ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Beyond the coronal plane in robotic total knee arthroplasty-Part 1: Variations in tibial slope and distal femoral flexion do not affect 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 27 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 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
- 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
- Radiographic Evaluation of Distal Femoral Sagittal Morphology Following Imageless Robotic-Assisted Total Knee Arthroplasty Using Functional Alignment.Journal of clinical medicine · 2026Article
- Augmented Reality-Guided Individualized Total Knee Arthroplasty: Initial Clinical Implementation and Results.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 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
- Sagittal femoral morphology is not associated with coronal alignment phenotypes: A radiographic analysis from the Brescia Knee Research Group.Journal of experimental orthopaedics · 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
- Posterior tibial slope varies across functional tibial phenotypes but not CPAK categories: A radiographic analysis from the FP-UCBM Knee Study Group.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- Iatrogenic coronal-sagittal coupling driven by a 12.4° rotational mismatch in manual total knee arthroplasty and precise decoupling with robotic assistance: a radiographic retrospective cohort study.Arthroplasty (London, England) · 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
- Article
- Robotic total knee arthroplasty with functional positioning safely addresses major coronal deformities: Comparable complications and survivorship.Journal of experimental orthopaedics · 2026Article
- Article
- 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
- Global bibliometric analysis of molecular imaging-guided robotic-assisted surgery: publication dynamics, thematic evolution, authorship patterns, and disciplinary landscape development (1982-2025).Journal of robotic surgery · 2025Article
- The 'over-the-top' technique allows for accurate and reproducible restoration of the native tibial slope in kinematically aligned total knee arthroplasty: A retrospective comparative analysis from the FP-UCBM Knee Study Group.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- 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
- Flexion gap discrepancy drives femoral rotational adjustment in robot-assisted TKA: a CPAK-Based phenotypic analysis.BMC musculoskeletal disorders · 2025Article
- Inverse Kinematic Alignment in Robot-Assisted Total Knee Arthroplasty: A Simplified Surgical Technique.Arthroplasty today · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeRobotic-assisted total knee arthroplasty (TKA) and new alignment principles are transforming traditional implant positioning, not only in the coronal plane but also in the sagittal and axial planes. The impact of differences between a patient's native tibial slope (TS) and distal femoral flexion (DFF) compared to the final implant positioning remains unclear. This study aims to evaluate whether variations in TS (ΔTS) and DFF (ΔDFF) play a role in clinical outcomes and implant survival.
methodsThis retrospective study analysed patients who underwent robotic-assisted TKA following functional alignment (FA) principles between March 2021 and January 2023. A total of 310 patients were included. Preoperative and postoperative data, including radiographic and robotic measurements, were collected. Clinical outcomes (KSS, FJS-12 and AKPS), range of motion (ROM), complication rates, and implant survival were compared between groups at a minimum of 2 years follow-up.
resultsAt the final follow-up (mean 2.93 ± 0.62 years), no significant differences were found in clinical scores or ROM between groups with different ΔTS or ΔDFF values. Complication rates and implant survival (99%) were also similar. However, patients with ΔTS > 5° had a slightly increased femoral valgus alignment, while those with ΔDFF ≤ 5° had lower preoperative ROM, with the femoral implant positioned in varus.
conclusionsVariations between native and implant TS and DFF in robotic-assisted TKA do not negatively impact functional outcomes or implant survival. A personalised sagittal alignment approach within the concept of FA represents a progression to a functional knee positioning based on three dimensions. Further research is needed to explore the long-term effects of sagittal alignment on TKA performance. LEVEL OF EVIDENCE: Level III.
Indexed as
Identifiers
What OpenQuestion holds
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.