{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:51:36Z","timestamp":1787583096817,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Robotic\u2010assisted total knee arthroplasty (TKA) has emerged as a reliable strategy to improve surgical accuracy and enable functional alignment (FA), also referred to as functional knee positioning (FKP). However, its application in patients with major coronal plane deformities remains under\u2010investigated. This study aimed to evaluate complication rates, implant survival, radiographic outcomes and patient\u2010reported measures in patients with severe deformities undergoing robotic\u2010assisted TKA with FA\/FKP principles compared to matched controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective comparative study was conducted on patients who underwent robotic\u2010assisted TKA between March 2021 and February 2023 at a single high\u2010volume centre. Patients with \u226515\u00b0 varus or \u226510\u00b0 valgus deformity were included in the study group and matched 1:1 with controls presenting neutral alignment. All procedures used the Mako robotic\u2010arm\u2010assisted system with standardised FA\/FKP principles. Clinical outcomes included knee society score (KSS), forgotten joint score (FJS\u201012), Kujala anterior knee pain scale (AKPS) and range of motion. Radiographic measurements and robotic data were assessed. Complications, reoperations and revision rates were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty\u2010eight patients (44 per group) were analysed, with a mean follow\u2010up of 2.8\u2009\u00b1\u20090.9 years. Complication and revision rates were comparable between groups (revision: 2.3% vs. 0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.987). Patients with major deformities achieved higher FJS\u201012 scores (83.9\u2009\u00b1\u200920.2 vs. 74.9\u2009\u00b1\u200919.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040), although the difference did not exceed the minimal clinically important difference (MCID\u2009=\u20099.9). Postoperative mHKA was less neutral in the deformity group (176.8\u00b0\u2009\u00b1\u20094.7 vs. 180.0\u00b0\u2009\u00b1\u20093.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), without adverse impact on implant survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Robotic\u2010assisted TKA performed with FA\/FKP principles appears to be a feasible option for patients with severe varus or valgus deformities. Despite residual alignment variability, complication and revision rates remained comparable to standard cases, and patient\u2010reported outcomes suggested greater perceived functional improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70613","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T14:57:25Z","timestamp":1768229845000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Robotic total knee arthroplasty with functional positioning safely addresses major coronal deformities: Comparable complications and survivorship"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1586-2542","authenticated-orcid":false,"given":"Luca","family":"Andriollo","sequence":"first","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"Ortopedia e Traumatologia, Fondazione Poliambulanza Istituto Ospedaliero Brescia Italy"},{"name":"Artificial Intelligence Center, Alma Mater Europaea University Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Diquattro","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"SC Ortopedia\u2010Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio, IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"2<sup>nd<\/sup> Department of Orthopaedic Surgery \u2018Hygeia\u2019 General Hospital of Athens Athens Greece"},{"name":"School of Rehabilitation Health Sciences, University of Patras Patras Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovan Giuseppe","family":"Mazzella","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"Department of Aging Orthopaedic and Rheumatological Sciences, 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