Robotic-Assisted Posterior-Stabilized Total Knee Arthroplasty.Clinics in orthopedic surgery · 2026Observational
- Personalized alignment in total knee arthroplasty reduces patellar tilt: A retrospective study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 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
- Robotic-Assisted Total Knee Arthroplasty in Complex Primary and Revision Cases: A Systematic Review.Current reviews in musculoskeletal medicine · 2026Review
- Intentional asymmetric balancing in robotic-assisted valgus TKA: Early outcomes and intraoperative laxity changes.Journal of experimental orthopaedics · 2026Article
- Patient-Specific Restoration of Constitutional Alignment Within Predefined Safety Boundaries Using Three-Dimensional Navigation in Primary Total Knee Arthroplasty: One-Year Clinical and Radiographic Outcomes.Journal of clinical medicine · 2026Article
- Unrestricted Kinematic Alignment Is a Feasible Strategy for Lateral Compartment Osteoarthritis: Short-Term Outcomes of a Contralateral Knee-Referenced Approach.Journal of clinical medicine · 2026Article
- Functional alignment preserves the native Coronal Plane Alignment of the Knee phenotype while improving early clinical outcomes after robotic-assisted total knee arthroplasty.Orthopedic reviews · 2026Article
- Short-Term Clinical Outcomes of a Manual "Inside-Out" Algorithm for Correcting Ranawat Grade II and III Valgus Deformity in Total Knee Arthroplasty.Advances in orthopedics · 2026Article
- Preoperative flexion contracture does not impair outcomes or early revision rates following robotic total knee arthroplasty with functional alignment.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Article
- Robotic total knee arthroplasty with functional positioning safely addresses major coronal deformities: Comparable complications and survivorship.Journal of experimental orthopaedics · 2026Article
- Does patellar resurfacing matter in robotic-assisted total knee arthroplasty with functional alignment principles?Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Functional alignment in robotic total knee arthroplasty achieves comparable outcomes in varus and valgus knees despite distinct intraoperative strategies: Analysis of 355 consecutive cases.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
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Authors and funding
6 authors.
Funding
Abstract
purposeFunctional alignment (FA) in total knee arthroplasty (TKA) prioritizes soft tissue balancing and anatomical restoration without systematic correction to neutral alignment. Most studies have focused on varus deformity, with little evidence available about FA in valgus deformity. The hypothesis of the present study was that FA in robotic-assisted TKA for valgus deformity would demonstrate correction of the coronal alignment and yield satisfactory short-term outcomes.
methodsThis retrospective study included 58 patients with valgus coronal alignment (hip-knee-angle [HKA] ≥ 183°) who underwent robotic-assisted TKA using the FA technique with a minimum of 1-year follow-up. Outcomes were assessed through the Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and radiographic measurements of alignment and phenotypes. Complication and revision rates were also analyzed.
resultsThe cohort included 39 females and 19 males with a median age of 70. Post-operatively, 86.2% of cases achieved coronal alignment within the safe zone (HKA 177-183°). Significant improvements were observed in KSS (part 1: 69.5-95, part 2: 65-94, p < 0.001), while OKS and FJS exhibited optimal outcomes. Two complications were recorded: one aseptic loosening (1.7%) and one early infection (1.7%). Kaplan-Meier survival analysis indicated favourable implant survivorship at a median follow-up of 18 months.
conclusionFA in image-based robotic TKA is a safe and effective approach for patients with valgus deformity. This procedure resulted in a modest correction of the coronal alignment, where no soft tissue releases were needed. The majority of the cases fell within the target coronal alignment boundaries by only accommodating the individual laxities, suggesting the aim of FA to restore each knee's pre-pathological alignment. LEVEL OF EVIDENCE: Level IV.
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