{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T13:44:05Z","timestamp":1767015845940,"version":"3.48.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Fondo de Investigaci\u00f3n Sanitaria","award":["PI12\/01098"],"award-info":[{"award-number":["PI12\/01098"]}]},{"DOI":"10.13039\/501100006382","name":"Universidad de Oviedo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006382","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Computer-assisted systems improve conventional instrumentation in normalizing the axis of the limb in frontal deformities. The performance of a postoperative X-ray has been questioned to verify this axis, assuming that it can be replaced by the final image that appears on the system monitor. The objective of this work is to verify whether both axes are similar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 123 patients with varus\u2013valgus frontal deformity, a total knee arthroplasty was implanted with the aid of the same navigation system without previous images. On the one hand, the final femorotibial angulation that appeared on the monitor screen, and on the other hand, the one observed in a long postoperative digitalized radiograph were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A discrepancy and poor correlation were observed between the femorotibial alignment verified radiographically and that shown on the system monitor at the end of the surgical procedure. Differences were significant in the valgus deformity group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04) and especially in the varus cases (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The median postoperative axis as measured by computer-assisted was very close to neutral, but a deviation toward varus was observed on the X-ray.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The axis of the limb observed with a computer-assisted system is closer to neutral alignment than that shown on the digitalized X-ray image after total arthroplasty in patients with frontal deformities. A postoperative X-ray is recommended as certification of the result, being more reliable than the final image from the system monitor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-025-04551-7","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:59:41Z","timestamp":1759852781000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is technological-assisted leg axis alignment reliable in total knee arthroplasty with varus\u2013valgus deformities?"],"prefix":"10.1007","volume":"35","author":[{"given":"Daniel","family":"Hernandez-Vaquero","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso","family":"Noriega-Fernandez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Roncero-Gonzalez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"4551_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32531-5","author":"JT Evans","year":"2019","unstructured":"Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR (2019) How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. https:\/\/doi.org\/10.1016\/S0140-6736(18)32531-5","journal-title":"Lancet"},{"key":"4551_CR2","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.1007\/s00264-020-04607-9","volume":"44","author":"N Nakano","year":"2020","unstructured":"Nakano N, Shoman H, Olavarria F, Matsumoto T, Kuroda R, Khanduja V (2020) Why are patients dissatisfied following a total knee replacement? A systematic review. Int Orthop 44:1971\u20132007. https:\/\/doi.org\/10.1007\/s00264-020-04607-9","journal-title":"Int Orthop"},{"key":"4551_CR3","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1007\/s00264-024-06093-9","volume":"48","author":"K Zheng","year":"2024","unstructured":"Zheng K, Wang Y, Wang T, Zhu F, Zhang L, Li R, Zhou J, Geng D, Xu Y (2024) Restoration of constitutional alignment optimizes outcomes of computer navigated total knee arthroplasty: a prospective randomized controlled trial. Int Orthop 48:971\u2013981. https:\/\/doi.org\/10.1007\/s00264-024-06093-9","journal-title":"Int