ArticleJournal of experimental orthopaedics2026
Intentional asymmetric balancing in robotic-assisted valgus TKA: Early outcomes and intraoperative laxity changes.
Article in Journal of experimental orthopaedics, 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
Purpose: To evaluate early patient-reported outcome measures (PROMs), radiographic alignment changes, intraoperative laxity changes and complications in a retrospective series of constitutional valgus knees treated with robotic-assisted total knee arthroplasty (TKA) using an intentional asymmetric balancing strategy and a semi-personalized (SP) alignment technique. Methods: This retrospective single-centre cohort included consecutive patients with end-stage valgus osteoarthritis (OA) and constitutional valgus morphotypes (coronal plane alignment of the knee III/VI) treated with imageless robotic-assisted TKA and a minimum follow-up of 12 months. The balancing workflow intentionally accepted mild residual lateral laxity. Medial and lateral compartment laxity (mm) were quantified intraoperatively at 0° and 90°. PROMs (Knee Society Score [KSS] and Forgotten Joint Score [FJS]), range of motion (ROM) and hip-knee-ankle angle (HKA) were assessed preoperatively and at the latest follow-up. Complications were recorded. Results: Fifty-eight patients were included at a mean follow-up of 26.5 ± 15.0 months. KSS Knee improved from 58.3 ± 9.4 to 87.9 ± 11.0 (mean change +29.6 points, 95% confidence interval [CI] = 26.0-33.2; Conclusion: In this retrospective single-surgeon series of constitutional valgus knees treated with robotic-assisted TKA, intentional asymmetric balancing was associated with good early clinical outcomes, correction towards less valgus alignment, and a reproducible reduction in lateral laxity, with a low complication rate. These findings support the feasibility of this measurable laxity-guided strategy, but do not establish superiority over alternative balancing philosophies. Level of Evidence: Level III, retrospective cohort.
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