{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:09:54Z","timestamp":1789153794559,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"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."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Functional alignment (FA) has emerged as an alternative to mechanical alignment (MA) in total knee arthroplasty (TKA), supported by robotic assistance to enhance precision and soft\u2011tissue preservation. Evidence comparing FA performed with robotic assistance to conventional MA\u2011TKA across mid\u2011term patient\u2011reported outcomes measures (PROMs) remains limited. This randomised controlled trial evaluated differences in recovery trajectories and 2\u2011year knee\u2011specific outcomes between FA\u2011RATKA and MA\u2011CTKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study reports the predefined primary 2\u2010year outcomes of a prospective randomised controlled non\u2010inferiority trial including 180 patients (FA\u2010RATKA,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200981; MA\u2010CTKA,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200982), of whom 163 completed follow\u2010up. Assessments were performed preoperatively and at 3\u2010months, 1\u2010 and 2\u2010years using validated PROMs: Knee Society Score (KSS) subdomains, Oxford Knee Score (OKS), Forgotten Joint Score (FJS\u201012), VAS pain, EQ\u20105D\u20105L (index and VAS), Lower Extremity Activity Scale (LEAS), and overall satisfaction. Mixed\u2010effects models evaluated group, time, and Group\u2009\u00d7\u2009Time interactions, adjusting for age, BMI, and soft\u2010tissue release. Effect sizes (\n                      <jats:italic>r<\/jats:italic>\n                      ) were calculated to contextualise clinical relevance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      FA\u2010RATKA demonstrated more favourable knee\u2010specific outcomes across follow\u2010up, with significant Group\u2009\u00d7\u2009Time interactions for KSS Function (\n                      <jats:italic>F<\/jats:italic>\n                      (3,679)\u2009=\u20096.970,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.173), KSS Satisfaction (\n                      <jats:italic>F<\/jats:italic>\n                      (3,679)\u2009=\u200910.892,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.214) and KSS Symptoms (\n                      <jats:italic>F<\/jats:italic>\n                      (3,679)\u2009=\u20094.425,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.138). FA\u2010RATKA also showed more favourable OKS trajectories (\n                      <jats:italic>F<\/jats:italic>\n                      (3,679)\u2009=\u20098.053,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.185), lower VAS pain (\n                      <jats:italic>F<\/jats:italic>\n                      (3,679)\u2009=\u20098.339,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.188), and higher EQ\u20105D index scores (\n                      <jats:italic>F<\/jats:italic>\n                      (2,515)\u2009=\u20095.227,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.141). Categorical satisfaction favoured FA\u2010RATKA at early follow\u2010up (\n                      <jats:italic>F<\/jats:italic>\n                      (2,503)\u2009=\u20093.491,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.117). Effect sizes ranged from\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.117 to 0.214, corresponding to small to small\u2010medium magnitudes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this prospective, randomised, single\u2010surgeon study, several knee\u2010specific patient\u2010reported outcomes demonstrated modest but statistically supported differences at 2\u2010year follow\u2010up, with consistently higher values in the FA\u2010RATKA group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level I, randomised controlled trials with adequate statistical power to detect differences (narrow confidence intervals) and follow up &gt;80%, as per the KSSTA guidelines.<\/jats:p>\n             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Healthcare NHS Trust London UK"},{"name":"Department of Orthopedic Surgery The Cleveland Clinic London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Albelooshi","sequence":"additional","affiliation":[{"name":"Orthocure Medical Center Dubai United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max Til","family":"Ettinger","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Pius Hospital Oldenburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Deltour","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Chirec Delta Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3975-6337","authenticated-orcid":false,"given":"Martijn Gerhardus Maria","family":"Schotanus","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery School of Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University Maastricht The Netherlands"},{"name":"Department of Orthopedic Surgery Zuyderland Medical Center Sittard\u2010Geleen and Heerlen The Netherlands"},{"name":"Academic Knowledge Center Work and Health South\u2010East Netherlands (AKAG\u2010ZON) Dutch National Institute for Employee Benefits Schemes (UWV) Heerlen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"issue":"11","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"3393","DOI":"10.1016\/j.arth.2020.03.005","article-title":"Clinical and radiological outcomes in robotic\u2010assisted total knee arthroplasty: a systematic review and meta\u2010analysis","volume":"35","author":"Agarwal N","year":"2020","journal-title":"J 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