ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical 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 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline 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
- Radiographic Evaluation of Distal Femoral Sagittal Morphology Following Imageless Robotic-Assisted Total Knee Arthroplasty Using Functional Alignment.Journal of clinical medicine · 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
- The three-pillar concept for functional knee positioning in robotic total knee arthroplasty.Journal of experimental orthopaedics · 2026Review
- Sagittal femoral morphology is not associated with coronal alignment phenotypes: A radiographic analysis from the Brescia Knee Research Group.Journal of experimental orthopaedics · 2026Article
- Short-term clinical outcomes of robotic-assisted total knee arthroplasty at 12-month follow-up: a prospective, multicenter, concomitant comparison to conventional total knee arthroplasty.Archives of orthopaedic and trauma surgery · 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
- Alignment and/or ligament balancing? Towards truly personalized total knee arthroplasty-A narrative review.Journal of experimental orthopaedics · 2026Review
- 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
- Robotic total knee arthroplasty with functional positioning safely addresses major coronal deformities: Comparable complications and survivorship.Journal of experimental orthopaedics · 2026Article
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- Total Knee Arthroplasty and the Evolution of Coronal Alignment: From Mechanical to Personalized Strategies.Journal of personalized medicine · 2025Review
- 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
- A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- The HKA axis varies significantly with knee motion: A robot-assisted intraoperative evaluation during total knee arthroplasty supports the use of dynamic, not static, alignment classifications.Journal of experimental orthopaedics · 2025Article
- Functional positioning in robotic patello-femoral arthroplasty: a step-by-step technique.SICOT-J · 2025Article
- Functional positioning in robotic medial unicompartmental knee arthroplasty: a step-by-step technique.SICOT-J · 2025Article
- Robotics total knee arthroplasty: is an image-based the only solution?Frontiers in surgery · 2025Review
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Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAlignment strategies in total knee arthroplasty (TKA) have predominantly emphasized coronal alignment in extension, with minimal focus on dynamic alignment during flexion. This study aims to identify the predictors of the intraoperative robotic hip-knee-ankle angle at 90° of flexion (rHKA-90F) and assess its clinical significance in postoperative outcomes, proposing that rHKA-90F may be a critical factor in enhancing functional results in TKA.
methodsA retrospective analysis was conducted on 180 patients with varus deformity undergoing robotic-assisted TKA under the functional alignment principles. Clinical outcomes were assessed using the Knee Society Score (KSS), Forgotten Joint Score (FJS-12) and Kujala Anterior Knee Pain Scale (AKPS) score. Predictors for final rHKA-90F and its intraoperative changes were identified using multiple linear regression models. Initial and intraoperative robotic measurements were also analyzed.
resultsSignificant predictors of the final rHKA-90F included femoral rotation, tibial varus/valgus alignment, initial rHKA-90F and the final robotic axis in extensions. Patients with a final rHKA-90F ≥ 5° of varus demonstrated superior KSS function and KSS knee compared to those with a final rHKA-90F between 0° and 4° of varus. Furthermore, patients with intraoperative changes of rHKA-90F > 2.5° neutralization (varus reduction or with a valgus value) achieved better FJS and AKPS score.
conclusionsThis study highlights the clinical relevance of rHKA-90F as an intraoperative tool in robotic knee arthroplasty, emphasizing the need to balance the correction of varus deformity with the maintenance of slight varus alignment in flexion. Personalized alignment strategies tailored to patient-specific anatomy and kinematics are crucial to optimizing outcomes. There is still a need for future research on the long-term effects of dynamic alignment. LEVEL OF EVIDENCE: Level III.
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