ArticleJournal of orthopaedic surgery and research2026
Deviation from native medial posterior tibial slope and dose-response relationships with forgotten joint score-12 in Robot-assisted versus conventional manual total Knee arthroplasty: A retrospective cohort study.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRobot-assisted total knee arthroplasty (TKA) enables high-precision osteotomy, but the clinical choice between pursuing a population-wide optimal posterior tibial slope (PTS) and individualizing the restoration of the native anatomical PTS remains debated. This study quantified the dose-response relationship between PTS deviation from native anatomy and the Forgotten Joint Score-12 (FJS-12), comparing outcomes between robot-assisted and conventional manual TKA.
methodsA retrospective cohort study analyzed 240 patients who underwent primary unilateral posterior-stabilized TKA, divided equally into conventional manual (n = 120) and robot-assisted (n = 120) groups. Postoperative PTS and absolute osteotomy errors were measured via CT scans. At the 1-year follow-up, the primary outcomes assessed were maximum active flexion and FJS-12 scores. Multivariate linear and quadratic regressions were utilized to map the association between postoperative PTS, absolute native deviation, and functional outcomes. Subgroup analysis was conducted using a 2° PTS deviation (Δ) threshold.
resultsThe robot-assisted group demonstrated a significantly lower absolute osteotomy error than the conventional group (1.2° ± 0.9° vs. 2.8° ± 1.6°, P < 0.001). Although the robotic cohort showed statistically greater maximum flexion and FJS-12 scores, objective functional metrics (KSS, OKS, WOMAC) did not significantly differ between groups. Regression analysis revealed a linear correlation between PTS and flexion (β = 1.9) and a quadratic (inverted U-shaped) relationship between PTS and FJS-12, peaking at approximately 5.3°. Crucially, greater deviation from the native PTS independently impaired FJS-12 scores (β = - 2.4). Subgroup analysis confirmed that patients with a precise reconstruction (Δ ≤ 2°) achieved distinctly higher FJS-12 scores compared to high-deviation groups (Δ > 2°), regardless of the surgical modality employed.
conclusionsThe postoperative PTS exhibits a nonlinear relationship with subjective joint awareness, with a population-level optimum of approximately 5.3°. However, anatomical deviation from the native PTS is an independent predictor of worsening FJS-12 scores. While robotic assistance is highly effective at minimizing extreme biomechanical outliers, surgical planning should prioritize the precise restoration of individualized native anatomy over universally fixed targets to maximize patient satisfaction.
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