Robotic-Assisted Dynamic Intraoperative Assessment of Coronal Plane Stability Across the Range of Motion During Total Knee Arthroplasty.

Introduction: Mid-flexion instability and variable gap balancing across the range of motion remain key challenges in achieving optimal outcomes in total knee arthroplasty (TKA). Different robotic systems, as well as traditional methods of gap assessment, are static and subjective, often failing to detect subtle instabilities intraoperatively. We describe a novel technical approach using a computed tomography-based Cuvis joint robotic system to perform real-time, dynamic assessment of coronal plane stability throughout knee motion. Technique: Using the Cuvis joint robotic system, intraoperative gap assessment was performed in a dynamic fashion during TKA. The robot enabled continuous quantification of medial and lateral gaps across the entire arc of motion (0-120°/maximum possible range) after putting in the trial prosthesis, both in neutral alignment and under controlled valgus and varus stress. The data-driven interface allowed for precise numerical evaluation of joint stability and identification of any mid-flexion or range-dependent instabilities. Results: The robotic-assisted method provided comprehensive, reproducible, and objective stability profiles, aiding intraoperative decision-making. Adjustments in soft-tissue balancing and component positioning were guided by quantitative feedback, allowing tailored correction of asymmetric or unstable gaps. Conclusion: Dynamic, robot-assisted intraoperative assessment using the Cuvis joint system offers a promising advancement in TKA, improving the precision of coronal plane balancing across the full range of motion. This technique enhances the surgeon's ability to detect and address instabilities that may be missed with static assessments.