{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:51:16Z","timestamp":1792083076504,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"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":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purposes of this study were to quantify final\u2010minus\u2010reference gap difference in the medial and lateral compartments in extension and flexion during passive, imageless robot\u2010assisted total knee arthroplasty (RA\u2010TKA) and to identify preoperative radiographic and initial intraoperative factors associated with greater final\u2010minus\u2010reference gap difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single\u2010surgeon series of 379 primary total knee arthroplasties performed using a passive, imageless robot\u2010assisted system for osteoarthritis was analysed. Medial and lateral compartment spaces were recorded in extension and at 90\u00b0 flexion before bone resection and after trial implantation. For each compartment and knee position, the reference gap was defined from the initial gap, validated resection depth, femoral component thickness and tibial\u2010side construct thickness. Multivariable linear regression models were adjusted for age, body mass index, sex and implant design, with cluster\u2010robust standard errors to account for bilateral knees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean final\u2010minus\u2010reference gap difference was positive in all four conditions, indicating that final gaps exceeded the calculated reference in both extension and flexion: 4.7\u2009\u00b1\u20092.1\u2009mm medially and 3.4\u2009\u00b1\u20092.8\u2009mm laterally in extension, and 4.2\u2009\u00b1\u20093.0\u2009mm medially and 3.2\u2009\u00b1\u20093.7\u2009mm laterally in flexion. Smaller initial compartment gaps and greater varus\u2013valgus laxity range were consistently associated with greater gap difference. Posterior\u2010stabilized design was associated with greater medial gap difference in extension and with greater medial and lateral gap difference in flexion. More valgus alignment and greater lateral osteophyte burden were associated with greater lateral gap difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In passive, imageless RA\u2010TKA, final measured gaps commonly exceeded a resection\u2010based reference during sequential balancing. Smaller initial compartment gaps and greater varus\u2013valgus laxity range were consistently associated with greater gap difference. These findings suggest that resection\u2010based preresection gap estimates should be interpreted with awareness of compartment\u2010specific tightness and coronal laxity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70851","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T17:29:35Z","timestamp":1784568575000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Final intraoperative gaps commonly exceed resection\u2010based reference gaps during sequential balancing in imageless robot\u2010assisted total knee arthroplasty"],"prefix":"10.1002","volume":"13","author":[{"given":"Yugo","family":"Morita","sequence":"first","affiliation":[{"name":"Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Service Hospital for Special Surgery New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonggu","family":"Shin","sequence":"additional","affiliation":[{"name":"Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Service Hospital for Special Surgery New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"El\u2010Hassan","sequence":"additional","affiliation":[{"name":"Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Service Hospital for Special Surgery New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ittai","family":"Shichman","sequence":"additional","affiliation":[{"name":"Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Service Hospital for Special Surgery New York New York 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