{"title":"Beyond the coronal plane in robotic total knee arthroplasty-Part 2: Combined flexion does not affect outcomes.","authors":"Luca Andriollo, Pietro Gregori, Christos Koutserimpas, Elvire Servien, Cécile Batailler, Sébastien Lustig","doi":"10.1002/ksa.12660","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Personalized 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.</p><p><strong>Methods: </strong>A 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.</p><p><strong>Results: </strong>Patients 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.</p><p><strong>Conclusions: </strong>Although 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.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ksa.12660","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Personalized 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.
Methods: A 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.
Results: Patients 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.
Conclusions: Although 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.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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