{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:09Z","timestamp":1789844529591,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":55,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"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":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Total knee arthroplasty (TKA) is effective for alleviating pain and restoring function in knee osteoarthritis patients, yet 10% report dissatisfaction due to persistent pain and functional limitations. Conventionally, mechanically aligned (MA) TKA often fail to replicate native kinematics. Kinematic alignment (KA) aims to replicate pre\u2010arthritic alignment for better function. The coronal plane alignment of the knee (CPAK) system classifies knees into nine groups. Changes in CPAK may alter load distribution, ligament tension and joint congruence. Conflicting studies exist on the impact of CPAK changes on outcomes. No prior study has used fluoroscopy to examine weight\u2010bearing kinematics stratified by CPAK changes post\u2010TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective analysis used data from a registry of primary robotic\u2010assisted TKAs (2019\u20132023) using NAVIO\/CORI (Smith &amp; Nephew) systems, with Journey II BCS implants. Exclusions: prior ipsilateral surgery, complicating conditions or missing radiographs. Procedures used MA or KA per surgeon preference, with standardized protocols. Demographics, operative data, pre\/post\u2010operative Knee Society Scores (KSS\/KSFS) at 12 months were collected. CPAK was calculated from radiographs. Patients performed weight\u2010bearing deep knee bends under fluoroscopy; kinematics were extracted via 3D\u2010to\u20102D registration, assessing flexion, condylar positions and axial rotation. Cohorts: CPAK change (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933) versus no change (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099). Student's\n                      <jats:italic>t<\/jats:italic>\n                      test compared outcomes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No differences in maximum flexion (Change: 105\u2009\u00b1\u200911.9\u00b0 vs. No Change: 101\u2009\u00b1\u200911.4\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.42), lateral condyle rollback (\u221213.1\u2009\u00b1\u20095.6\u2009mm vs. 10.1\u2009\u00b1\u20095.2\u2009mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.15), medial condyle rollback (\u22125.9\u2009\u00b1\u20093.1\u2009mm vs. \u22124.7\u2009\u00b1\u20092.7\u2009mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.29) or axial rotation (8.9\u2009\u00b1\u20095.9\u00b0 vs. 6.5\u2009\u00b1\u20094.1\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.27). KSFS improvements (+28\u2009\u00b1\u200921.1 vs. +17\u2009\u00b1\u200919.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.16) and KSS (+38\u2009\u00b1\u200919.2 vs. +38\u2009\u00b1\u200925.9,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.95) were similar. Post\u2010operative CPAK 3 was the most frequent (45.2%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CPAK changes after robotic\u2010assisted TKA do not affect in vivo kinematics or short\u2010term outcomes, supporting alignment flexibility with precise techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70776","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T13:02:13Z","timestamp":1779800533000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronal plane alignment changes do not affect in vivo kinematics for robotically performed total knee arthroplasty"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8184-1845","authenticated-orcid":false,"given":"Cham\u2010Kit","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology Prince of Wales Hospital Shatin Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1305-7706","authenticated-orcid":false,"given":"Michael","family":"LaCour","sequence":"additional","affiliation":[{"name":"Department of Mechanical, Aerospace, and Biomedical Engineering Center for Musculoskeletal Research University of Tennessee, Knoxville Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garett","family":"Dessinger","sequence":"additional","affiliation":[{"name":"Department of Mechanical, Aerospace, and Biomedical Engineering Center for Musculoskeletal Research University of Tennessee, Knoxville Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D.","family":"Komistek","sequence":"additional","affiliation":[{"name":"Department of Mechanical, Aerospace, and Biomedical Engineering Center for Musculoskeletal Research University of Tennessee, Knoxville Knoxville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1888-5508","authenticated-orcid":false,"given":"Rex Wang\u2011Fung","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Prince of Wales Hospital Shatin Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0167-8000","authenticated-orcid":false,"given":"Jonathan Patrick","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Prince of Wales Hospital Shatin Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria Yan\u2011Ting","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Alice Ho Miu Ling Nethersole Hospital Tai Po Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsz\u2011Lung","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Alice Ho Miu Ling Nethersole Hospital Tai Po Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1445-7856","authenticated-orcid":false,"given":"Mingde","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology The Chinese University of Hong Kong Shatin Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8647-8475","authenticated-orcid":false,"given":"Kevin Ki\u2011Wai","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology Chinese University of Hong Kong Medical Centre Shatin Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4460-9286","authenticated-orcid":false,"given":"Michael Tim\u2010Yun","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology The Chinese University of Hong Kong Shatin Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7214-5503","authenticated-orcid":false,"given":"Patrick Shu\u2010Hang","family":"Yung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology The Chinese University of Hong Kong Shatin Hong Kong SAR, China"},{"name":"Department of Orthopaedics and Traumatology Chinese University of Hong Kong Medical Centre Shatin Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42836-024-00239-1"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1302\/1358-992X.2024.17.002"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(97)90026-7"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5174-1"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12740"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2022.10.011"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000148777.98244.84"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.24920\/004372"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-025-08868-6"},{"key":"e_1_2_12_11_1","article-title":"The coronal plane alignment of the knee classification: how it works, how to apply it, and how it can affect outcomes in knee reconstruction surgery","volume":"10","author":"Grant S","year":"2025","journal-title":"JB JS Open Access"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-019-05509-z"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-013-2621-x"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11420-018-9614-8"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12081285"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.106B10.BJJ-2023-1425.R1"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B6.BJJ-2016-0713.R1"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2025.06.024"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.103B2.BJJ-2020-1050.R1"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2003.820027"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.26091"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-025-05984-9"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-06995-4"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jorep.2023.100277"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-025-05709-z"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.4055\/cios23250"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000001150"}],"container-title":["Journal of Experimental Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70776","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jeo2.70776","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jeo2.70776","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:15:04Z","timestamp":1789841704000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/jeo2.70776"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":26,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/jeo2.70776"],"URL":"https:\/\/doi.org\/10.1002\/jeo2.70776","archive":["Portico"],"relation":{},"ISSN":["2197-1153","2197-1153"],"issn-type":[{"value":"2197-1153","type":"print"},{"value":"2197-1153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-03-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70776"}}