Orthop"},{"key":"4551_CR4","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s00167-021-06811-5","volume":"30","author":"BL Schelker","year":"2022","unstructured":"Schelker BL, Nowakowski AM, Hirschmann MT (2022) What is the \u201csafe zone\u201d for transition of coronal alignment from systematic to a more personalized one in total knee arthroplasty? A systematic review. Knee Surg Sports Traumatol Arthrosc 30:419\u2013427. https:\/\/doi.org\/10.1007\/s00167-021-06811-5","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR5","doi-asserted-by":"crossref","unstructured":"- Worden JA, Fuqua A, Ross BJ, Gillis J, Heo KY, Wilson JM. Premkumar A (2025). Trends in utilization of technology-assisted navigation inuUnicompartmental and total knee arthroplasty between 2009 and 2022. J Arthroplast S0883\u20135403(25)01153\u20132","DOI":"10.1016\/j.arth.2025.08.082"},{"key":"4551_CR6","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s00167-022-07158-1","volume":"31","author":"OM Farhan-Alanie","year":"2023","unstructured":"Farhan-Alanie OM, Altell T, O\u2019Donnell S, May P, Doonan J, Rowe P, Jones B, Blyth MJG (2023) No advantage with navigated versus conventional mechanically aligned total knee arthroplasty-10 year results of a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 31:751\u2013759. https:\/\/doi.org\/10.1007\/s00167-022-07158-1","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR7","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1007\/s11999-009-1175-1","volume":"468","author":"D Hern\u00e1ndez-Vaquero","year":"2010","unstructured":"Hern\u00e1ndez-Vaquero D, Suarez-Vazquez A, Sandoval-Garcia MA, Noriega-Fernandez A (2010) Computer assistance increases precision of component placement in total knee arthroplasty with articular deformity. Clin Orthop Relat Res 468:1237\u20131241. https:\/\/doi.org\/10.1007\/s11999-009-1175-1","journal-title":"Clin Orthop Relat Res"},{"key":"4551_CR8","doi-asserted-by":"publisher","first-page":"126","DOI":"10.2106\/JBJS.K.00607","volume":"95","author":"MA Ritter","year":"2013","unstructured":"Ritter MA, Davis KE, Davis P, Farris A, Malinzak RA, Berend ME, Meding JB (2013) Preoperative malalignment increases risk of failure after total knee arthroplasty. J Bone Joint Surg Am 95:126\u2013131. https:\/\/doi.org\/10.2106\/JBJS.K.00607","journal-title":"J Bone Joint Surg Am"},{"key":"4551_CR9","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.04.057","volume":"39","author":"P Gurusamy","year":"2024","unstructured":"Gurusamy P, Liu JW, Sullivan TC, Clyburn TA, Lambert BS, Incavo SJ (2024) Alignment in total knee arthroplasty: avoid crossing over from varus to valgus. J Arthroplasty 39:S206\u2013S211. https:\/\/doi.org\/10.1016\/j.arth.2024.04.057","journal-title":"J Arthroplasty"},{"issue":"20","key":"4551_CR10","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1186\/s12891-019-2940-2","volume":"23","author":"K Kizaki","year":"2019","unstructured":"Kizaki K, Shanmugaraj A, Yamashita F, Simunovic N, Duong A, Khanna V, Ayeni OR (2019) Total knee arthroplasty using patient-specific instrumentation for osteoarthritis of the knee: a meta-analysis. BMC Musculoskelet Disord 23(20):561. https:\/\/doi.org\/10.1186\/s12891-019-2940-2","journal-title":"BMC Musculoskelet Disord"},{"key":"4551_CR11","doi-asserted-by":"publisher","DOI":"10.1186\/s42836-024-00246-2","volume":"6","author":"T Hiranaka","year":"2024","unstructured":"Hiranaka T (2024) Current concept: personalized alignment total knee arthroplasty as a contrast to classical mechanical alignment total knee arthroplasty. Arthroplasty 6:23. https:\/\/doi.org\/10.1186\/s42836-024-00246-2","journal-title":"Arthroplasty"},{"key":"4551_CR12","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1055\/s-0040-1722694","volume":"35","author":"R Larrainzar-Garijo","year":"2022","unstructured":"Larrainzar-Garijo R, Molanes-Lopez EM, Murillo-Vizuete D, Garcia-Bogalo R, Escobar-Anton D, Lopez-Rodriguez J, Diez-Fernandez