{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:13Z","timestamp":1789844533502,"version":"4.0.1"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":82,"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>To evaluate early patient\u2010reported outcome measures (PROMs), radiographic alignment changes, intraoperative laxity changes and complications in a retrospective series of constitutional valgus knees treated with robotic\u2010assisted total knee arthroplasty (TKA) using an intentional asymmetric balancing strategy and a semi\u2010personalized (SP) alignment technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single\u2010centre cohort included consecutive patients with end\u2010stage valgus osteoarthritis (OA) and constitutional valgus morphotypes (coronal plane alignment of the knee III\/VI) treated with imageless robotic\u2010assisted TKA and a minimum follow\u2010up of 12 months. The balancing workflow intentionally accepted mild residual lateral laxity. Medial and lateral compartment laxity (mm) were quantified intraoperatively at 0\u00b0 and 90\u00b0. PROMs (Knee Society Score [KSS] and Forgotten Joint Score [FJS]), range of motion (ROM) and hip\u2013knee\u2013ankle angle (HKA) were assessed preoperatively and at the latest follow\u2010up. Complications were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010eight patients were included at a mean follow\u2010up of 26.5\u2009\u00b1\u200915.0 months. KSS Knee improved from 58.3\u2009\u00b1\u20099.4 to 87.9\u2009\u00b1\u200911.0 (mean change +29.6 points, 95% confidence interval [CI]\u2009=\u200926.0\u201333.2;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.00002) and KSS Function from 58.8\u2009\u00b1\u200915.0 to 82.4\u2009\u00b1\u200915.7 (mean change +23.6 points, 95% CI\u2009=\u200918.8\u201328.4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.00004). Flexion contracture improved from 3.9\u2009\u00b1\u20094.0\u00b0 to 0.6\u2009\u00b1\u20091.2\u00b0 (mean change \u22123.3\u00b0, 95% CI\u2009=\u2009\u22124.3 to \u22122.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.00010), while flexion increased from 101.4\u2009\u00b1\u20096.0\u00b0 to 126.8\u2009\u00b1\u20098.6\u00b0 (mean change +25.4\u00b0, 95% CI\u2009=\u200923.2\u201327.6;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.00001). HKA improved from 6.2\u2009\u00b1\u20094.5\u00b0 valgus to 2.1\u2009\u00b1\u20091.8\u00b0 valgus (mean change \u22124.1\u00b0, 95% CI\u2009=\u2009\u22125.2 to \u22123.0; p\u2009=\u20090.00030). Lateral laxity decreased in extension from 4.5\u2009\u00b1\u20091.7 to 2.5\u2009\u00b1\u20091.3\u2009mm (mean change \u22122.0\u2009mm, 95% CI\u2009=\u2009\u22122.7 to \u22121.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and at 90\u00b0 from 5.3\u2009\u00b1\u20092.0 to 1.9\u2009\u00b1\u20091.2\u2009mm (mean change \u22123.4\u2009mm, 95% CI\u2009=\u2009\u22124.3 to \u22122.5;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0008), with smaller medial reductions. Post\u2010operative complications occurred in four patients (6.9%) (deep vein thrombosis, transient peroneal neuropraxia, superficial wound issue and one manipulation under anaesthesia); there were no pulmonary emboli, periprosthetic joint infection or revision procedures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective single\u2010surgeon series of constitutional valgus knees treated with robotic\u2010assisted 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\u2010guided strategy, but do not establish superiority over alternative balancing philosophies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70810","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T14:44:44Z","timestamp":1782139484000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intentional asymmetric balancing in robotic\u2010assisted valgus TKA: Early outcomes and intraoperative laxity changes"],"prefix":"10.1002","volume":"13","author":[{"given":"Stefano G.","family":"Petrillo","sequence":"first","affiliation":[{"name":"Prosthetic Surgery Centre, IRCCS Galeazzi Sant'Ambrogio Hospital Milan 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