{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:58:20Z","timestamp":1774634300299,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the femoral component alignment in patients undergoing soft tissue\u2010guided, navigated total knee arthroplasty (TKA). It was hypothesized that with a mechanically aligned tibial component, the soft tissues tensioned and symmetric medial and lateral gaps in flexion\/extension, the femoral component would be aligned to the preoperative distal femoral joint line, as measured on knee radiographs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between 2015 and 2017, 77 patients (78\u00a0knees) underwent navigated soft tissue\u2010guided TKA at a single centre. Pre and postoperative radiographs were collected and varus knees were taken into account. The tibial cut was performed with navigation in neutral alignment. The femoral cuts were adjusted based on tensioned soft tissues, aiming for equal medial and lateral gaps in flexion and extension. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Knee Society Score (KSS) were collected pre and postoperatively as a secondary outcome measure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 58 TKAs on varus knees were assessed. On average, the femoral component was placed at 1.7\u00b0 (SD 1.7) varus in the coronal plane. The comparison between the radiographic native distal femoral alignment and the orientation of the femoral component coronal cut demonstrated a statistically significant (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), linear inverse relationship (<jats:italic>r<\/jats:italic>\u2009=\u20090.5). Satisfactory knee function and excellent pain remission were demonstrated by KOOS and KSS scores at a mean of 2.8 years (SD 0.5) follow\u2010up. One TKA was revised, resulting in a 98.3% survivorship at three years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The proposed soft tissue\u2010guided, navigated technique, aiming to preserve the integrity of the ligaments and a neutrally aligned tibial cut, provided a joint line respecting femoral coronal cut and encouraging short\u2010term clinical results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-06056-8","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T13:03:52Z","timestamp":1589547832000},"page":"966-974","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Navigated, soft tissue\u2010guided total knee arthroplasty restores the distal femoral joint line orientation in a modified mechanically aligned technique"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7634-5692","authenticated-orcid":false,"given":"Francesco","family":"Zambianchi","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena University of Modena and Reggio\u2010Emilia Via del Pozzo, 71 41124 Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Giorgini","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena University of Modena and Reggio\u2010Emilia Via del Pozzo, 71 41124 Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Ensini","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena University of Modena and Reggio\u2010Emilia Via del Pozzo, 71 41124 Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Lombari","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena University of Modena and Reggio\u2010Emilia Via del Pozzo, 71 41124 Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerio","family":"Daffara","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena University of Modena and Reggio\u2010Emilia Via del Pozzo, 71 41124 Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Catani","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria Di Modena University of Modena and Reggio\u2010Emilia Via del Pozzo, 71 41124 Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,5,15]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.01587"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010011\u20101936\u20105"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.93B9.26573"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.04.034"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.00306"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2011.12.028"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005507\u20101"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005508\u20100"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005509\u2010z"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010012\u20102220\u20102"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010012\u20102613\u2010z"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010009\u20100984\u20106"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010015\u20102743\u20105"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010013\u20102621\u2010x"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.07.038"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198911000-00004"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010014\u20103540\u2010y"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104558\u2010y"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010011\u20101988\u20106"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2016.07.007"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010016\u20104094\u20101"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.102B3.BJJ-2019-1729"},{"key":"e_1_2_10_24_2","first-page":"48","article-title":"Mechanical axis deviation of the lower limbs: Preoperative planning of uniapical angular deformities of the tibia or femur","volume":"280","author":"Paley D","year":"1992","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01398"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.00772"},{"key":"e_1_2_10_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2017.07.010"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477\u20107525\u20101\u201064"},{"key":"e_1_2_10_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.07.024"},{"key":"e_1_2_10_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2005.10.020"},{"key":"e_1_2_10_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010017\u20104765\u20106"},{"key":"e_1_2_10_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010013\u20102481\u20104"},{"key":"e_1_2_10_33_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010013\u20102898\u20106"},{"key":"e_1_2_10_34_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B10.36862"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-020-06056-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-020-06056-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-020-06056-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-020-06056-8","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T14:38:54Z","timestamp":1760884734000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-020-06056-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,15]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1007\/s00167-020-06056-8"],"URL":"https:\/\/doi.org\/10.1007\/s00167-020-06056-8","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,15]]},"assertion":[{"value":"2 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors Francesco Zambianchi, Andrea Giorgini, Andrea Ensini, Vincenzo Lombari and Valerio Daffara, or any member of their immediate family, have no funding or commercial associations (e.g. consultancies, stock ownership, equity interest, patent\/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The author Fabio Catani reports consultancy fees, royalties, and fees for participation in review activities from Stryker and consultancy fees from Adler.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The present study was performed in accordance with the Ethical Standards of the 1964 Helsinki Declaration and its later amendments, and IRB approval was obtained (347\/17, transmitted with protocol N. 4394\/C.E. on 29th November 2017).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}