{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T20:47:25Z","timestamp":1784580445346,"version":"3.55.0"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Acquired idiopathic stiffness (AIS) following total knee arthroplasty (TKA) often requires manipulation under anesthesia (MUA). Robotic-assisted TKA (RA-TKA) systems provide gap balance templates for objective correlation with the rate of AIS. The purpose of this study was to assess intraoperative balancing parameters that were associated with MUA utilizing an \u201canatomical\u201d implant design.<\/jats:p><jats:p>We performed a retrospective chart review of 265 imageless RA-TKA procedures performed by R.M. and K.D. between 2018 and 2020. The primary outcome for AIS or clinically significant \u201carthrofibrosis\u201d was MUA. Patient intraoperative gap planning data were examined for association.<\/jats:p><jats:p>The rate of MUA was 8.7% (23\/265), which was performed at a mean follow-up time of 75.9\u2009\u00b1\u200932.2 days. The lateral to medial gap difference in extension was significantly less in patients requiring MUA (odds ratio [OR] = 0.86, 95% confidence interval [CI], 0.75\u20130.99) (p = 0.034). Significantly less preoperative varus mechanical axis was associated with knees requiring MUA (1.83\u00b0 vs. 4.04\u00b0, OR = 1.09, 95% CI, 1.00\u20131.19). Decreased templated mechanical axis correction was associated with MUA (2.09\u00b0 vs. 4.75\u00b0, p\u2009&lt;\u20090.0001).<\/jats:p><jats:p>A tighter lateral-to-medial gap in extension, less preoperative varus, and smaller templated mechanical axis corrections were associated with increased rates of MUA.<\/jats:p>","DOI":"10.1055\/a-2410-2668","type":"journal-article","created":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T23:11:25Z","timestamp":1725577885000},"page":"053-061","source":"Crossref","is-referenced-by-count":1,"title":["The Influence of Preimplant Balancing on Manipulation under Anesthesia Rates following Imageless Robotic-Assisted Total Knee Arthroplasty"],"prefix":"10.1055","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0652-5134","authenticated-orcid":false,"given":"Justin T.","family":"Butler","sequence":"additional","affiliation":[{"name":"The CORE Institute, Hip and Knee Reconstruction, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel D.","family":"Stegelmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Medical City Denton, Denton, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trent","family":"Davis","sequence":"additional","affiliation":[{"name":"Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Singleton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Mercy Health\u2014St. Vincent Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hunter","family":"Ostlie","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Mercy Health\u2014St. Vincent Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Mercy Health\u2014St. Vincent Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk","family":"Davis","sequence":"additional","affiliation":[{"name":"Fulton County Health Center, FCHC Orthopedics, Wauseon, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,10,1]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1016\/j.joca.2017.07.022","article-title":"Projected increase in total knee arthroplasty in the United States\u2014an alternative projection model","volume":"25","author":"M CS Inacio","year":"2017","journal-title":"Osteoarthritis Cartilage"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11999-009-1119-9","article-title":"Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?","volume":"468","author":"R B Bourne","year":"2010","journal-title":"Clin Orthop Relat Res"},{"issue":"14","key":"ref3","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.2106\/JBJS.18.01217","article-title":"Acquired idiopathic stiffness after total knee arthroplasty: a systematic review and meta-analysis","volume":"101","author":"M E Tibbo","year":"2019","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"ref4","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1302\/0301-620X.98B10.37957","article-title":"International consensus on the definition and classification of fibrosis of the knee joint","volume":"98-B","author":"N S Kalson","year":"2016","journal-title":"Bone Joint J"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"2604","DOI":"10.1016\/j.arth.2017.02.005","article-title":"Arthrofibrosis associated with total knee arthroplasty","volume":"32","author":"V A Cheuy","year":"2017","journal-title":"J Arthroplasty"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.2106\/00004623-200407000-00017","article-title":"Stiffness after total knee arthroplasty. 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