{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:08:08Z","timestamp":1782518888265,"version":"3.54.5"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>In functionally aligned (FA) total knee arthroplasty (TKA), femoral component rotation (FCR) is personalised to optimise flexion gap balance. As axial malalignment has been attributed to patellofemoral complications, this study assessed FA FCR in relation to the surgical transepicondylar axis (TEA) and early implant survivorship.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed 446 robotic\u2010assisted primary TKAs in 393 patients using FA with preresection gap balancing. Femoral and tibial coronal resection boundaries were 6\u00b0 valgus to 3\u00b0 varus and 6\u00b0 varus to 3\u00b0 valgus, respectively. The TEA and posterior condylar axis (PCA) were identified on preoperative computed tomographic scans. Intraoperatively, FCR was initially set parallel to the PCA, then rotated to achieve flexion balance within 6\u00b0 boundaries to the TEA. The primary outcome was the mean angular difference between the TEA and final FCR and the proportion of patients with FCR within 2\u00b0, 4\u00b0 and 6\u00b0 from the TEA. Secondary outcomes included all\u2010cause revisions for the robotic\u2010assisted TKAs in this series from our in\u2010house database and a national joint replacement registry at a mean of 3.3 years postoperatively (range 2.2\u20135.5).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean FCR was 0.0\u00b0 (SD 2.1\u00b0) relative to the TEA and 1.8\u00b0 (SD 1.4\u00b0) externally rotated to the PCA. Final FCR was within 2\u00b0 in 74.9%, within 4\u00b0 in 97.3% and within 6\u00b0 in 99.6% of patients relative to the TEA. There were seven postoperative procedures (1.6%) within the study period: two reoperations (0.5%) for early arthrotomy failure requiring repair (both exhibiting FCR within 1\u00b0 to the TEA) and three revisions (0.7%) for deep surgical site infection (one after early traumatic arthrotomy failure, one revision for instability and one manipulation for stiffness).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In FA TKA, femoral components more closely align to the TEA than the PCA to achieve a balanced flexion gap. In conjunction with a low incidence of revision surgeries, this suggests the FA technique does not result in significant patellofemoral complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ksa.12590","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T03:51:50Z","timestamp":1737517910000},"page":"1784-1791","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["In functionally aligned total knee arthroplasty, femoral component rotation follows the transepicondylar axis to achieve flexion balance"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0073-1818","authenticated-orcid":false,"given":"Joss","family":"Moore","sequence":"first","affiliation":[{"name":"Clinical Research Department Sydney Knee Specialists Kogarah New South Wales Australia"},{"name":"Department of Orthopaedics The Galway Clinic, Blackrock Health Galway Ireland"},{"name":"Irish Institute of Trauma and Orthopaedic Surgery Royal College of Surgeons Ireland Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-8887","authenticated-orcid":false,"given":"Victor A.","family":"Van de Graaf","sequence":"additional","affiliation":[{"name":"Clinical Research Department Sydney Knee Specialists Kogarah New South Wales Australia"},{"name":"Department of Orthopaedic Surgery Bergman Clinics Rijswijk The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6635-1661","authenticated-orcid":false,"given":"Jil A.","family":"Wood","sequence":"additional","affiliation":[{"name":"Clinical Research Department Sydney Knee Specialists Kogarah New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1101-7871","authenticated-orcid":false,"given":"Darren B.","family":"Chen","sequence":"additional","affiliation":[{"name":"Clinical Research Department Sydney Knee Specialists Kogarah New South Wales Australia"},{"name":"CPAK Research Group Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1578-7614","authenticated-orcid":false,"given":"Samuel J.","family":"MacDessi","sequence":"additional","affiliation":[{"name":"Clinical Research Department Sydney Knee Specialists Kogarah New South Wales Australia"},{"name":"CPAK Research Group Sydney Australia"},{"name":"Department of Orthopaedic Surgery, School of Clinical Medicine University of NSW Medicine and Health Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200403000-00030"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-07156-3"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BTO.0000000000000567"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11226680"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2023.08.080"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06473-3"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4377-1503-3.00120-7"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20080901-15"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07598-3"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.05.065"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1051\/sicotj\/2021021"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.105B2.BJJ-2022-1345"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2023.10.010"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2015.08.006"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-016-3287-z"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.01.051"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07504-x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.102B3.BJJ-2019-1729"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1051\/sicotj\/2022010"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-07073-5"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-023-07567-w"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-020-06165-4"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-4844-x"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12590","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T10:22:52Z","timestamp":1760869372000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.12590"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,22]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/ksa.12590"],"URL":"https:\/\/doi.org\/10.1002\/ksa.12590","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,22]]},"assertion":[{"value":"2024-09-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}