A, Corella-Montoya F (2022) Mechanical alignment in knee replacement homogenizes postoperative coronal hip-knee-ankle angle in varus knees: A navigation-based study. J Knee Surg 35:1285\u20131294. https:\/\/doi.org\/10.1055\/s-0040-1722694","journal-title":"J Knee Surg"},{"key":"4551_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2024.07.028","author":"CA Pagan","year":"2024","unstructured":"Pagan CA, Karasavvidis T, Cohen-Rosenblum AR, Hannon CP, Lombardi AV Jr, Vigdorchik JM (2024) Technology in total knee arthroplasty in 2023. J Arthroplasty. https:\/\/doi.org\/10.1016\/j.arth.2024.07.028","journal-title":"J Arthroplasty"},{"issue":"6S","key":"4551_CR14","doi-asserted-by":"publisher","first-page":"S211","DOI":"10.1016\/j.arth.2022.02.004","volume":"37","author":"K Varshneya","year":"2022","unstructured":"Varshneya K, Hong CS, Tyagi V, Ruberte Thiele RA, Huddleston JI 3rd (2022) Imageless computer navigation reduces 5-Year all-cause revision rates after primary total knee arthroplasty. J Arthroplast 37(6S):S211-215. https:\/\/doi.org\/10.1016\/j.arth.2022.02.004","journal-title":"J Arthroplast"},{"key":"4551_CR15","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.2106\/JBJS.23.00555","volume":"106","author":"Tian Y, Ahmed AG, Hiredesai AN, Hua","year":"2024","unstructured":"Tian Y, Ahmed AG, Hiredesai AN, Huang LW, Patel AM, Ghomrawi HMK, (2024) The cost-effectiveness of computer-assisted compared with conventional total knee arthroplasty: A Payer\u2019s perspective. J Bone Joint Surg Am 106:1680\u20131487. https:\/\/doi.org\/10.2106\/JBJS.23.00555","journal-title":"J Bone Joint Surg Am"},{"key":"4551_CR16","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.2106\/JBJS.23.01092","volume":"106","author":"A Fontalis","year":"2024","unstructured":"Fontalis A, Luyckx T, Vanspauwen T, Moreels R, Mancino F, Raj RD, Winnock de Grave P, Plastow R, Putzeys P, Haddad FS (2024) Strong correlation between standing long-leg radiographs and CT scans in measuring coronal knee alignment. J Bone Joint Surg Am 106:1373\u20131383. https:\/\/doi.org\/10.2106\/JBJS.23.01092","journal-title":"J Bone Joint Surg Am"},{"key":"4551_CR17","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1055\/a-2333-1619","volume":"37","author":"JR Giordano","year":"2024","unstructured":"Giordano JR, Bartlett L, Huyke F, Sadh P, Thompson K, Ajah O, Danoff J (2024) Is immediate postoperative radiograph necessary following robotic-assisted total knee arthroplasty? J Knee Surg 37:851\u2013855. https:\/\/doi.org\/10.1055\/a-2333-1619","journal-title":"J Knee Surg"},{"key":"4551_CR18","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1007\/s00167-020-06201-3","volume":"30","author":"KH Shin","year":"2022","unstructured":"Shin KH, Jang KM, Han SB (2022) Residual varus alignment can reduce joint awareness, restore joint parallelism, and preserve the soft tissue envelope during total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc 30:507\u2013516. https:\/\/doi.org\/10.1007\/s00167-020-06201-3","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR19","doi-asserted-by":"publisher","first-page":"4171","DOI":"10.1007\/s00167-023-07448-2","volume":"31","author":"T Luyckx","year":"2023","unstructured":"Luyckx T, Moreels R, Geernaert H, Scheys L, Vandenneucker H (2023) Valgus alignment of the femoral component is associated with higher revision rates 10 years after TKA. Knee Surg Sports Traumatol Arthrosc 31:4171\u20134178. https:\/\/doi.org\/10.1007\/s00167-023-07448-2","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR20","doi-asserted-by":"publisher","first-page":"2663","DOI":"10.1007\/s00167-015-3781-7","volume":"24","author":"HX Liu","year":"2016","unstructured":"Liu HX, Shang P, Ying XZ, Zhang Y (2016) Shorter survival rate in varus-aligned knees after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2663\u20132671. https:\/\/doi.org\/10.1007\/s00167-015-3781-7","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR21","doi-asserted-by":"publisher","first-page":"2248","DOI":"10.1007\/s00167-012-2263-4","volume":"21","author":"DK