{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:38:26Z","timestamp":1787161106202,"version":"build-2736575974"},"reference-count":59,"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:\/\/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":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Functional alignment (FA) aims to restore knee kinematics by balancing laxities and adapting implant positioning. This study evaluates safety and outcomes of\u2009&gt;3\u00b0 varus tibial positioning in patients with varus deformity undergoing robotic\u2010assisted total knee arthroplasty (TKA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 337 patients with varus deformity undergoing robotic\u2010assisted TKA with FA principles with a minimum of 2\u2010year follow\u2010up. Patients were divided into two groups based on tibial varus positioning: \u22643\u00b0 varus: Group A and &gt;3\u00b0 varus: Group B. Preoperative and postoperative coronal alignment, implant positioning, and outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score (FJS) at final follow\u2010up. The primary outcome was implants' survivorship, and secondary outcomes included complication rates and functional scores. Statistical analyses included Mann\u2013Whitney and Chi\u2010square tests for group comparisons, Kaplan\u2013Meier survival analysis for implant survivorship, and multivariate regression for key covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Implant survivorship was 99.4% in Group B over a median follow\u2010up of 30 months, with one revision due to aseptic loosening and 100% in Group A (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.36). The overall complication rates were 12.7% in Group A and 10.2% in B (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.48). The median KSS\u2010knee and function scores were 94.5 and 90 in Group A and 94 and 90 in B (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.88 and 0.8, respectively). The final FJS was 82 in Group A and 84 in B (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.8). No significant differences were observed in postoperative knee range of motion between the two groups. Multivariate regression analysis showed that none of the included covariates were statistically significant predictors of implant failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>FA in robotic\u2010assisted TKA with tibial positioning\u2009&gt;3\u00b0 varus seems to be safe and reliable in patients with varus deformity, demonstrating similar revision rates, implant survivorship, and outcomes compared to the\u2009\u22643\u00b0 tibial varus group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  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