{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:21:46Z","timestamp":1785763306230,"version":"3.56.0"},"reference-count":33,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,5,11]],"date-time":"2025-05-11T00:00:00Z","timestamp":1746921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["arthroplastyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Arthroplasty"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.arth.2025.05.011","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T19:16:51Z","timestamp":1746818211000},"page":"2910-2915","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"title":["Type IIB Spino-Pelvic Imbalance Is an Independent Risk Factor for Flexion Contracture after Total Knee Arthroplasty"],"prefix":"10.1016","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9604-2042","authenticated-orcid":false,"given":"Matteo","family":"Innocenti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1289-8849","authenticated-orcid":false,"given":"Filippo","family":"Leggieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0393-4848","authenticated-orcid":false,"given":"Davide","family":"Stimolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5315-5348","authenticated-orcid":false,"given":"Alessandro","family":"Civinini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4813-772X","authenticated-orcid":false,"given":"Fabrizio","family":"Matassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0010-7532","authenticated-orcid":false,"given":"Roberto","family":"Civinini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.arth.2025.05.011_bib1","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1007\/s00264-013-1993-3","article-title":"The natural history of a newly developed flexion contracture following primary total knee arthroplasty","volume":"37","author":"Anania","year":"2013","journal-title":"Int Orthop"},{"key":"10.1016\/j.arth.2025.05.011_bib2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1051\/sicotj\/2024007","article-title":"Management of fixed flexion contracture in primary total knee arthroplasty: recent systematic review","volume":"10","author":"Sappey-Marinier","year":"2024","journal-title":"SICOT J"},{"issue":"6 Suppl 2","key":"10.1016\/j.arth.2025.05.011_bib3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.arth.2007.03.037","article-title":"Surgical treatment of flexion contractures after total knee arthroplasty","volume":"22","author":"Fehring","year":"2007","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.arth.2025.05.011_bib4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11999-011-2135-0","article-title":"The New knee society knee scoring system","volume":"470","author":"Scuderi","year":"2012","journal-title":"Clin Orthop"},{"key":"10.1016\/j.arth.2025.05.011_bib5","doi-asserted-by":"crossref","first-page":"e855","DOI":"10.3928\/01477447-20111021-18","article-title":"Flexion contracture following primary total knee arthroplasty: risk factors and outcomes","volume":"34","author":"Goudie","year":"2011","journal-title":"Orthopedics"},{"issue":"11 Suppl A","key":"10.1016\/j.arth.2025.05.011_bib6","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1302\/0301-620X.94B11.30512","article-title":"Fixed flexion deformity and total knee arthroplasty","volume":"94","author":"Su","year":"2012","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.arth.2025.05.011_bib7","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.arth.2006.11.009","article-title":"The role of flexion contracture on outcomes in primary total knee arthroplasty","volume":"22","author":"Ritter","year":"2007","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.arth.2025.05.011_bib8","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1016\/j.arth.2017.03.074","article-title":"What is the ideal degree of extension after primary total knee arthroplasty?","volume":"32","author":"Kim","year":"2017","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.arth.2025.05.011_bib9","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.2106\/00004623-200307000-00014","article-title":"Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis","volume":"85","author":"Ritter","year":"2003","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.arth.2025.05.011_bib10","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1302\/0301-620X.79B4.0790626","article-title":"Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis","volume":"79","author":"Lizaur","year":"1997","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.arth.2025.05.011_bib11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1055\/s-0030-1248221","article-title":"Factors affecting postoperative range of motion after total knee arthroplasty","volume":"17","author":"Gatha","year":"2004","journal-title":"J Knee Surg"},{"key":"10.1016\/j.arth.2025.05.011_bib12","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1302\/0301-620X.69B3.3584192","article-title":"Effect of knee arthroplasty on flexion deformity","volume":"69","author":"Tew","year":"1987","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.arth.2025.05.011_bib13","doi-asserted-by":"crossref","first-page":"961","DOI":"10.2106\/00004623-197557070-00014","article-title":"Analysis of knee-joint forces during flexed-knee stance","volume":"57","author":"Perry","year":"1975","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.arth.2025.05.011_bib14","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.arth.2013.04.039","article-title":"The effect of knee flexion contracture following total knee arthroplasty on the energy cost of walking","volume":"29","author":"Murphy","year":"2014","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.arth.2025.05.011_bib15","doi-asserted-by":"crossref","first-page":"777","DOI":"10.2106\/JBJS.F.01022","article-title":"The effect of postoperative range of motion on functional activities after posterior cruciate-retaining total knee arthroplasty","volume":"90","author":"Ritter","year":"2008","journal-title":"J Bone Joint Surg Am"},{"key":"10.1016\/j.arth.2025.05.011_bib16","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/0883-5403(94)90096-5","article-title":"Natural history of uncorrected flexion contractures following total knee