Observational studyKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Femoral component rotational alignment in robotic-assisted total knee arthroplasty with functional knee positioning varies across knee phenotypes without affecting clinical outcomes.
Observational study 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 6 papers.
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Who cites it
6 citing papers in PubMed.
- 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
- Overstuffing of the lateral distal condyle is associated with worse intraoperative patellar tracking and postoperative lateral patellar tilt during robotic-assisted cruciate-retaining total knee arthroplasty.Journal of robotic surgery · 2026Article
- 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
- Robotic-assisted total knee arthroplasty: radiological precision, clinical outcomes, and benchmarks for emerging systems.Journal of robotic surgery · 2026Review
- Femoral component rotational alignment in robotic-assisted total knee arthroplasty with functional knee positioning varies across knee phenotypes without affecting clinical outcomes.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Observational
- Flexion gap discrepancy drives femoral rotational adjustment in robot-assisted TKA: a CPAK-Based phenotypic analysis.BMC musculoskeletal disorders · 2025Article
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Authors and funding
6 authors.
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Abstract
purposeThis retrospective, observational study aimed to investigate the distribution of femoral component rotational alignment among different knee phenotypes and assess the clinical relevance of femoral component rotation variability in patients undergoing image-based robotic-assisted total knee arthroplasty (RA-TKA) performed with functional knee positioning (FP). It was hypothesized that femoral component rotational alignment can change based on preoperative knee phenotypes, without affecting clinical outcomes.
methodsA total of 256 patients who underwent image-based RA-TKA with the Mako robotic system at a single centre from February 2020 to March 2022 were included. Preoperative robotic-derived computed tomography (CT) data were gathered to determine the Coronal Plane Alignment of the Knee (CPAK) classification and the axial orientation of the distal femur. Intraoperative data relative to femoral component rotational alignment were collected. At a minimum of 24 months post-operatively, patients were administered the Forgotten Joint Score-12 (FJS-12) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR). The distribution of femoral component rotation among phenotypes, as well as the relationships between alignment parameters and clinical outcomes, were assessed by means of linear regression models and one-way analysis of variance.
resultsA total of 219 cruciate retaining TKAs were considered for implant positioning assessment. Femoral component rotational alignment varied significantly among different knee phenotypes, ranging from -6.9° internal to 6.6° external rotation with respect to surgical transepicondylar axis. No significant association was found between femoral component rotation and patient-reported outcomes (FJS-12 and KOOS-JR). Three patients (1.4%) underwent RA-TKA revision, while no patello-femoral complications were reported in any of the patients.
conclusionsIn the setting of image-based RA-TKA performed with FP, the rotational alignment of the femoral component changes significantly among different knee phenotypes. These variations do not affect clinical outcomes at a minimum of 2 years of follow-up and do not result in significant patello-femoral complications. LEVEL OF EVIDENCE: Level III.
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