Bae","year":"2013","unstructured":"Bae DK, Song SJ, Heo DB, Tak DH (2013) Does the severity of preoperative varus deformity influence postoperative alignment in both conventional and computer-assisted total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 21:2248\u20132254. https:\/\/doi.org\/10.1007\/s00167-012-2263-4","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR22","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.arth.2010.07.020","volume":"26","author":"WC Choi","year":"2011","unstructured":"Choi WC, Lee S, An JH, Kim D, Seong SC, Lee MC (2011) Plain radiograph fails to reflect the alignment and advantages of navigation in total knee arthroplasty. J Arthroplasty 26:756\u2013764. https:\/\/doi.org\/10.1016\/j.arth.2010.07.020","journal-title":"J Arthroplasty"},{"key":"4551_CR23","doi-asserted-by":"publisher","first-page":"2721","DOI":"10.1007\/s00167-013-2599-4","volume":"22","author":"J Dexel","year":"2014","unstructured":"Dexel J, Kirschner S, G\u00fcnther KP, L\u00fctzner J (2014) Agreement between radiological and computer navigation measurement of lower limb alignment. Knee Surg Sports Traumatol Arthrosc 22:2721\u20132727. https:\/\/doi.org\/10.1007\/s00167-013-2599-4","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR24","doi-asserted-by":"publisher","first-page":"2736","DOI":"10.1007\/s11999-008-0427-9","volume":"466","author":"MA Yaffe","year":"2008","unstructured":"Yaffe MA, Koo SS, Stulberg SD (2008) Radiographic and navigation measurements of TKA limb alignment do not correlate. Clin Orthop Relat Res 466:2736\u20132744. https:\/\/doi.org\/10.1007\/s11999-008-0427-9","journal-title":"Clin Orthop Relat Res"},{"key":"4551_CR25","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1302\/0301-620X.94B9.28250","volume":"94","author":"NM Willcox","year":"2012","unstructured":"Willcox NM, Clarke JV, Smith BR, Deakin AH, Deep K (2012) A comparison of radiological and computer navigation measurements of lower limb coronal alignment before and after total knee replacement. J Bone Joint Surg Br 94:1234\u20131240. https:\/\/doi.org\/10.1302\/0301-620X.94B9.28250","journal-title":"J Bone Joint Surg Br"},{"key":"4551_CR26","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1007\/s00167-010-1144-y","volume":"18","author":"O Hauschild","year":"2010","unstructured":"Hauschild O, Konstantinidis L, Baumann T, Niemeyer P, Suedkamp NP, Helwig P (2010) Correlation of radiographic and navigated measurements of TKA limb alignment: a matter of time? Knee Surg Sports Traumatol Arthrosc 18:1317\u20131322. https:\/\/doi.org\/10.1007\/s00167-010-1144-y","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4551_CR27","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1503\/cjs.031313","volume":"57","author":"A Carli","year":"2014","unstructured":"Carli A, Aoude A, Reuven A, Matache B, Antoniou J, Zukor DJ (2014) Inconsistencies between navigation data and radiographs in total knee arthroplasty are system-dependent and affect coronal alignment. Can J Surg 57:305\u2013513. https:\/\/doi.org\/10.1503\/cjs.031313","journal-title":"Can J Surg"}],"container-title":["European Journal of Orthopaedic Surgery &amp; Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-025-04551-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-025-04551-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-025-04551-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T13:40:58Z","timestamp":1767015658000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-025-04551-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,7]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4551"],"URL":"https:\/\/doi.org\/10.1007\/s00590-025-04551-7","relation":{},"ISSN":["1432-1068"],"issn-type":[{"type":"electronic","value":"1432-1068"}],"subject":[],"published":{"date-parts":[[2025,10,7]]},"assertion":[{"value":"28 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"423"}}