{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T16:25:01Z","timestamp":1794241501820,"version":"4.9.0"},"reference-count":46,"publisher":"EDP Sciences","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SICOT-J"],"accepted":{"date-parts":[[2025,12,22]]},"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>\n                    <jats:italic>Introduction<\/jats:italic>\n                    : Functional alignment (FA) or functional knee positioning is a patient-specific strategy for total knee arthroplasty (TKA) that utilizes robotics to balance coronal, sagittal, and axial planes while preserving joint-line orientation and soft-tissue tension within predefined guardrails. Although early clinical outcomes are encouraging, the radiographic profile and workflow consistency of robotic FA have not been clearly synthesized.\n                    <jats:italic>Methods<\/jats:italic>\n                    : In accordance with PRISMA guidelines, English-language studies of primary robotic FA-TKA with \u22652-year follow-up were searched. Eligible designs included RCTs, prospective\/retrospective cohorts, and large case series (\u226550 patients). Information on pre- and postoperative coronal alignment [hip\u2013knee\u2013ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA)], component positioning (femoral valgus\/rotation\/flexion; tibial varus\/rotation\/slope), and explicit FA workflow boundaries (guardrails) was extracted.\n                    <jats:italic>Results<\/jats:italic>\n                    : Twenty-one cohorts (5,360 knees) reported at least one radiographic or workflow endpoint. Preoperatively, the predominant deformity was varus. Postoperatively, limb alignment converged near neutral: HKA clustered around 178\u2013179.5\u00b0, with LDFA ~89\u201391\u00b0 and MPTA ~87\u201389\u00b0. Component positions were tightly distributed within FA targets: femoral valgus \u2248 0.5\u20131.5\u00b0, tibial varus \u2248 ~3\u00b0, femoral flexion ~6\u20139\u00b0, and tibial slope ~0\u20133\u00b0; tibial rotation was overwhelmingly referenced to Akagi\u2019s line, and femoral rotation to the TEA in most series. Reported guardrails showed strong convergence: typical workflows included femoral valgus \u22123\u00b0 to +6\u00b0, tibial varus 0\u20136\u00b0, tibial slope 0\u20133\u00b0, and femoral ER ~3\u20136\u00b0 to TEA. Across cohorts, achieved radiographs closely tracked these limits, indicating high adherence and reproducibility. Most observational studies had a moderate risk of bias; the lone RCT was low risk.\n                    <jats:italic>Discussion<\/jats:italic>\n                    : Robotic FA-TKA delivers a radiographic profile with slight femoral valgus and modest tibial varus, while keeping components within narrow, pre-specified guardrails.\n                    <jats:italic>Level of evidence<\/jats:italic>\n                    : Level III, systematic review and meta-analysis.\n                  <\/jats:p>","DOI":"10.1051\/sicotj\/2025068","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:54:58Z","timestamp":1769590498000},"page":"4","source":"Crossref","is-referenced-by-count":6,"title":["A systematic review of radiological outcomes and implant positioning in robotic-assisted functionally aligned robotic total knee arthroplasty"],"prefix":"10.1051","volume":"12","author":[{"given":"Vasileios","family":"Giovanoulis","sequence":"first","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, H\u00f4pital de la Croix-Rousse","place":["France"]},{"name":"Third Academic Department of Orthopaedics, Papageorgiou General Hospital","place":["Greece"]},{"name":"Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo V.","family":"Vasiliadis","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, H\u00f4pital de la Croix-Rousse","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftherios","family":"Tsiridis","sequence":"additional","affiliation":[{"name":"Third Academic Department of Orthopaedics, Papageorgiou General Hospital","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Andriollo","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, H\u00f4pital de la Croix-Rousse","place":["France"]},{"name":"Ortopedia e Traumatologia, Fondazione Poliambulanza Istituto Ospedaliero","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Gregori","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, H\u00f4pital de la Croix-Rousse","place":["France"]},{"name":"Fondazione Policlinico Universitario Campus Bio-Medico","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Dretakis","sequence":"additional","affiliation":[{"name":"Second Department of Orthopaedics, Hygeia General Hospital of Athens","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, H\u00f4pital de la Croix-Rousse","place":["France"]},{"name":"Second Department of Orthopaedics, Hygeia General Hospital of Athens","place":["Greece"]},{"name":"School of Health Rehabilitation Sciences, University of Patras","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Lustig","sequence":"additional","affiliation":[{"name":"Orthopaedics Surgery and Sports Medicine Department, H\u00f4pital de la Croix-Rousse","place":["France"]},{"name":"IFSTTAR, LBMC UMR_T9406, Univ Lyon, Claude Bernard Lyon 1 University, 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