{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T22:48:27Z","timestamp":1784242107228,"version":"3.55.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"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":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Preoperative flexion contracture remains a challenging deformity in total knee arthroplasty (TKA). This study aimed to evaluate whether the presence of preoperative flexion contracture influences outcomes and early revision rates following robotic\u2010assisted TKA performed with functional alignment (FA) principles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective comparative study analysed 190 patients who underwent robotic\u2010assisted TKA using a computed tomography\u2010based FA strategy. Patients were grouped based on intraoperative measurement of flexion contracture: \u226510\u00b0 (study group; 43 patients) and &lt;10\u00b0 (control group; 147 patients). Clinical outcomes, intraoperative data, and early revision rates were assessed at a minimum 24\u2010month follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study group exhibited significantly more varus alignment intraoperatively and required greater lateral tibial and posterior medial femoral resections. Preoperative knee flexion was lower in the contracture group (110\u00b0 vs. 120\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0018), and postoperative flexion remained slightly reduced (120\u00b0 vs. 130\u00b0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05). Flexion contracture at follow\u2010up was 1\u00b0 in the study group versus 0\u00b0 in controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). However, no significant differences were observed in Knee Society Scores, Forgotten Joint Score, Kujala score, or early revision rates. All\u2010cause revision rates were similar (97.67% vs. 98.64%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.66), with a hazard ratio of 1.85 (95% CI: 0.12\u201327.72). Aseptic survivorship was 100% in the contracture group versus 99.32% in controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.59).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with preoperative flexion contracture\u2009\u2265\u200910\u00b0 achieved comparable mid\u2010term outcomes and early survivorship to those without contracture following robotic\u2010assisted TKA using FA. These findings support FA as a reliable strategy to manage complex deformities without the need for soft tissue releases.<\/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.12799","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T08:13:36Z","timestamp":1753085616000},"page":"183-191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Preoperative flexion contracture does not impair outcomes or early revision rates following robotic total knee arthroplasty with functional alignment"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1398-9626","authenticated-orcid":false,"given":"Christos","family":"Koutserimpas","sequence":"first","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"2nd Department of Orthopaedic Surgery \u2018Hygeia\u2019 General Hospital of Athens Athens Greece"},{"name":"School of Rehabilitation Health Sciences University of Patras Patras Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovan Giuseppe","family":"Mazzella","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"Department of Aging, Orthopaedic and Rheumatological Sciences Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Andriollo","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital, Hospices Civils de Lyon 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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Diquattro","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix\u2010Rousse Hospital Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"SC Ortopedia\u2010Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e Ginocchio IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"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\u2010Rousse Hospital Lyon University Hospital, Hospices Civils de Lyon 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\u2010Rousse Hospital Lyon University Hospital, Hospices Civils de Lyon Lyon France"},{"name":"LIBM\u2010EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University Lyon 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