arthroplasty","volume":"9","author":"McPherson","year":"1994","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.arth.2025.05.011_bib17","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1302\/0301-620X.85B1.13389","article-title":"The knee-spine syndrome. Association between lumbar lordosis and extension of the knee","volume":"85","author":"Murata","year":"2003","journal-title":"J Bone Joint Surg Br"},{"key":"10.1016\/j.arth.2025.05.011_bib18","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s007760200092","article-title":"Knee-spine syndrome: correlation between sacral inclination and patellofemoral joint pain","volume":"7","author":"Tsuji","year":"2002","journal-title":"J Orthop Sci"},{"issue":"Suppl 5","key":"10.1016\/j.arth.2025.05.011_bib19","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1007\/s00586-011-1930-3","article-title":"Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms?","volume":"20","author":"Barrey","year":"2011","journal-title":"Eur Spine J"},{"key":"10.1016\/j.arth.2025.05.011_bib20","doi-asserted-by":"crossref","first-page":"436","DOI":"10.3171\/2015.5.SPINE14989","article-title":"Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity","volume":"24","author":"Ferrero","year":"2016","journal-title":"J Neurosurg Spine"},{"key":"10.1016\/j.arth.2025.05.011_bib21","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1007\/s00586-013-2661-4","article-title":"The effect of simulated knee flexion on sagittal spinal alignment: novel interpretation of Spino-pelvic alignment","volume":"22","author":"Lee","year":"2013","journal-title":"Eur Spine J"},{"key":"10.1016\/j.arth.2025.05.011_bib22","doi-asserted-by":"crossref","first-page":"e888","DOI":"10.5435\/JAAOS-D-20-00953","article-title":"Spino-pelvic biomechanics and total hip arthroplasty: a primer for clinical practice","volume":"29","author":"Heckmann","year":"2021","journal-title":"J Am Acad Orthop Surg"},{"issue":"Suppl 5","key":"10.1016\/j.arth.2025.05.011_bib23","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s00586-011-1936-x","article-title":"Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee","volume":"20 Suppl 5","author":"Obeid","year":"2011","journal-title":"Eur Spine J"},{"key":"10.1016\/j.arth.2025.05.011_bib24","first-page":"213","article-title":"Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation","volume":"71","author":"Legaye","year":"2005","journal-title":"Acta Orthop Belg"},{"key":"10.1016\/j.arth.2025.05.011_bib25","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1097\/BRS.0b013e3181a13c08","article-title":"Sagittal plane considerations and the pelvis in the adult patient","volume":"34","author":"Schwab","year":"2009","journal-title":"Spine"},{"key":"10.1016\/j.arth.2025.05.011_bib26","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/BRS.0000000000001863","article-title":"Full-body analysis of age-adjusted alignment in adult spinal deformity patients and lower-limb compensation","volume":"42","author":"Jalai","year":"2017","journal-title":"Spine"},{"key":"10.1016\/j.arth.2025.05.011_bib27","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1016\/j.arth.2020.12.029","article-title":"Prevalence of risk factors for adverse spino-pelvic mobility among patients undergoing total hip arthroplasty","volume":"36","author":"Vigdorchik","year":"2021","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.arth.2025.05.011_bib28","doi-asserted-by":"crossref","first-page":"3242","DOI":"10.3390\/jcm10153242","article-title":"Effects of total knee arthroplasty on coronal and sagittal whole-body alignments: serial assessments using whole-body EOS","volume":"10","author":"Kim","year":"2021","journal-title":"J Clin Med"},{"key":"10.1016\/j.arth.2025.05.011_bib29","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.knee.2021.02.027","article-title":"Relationships between the changes in flexion contracture and standing flexion angle of the knee and sagittal spinal alignment after total knee arthroplasty","volume":"29","author":"Han","year":"2021","journal-title":"Knee"},{"issue":"6, Supplement","key":"10.1016\/j.arth.2025.05.011_bib30","doi-asserted-by":"crossref","first-page":"S330","DOI":"10.1016\/j.arth.2020.02.031","article-title":"Stiffness after total knee arthroplasty: is it a result of spinal deformity?","volume":"35","author":"Vigdorchik","year":"2020","journal-title":"J Arthroplasty"},{"key":"10.1016\/j.arth.2025.05.011_bib31","doi-asserted-by":"crossref","DOI":"10.3389\/fsurg.2021.697020","article-title":"Restricted kinematic alignment, the fundamentals, and clinical applications","volume":"8","author":"Vendittoli","year":"2021","journal-title":"Front Surg"},{"key":"10.1016\/j.arth.2025.05.011_bib32","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s13063-020-4123-8","article-title":"A prospective double-blinded randomised control trial comparing robotic arm-assisted functionally aligned total knee arthroplasty versus robotic arm-assisted mechanically aligned total knee arthroplasty","volume":"21","author":"Kayani","year":"2020","journal-title":"Trials"},{"key":"10.1016\/j.arth.2025.05.011_bib34","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/BRS.0000000000004957","article-title":"Impact of hip and knee osteoarthritis on full Body sagittal alignment and compensation for sagittal spinal deformity","volume":"49","author":"Balmaceno-Criss","year":"2024","journal-title":"Spine"}],"container-title":["The Journal of Arthroplasty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0883540325005054?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0883540325005054?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T13:33:28Z","timestamp":1761399208000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0883540325005054"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":33,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["S0883540325005054"],"URL":"https:\/\/doi.org\/10.1016\/j.arth.2025.05.011","relation":{},"ISSN":["0883-5403"],"issn-type":[{"value":"0883-5403","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Type IIB Spino-Pelvic Imbalance Is an Independent Risk Factor for Flexion Contracture after Total Knee Arthroplasty","name":"articletitle","label":"Article Title"},{"value":"The Journal of Arthroplasty","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arth.2025.05.011","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}