{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:34Z","timestamp":1787702434009,"version":"build-2784847793"},"reference-count":32,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Alignment strategies in total knee arthroplasty (TKA) have predominantly emphasized coronal alignment in extension, with minimal focus on dynamic alignment during flexion. This study aims to identify the predictors of the intraoperative robotic hip\u2013knee\u2013ankle angle at 90\u00b0 of flexion (rHKA\u201090F) and assess its clinical significance in postoperative outcomes, proposing that rHKA\u201090F may be a critical factor in enhancing functional results in TKA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted on 180 patients with varus deformity undergoing robotic\u2010assisted TKA under the functional alignment principles. Clinical outcomes were assessed using the Knee Society Score (KSS), Forgotten Joint Score (FJS\u201012) and Kujala Anterior Knee Pain Scale (AKPS) score. Predictors for final rHKA\u201090F and its intraoperative changes were identified using multiple linear regression models. Initial and intraoperative robotic measurements were also analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Significant predictors of the final rHKA\u201090F included femoral rotation, tibial varus\/valgus alignment, initial rHKA\u201090F and the final robotic axis in extensions. Patients with a final rHKA\u201090F\u2009\u2265\u20095\u00b0 of varus demonstrated superior KSS function and KSS knee compared to those with a final rHKA\u201090F between 0\u00b0 and 4\u00b0 of varus. Furthermore, patients with intraoperative changes of rHKA\u201090F\u2009&gt;\u20092.5\u00b0 neutralization (varus reduction or with a valgus value) achieved better FJS and AKPS score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study highlights the clinical relevance of rHKA\u201090F as an intraoperative tool in robotic knee arthroplasty, emphasizing the need to balance the correction of varus deformity with the maintenance of slight varus alignment in flexion. Personalized alignment strategies tailored to patient\u2010specific anatomy and kinematics are crucial to optimizing outcomes. There is still a need for future research on the long\u2010term effects of dynamic alignment.<\/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.12648","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T06:07:58Z","timestamp":1742278078000},"page":"2581-2591","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90\u00b0 of flexion impacts clinical outcomes"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1586-2542","authenticated-orcid":false,"given":"Luca","family":"Andriollo","sequence":"first","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon Lyon North University Hospital Lyon France"},{"name":"Sezione di Chirurgia Protesica ad Indirizzo Robotico \u2010 Unit\u00e0 di Traumatologia Dello Sport, Ortopedia e Traumatologia, Fondazione Poliambulanza Istituto Ospedaliero Brescia Italy"},{"name":"Ortopedia e Traumatologia Universit\u00e0 Cattolica del Sacro Cuore Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon Lyon North University Hospital Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Gregori","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon Lyon North University Hospital Lyon France"},{"name":"Fondazione Policlinico Universitario Campus Bio\u2010Medico Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvire","family":"Servien","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon Lyon North University Hospital Lyon France"},{"name":"LIBM\u2010EA 7424, Interuniversity Laboratory of Biology of Mobility Claude Bernard Lyon 1 University Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Batailler","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon Lyon North University Hospital Lyon France"},{"name":"Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 Lyon 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