{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:19:04Z","timestamp":1787768344400,"version":"build-2784847793"},"reference-count":44,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"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":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Robotic\u2010assisted total knee arthroplasty (TKA) and new alignment principles are transforming traditional implant positioning, not only in the coronal plane but also in the sagittal and axial planes. The impact of differences between a patient's native tibial slope (TS) and distal femoral flexion (DFF) compared to the final implant positioning remains unclear. This study aims to evaluate whether variations in TS (\u0394TS) and DFF (\u0394DFF) play a role in clinical outcomes and implant survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analysed patients who underwent robotic\u2010assisted TKA following functional alignment (FA) principles between March 2021 and January 2023. A total of 310 patients were included. Preoperative and postoperative data, including radiographic and robotic measurements, were collected. Clinical outcomes (KSS, FJS\u201012 and AKPS), range of motion (ROM), complication rates, and implant survival were compared between groups at a minimum of 2 years follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At the final follow\u2010up (mean 2.93\u2009\u00b1\u20090.62 years), no significant differences were found in clinical scores or ROM between groups with different \u0394TS or \u0394DFF values. Complication rates and implant survival (99%) were also similar. However, patients with \u0394TS\u2009&gt;\u20095\u00b0 had a slightly increased femoral valgus alignment, while those with \u0394DFF\u2009\u2264\u20095\u00b0 had lower preoperative ROM, with the femoral implant positioned in varus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Variations between native and implant TS and DFF in robotic\u2010assisted TKA do not negatively impact functional outcomes or implant survival. A personalised sagittal alignment approach within the concept of FA represents a progression to a functional knee positioning based on three dimensions. Further research is needed to explore the long\u2010term effects of sagittal alignment on TKA performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.12658","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T02:06:07Z","timestamp":1743041167000},"page":"2928-2938","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Beyond the coronal plane in robotic total knee arthroplasty\u2014Part 1: Variations in tibial slope and distal femoral flexion do not affect 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":"Department of Orthopaedics Surgery and Sports Medicine FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital Lyon France"},{"name":"Ortopedia e Traumatologia, Fondazione Poliambulanza Istituto Ospedaliero Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery and Sports Medicine 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":"Department of Orthopaedics Surgery and Sports Medicine 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":"Department of Orthopaedics Surgery and Sports Medicine 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":"Department of Orthopaedics Surgery and Sports Medicine 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 France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Lustig","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery and Sports Medicine 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 France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.23.00076"},{"key":"e_1_2_11_3_1","article-title":"The use of an imageless robotic system in revision of unicompartmental knee arthroplasty","volume":"1","author":"Andriollo L","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4098-x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-004-0557-x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/life14121528"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2023.08.006"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12319"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06507-6"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2021.02.063"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2023.04.040"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12349"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.07.029"},{"key":"e_1_2_11_14_1","article-title":"Functional alignment in robotic\u2010assisted total knee arthroplasty for valgus deformity achieves safe coronal alignment and excellent short\u2010term outcomes","volume":"1","author":"Gregori P","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.12.026"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12503"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12066"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12337"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5093-1"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13534-023-00312-9"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-2097-9"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12450"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1729967"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1051\/sicotj\/2021021"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-012-1580-z"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-022-04653-5"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2012.10.028"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40634-022-00546-z"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-017-3490-6"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-33183-2"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.02.042"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e15637"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.04.021"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.3233\/THC-231261"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-021-06800-8"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.18.01096"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.103B9.BJJ-2020-2129.R2"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.5792\/ksrr.2013.25.1.25"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1051\/sicotj\/2022010"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13020212"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12306-022-00768-5"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1700570"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42836-021-00085-5"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-024-05027-w"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06840-w"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.12658","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T13:18:52Z","timestamp":1760879932000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.12658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":44,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/ksa.12658"],"URL":"https:\/\/doi.org\/10.1002\/ksa.12658","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]},"assertion":[{"value":"2025-02-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}