ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Beyond the coronal plane in robotic total knee arthroplasty-Part 2: Combined flexion does 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 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
- 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
- Sagittal femoral morphology is not associated with coronal alignment phenotypes: A radiographic analysis from the Brescia Knee Research Group.Journal of experimental orthopaedics · 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
- Robot-assisted total knee arthroplasty is associated with reduced early anterior knee pain compared with conventional techniques : A propensity score-matched study.Orthopadie (Heidelberg, Germany) · 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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- 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
- 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
- Comparable outcomes with a potential functional advantage of PCL preservation in medial-stabilized total knee arthroplasty: A systematic review and meta-analysis from the FP-UCBM Knee Study Group.Journal of experimental orthopaedics · 2025Review
- Beyond the coronal plane in robotic total knee arthroplasty-Part 2: Combined flexion does not affect outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Robotics total knee arthroplasty: is an image-based the only solution?Frontiers in surgery · 2025Review
- 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
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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
purposePersonalized alignment in total knee arthroplasty (TKA) is becoming increasingly widespread, driven in part by advancements in robotic-assisted surgery. However, true personalization must extend beyond the coronal plane to include sagittal and axial planes. This study investigates the impact of combined flexion (CF) of the femoral and tibial components in robotic-assisted TKA within functional alignment (FA), also analyzing its variation (ΔCF) from native anatomy and its correlation with functional outcomes and complications.
methodsA retrospective analysis was conducted on 310 patients who underwent primary TKA using an image-based robotic system between March 2021 and January 2023. CF was calculated based on tibial slope (TS) and distal femoral flexion (DFF). Patients were stratified into groups based on CF (≤7.5° vs. >7.5°) and CF variation (ΔCF < -3, -3 to 3 and >3). Clinical scores, radiographic parameters and complication rates were analyzed.
resultsPatients with CF ≤ 7.5° had lower preoperative maximum flexion values (p = 0.005). No significant differences in complication rates or clinical outcomes were observed between groups. ΔCF were associated with post-operative coronal alignment changes (mechanical hip-knee-ankle angle and medial proximal tibial angle) but did not impact patient-reported outcomes. Additionally, subgroup analysis revealed that ΔCF were not linked to differences in implant survival, revision rates or mechanical failure.
conclusionsAlthough CF influences knee biomechanics, its direct impact on clinical outcomes remains unclear. It is evident that a personalized approach to sagittal alignment can be an integral component of functional knee positioning. LEVEL OF EVIDENCE: Level III.
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