{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:44:08Z","timestamp":1792082648023,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Associations between preoperative\u2010to\u2010post\u2010operative changes in arithmetic hip\u2013knee\u2013ankle angle (aHKA) and joint line obliquity (JLO) and final balance after robot\u2010assisted total knee arthroplasty (TKA) were evaluated. Relationships with resection redistribution and tibial\u2010varus reduction were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single\u2010surgeon series of 402 primary robot\u2010assisted TKAs was analysed. Preoperative and post\u2010operative aHKA, JLO and coronal plane alignment of the knee (CPAK) type were determined from full\u2010length radiographs. Final extension and flexion imbalance and laxity ranges after trial implantation were the primary outcomes. Signed and absolute changes were assessed in multivariable models; resection redistribution and a varus\u2010only tibial\u2010boundary subgroup were examined in supportive analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A change in CPAK type was observed in 300 knees (74.6%), including a JLO\u2010zone change in 221 (55.0%). Greater \u0394JLO was associated with smaller final flexion imbalance (\u03b2\u2009=\u2009\u22120.060; p\u2009&lt;\u20090.001) and a narrower final extension laxity range (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.055;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Corresponding associations were found for |\u0394JLO| (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.046;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018 and\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.070;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Neither signed nor absolute aHKA change was associated with final extension or flexion imbalance. In varus knees, tibial\u2010varus reduction was associated with greater JLO and aHKA changes, coronal femoral adjustment and smaller final flexion imbalance. Neither |\u0394aHKA| nor |\u0394JLO| was associated with improvement in the Knee injury and Osteoarthritis Outcome Score for Joint Replacement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Greater JLO change was associated with smaller final flexion imbalance and a narrower extension laxity range rather than impaired balance. In varus knees, JLO change accompanied tibial\u2010varus reduction and coordinated femoral adjustment. JLO change may therefore reflect specific aspects of the final balancing state rather than an unintended deviation from the native phenotype.<\/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\/jeo2.70936","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T12:58:01Z","timestamp":1791032281000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Joint line obliquity change was associated with femoral and tibial resection patterns and smaller final flexion imbalance after robot\u2010assisted total knee arthroplasty"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8642-6613","authenticated-orcid":false,"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 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Long","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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7050-5571","authenticated-orcid":false,"given":"Peter K.","family":"Sculco","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"}]}],"member":"311","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12311"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.70780"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-021-04048-y"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12561"},{"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":"10.1007\/s00167-022-07227-5"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-07156-3"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2023.04.004"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12772"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000002857"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-025-06692-0"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12730"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.12100"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12734"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-025-04265-w"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43019-023-00204-3"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.106B10.BJJ-2023-1425.R1"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12764"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-4719-1"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.103B2.BJJ-2020-1050.R1"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.6.210015"},{"key":"e_1_2_12_23_1","first-page":"231","article-title":"Avoiding 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