{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:14:21Z","timestamp":1777889661352,"version":"3.51.4"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The aim of this study was to evaluate the deviation from the surgical plan of femoral and tibial components positioning after robotic total knee arthroplasty (R-TKA) compared with conventional TKA (C-TKA) based on postoperative three-dimensional computed tomography (3D-CT). This prospective randomized trial included 60 patients: 29 in the C-TKA group and 31 in the R-TKA one. Early postoperative 3D-CT-based analysis of implants positioning was performed. Measurements were performed twice by two observers, showing good to excellent intra- and interobserver reproducibility (interclass coefficient ranging from 0.71 to 0.96). Absolute deviations from the surgical plan (mechanical alignment in the C-TKA group and personalized alignment in the R-TKA group) were compared between groups. Primary endpoint was coronal lower limb frontal alignment: hip\u2013knee\u2013ankle (HKA) angle. Secondary endpoints were frontal, sagittal, and rotational positioning of both tibial and femoral components. Planned frontal lower limb alignment was similarly achieved in both group: HKA angle mean difference was 2.28\u2009\u00b1\u20091.81\u2009degrees in the C-TKA group and 1.84\u2009\u00b1\u20091.46\u2009degrees in the R-TKA group (p\u2009=\u20090.379). Deviations from the surgical plan were lower in the R-TKA group compared with the C-TKA group for all parameters, except tibial rotation (9.02\u2009\u00b1\u20094.51 vs. 7.42\u2009\u00b1\u20093.96\u2009degrees, respectively). These differences turned out to be statistically significant only for sagittal alignment of both femoral (1.71\u2009\u00b1\u20091.34 vs. 3.61\u2009\u00b1\u20092.05\u2009degrees, p\u2009&lt;\u20090.001) and tibial (3.78\u2009\u00b1\u20091.15 vs. 4.94\u2009\u00b1\u20091.99\u2009degrees, p\u2009=\u20090.018) components. Accuracy in achieving planned coronal lower limb alignment is not higher using R-TKA compared with C-TKA. Regarding component positioning, R-TKA appears superior in the sagittal plane while no significant differences were identified in terms of frontal alignment and rotation.<\/jats:p>\n                  <jats:p>Level of Evidence\u2003I.<\/jats:p>","DOI":"10.1055\/a-2664-7551","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T23:07:08Z","timestamp":1754521628000},"page":"009-016","source":"Crossref","is-referenced-by-count":2,"title":["Computed Tomography-Based Analysis of Implant Positioning after Total Knee Arthroplasty: A Randomized Controlled Trial Comparing Conventional and Robotic Arm-Assisted Procedures"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8172-1090","authenticated-orcid":false,"given":"Cl\u00e9ment","family":"Horteur","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, Echirolles, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benoit","family":"Gaulin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, Echirolles, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Pascal","sequence":"additional","affiliation":[{"name":"Department of Radiology, Grenoble-Alpes University Hospital, Grenoble, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corentin","family":"Leroy","sequence":"additional","affiliation":[{"name":"Data Engineering Unit, CIC, Public Health Department, Universit\u00e9 Grenoble Alpes, Inserm, Grenoble Alpes University Hospital, Grenoble, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joris","family":"Giai","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, INSERM CIC1406, Grenoble, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00e9r\u00f4me","family":"Murgier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Clinique Aguilera RAMSAY, Sant\u00e9 Biarritz, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Barth","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Clinique Aguilera RAMSAY, Sant\u00e9 Biarritz, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u00e9gis","family":"Pailh\u00e9","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Clinique Aguilera RAMSAY, Sant\u00e9 Biarritz, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.arth.2022.10.011","article-title":"Are 20% of patients actually dissatisfied following total knee arthroplasty? A systematic review of the literature","volume":"38","author":"M J DeFrance","year":"2023","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00264-018-3913-z","article-title":"Total knee arthroplasties from the origin to navigation: history, rationale, indications","volume":"43","author":"D Saragaglia","year":"2019","journal-title":"Int Orthop"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.arth.2013.06.029","article-title":"In-vivo alignment comparing patient specific instrumentation with both conventional and computer assisted surgery (CAS) instrumentation in total knee arthroplasty","volume":"29","author":"W Barrett","year":"2014","journal-title":"J Arthroplasty"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1112147","DOI":"10.3389\/fsurg.2023.1112147","article-title":"Comparison of navigation systems for total knee arthroplasty: a systematic review and meta-analysis","volume":"10","author":"Y Luan","year":"2023","journal-title":"Front Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"102780","DOI":"10.1016\/j.otsr.2020.102780","article-title":"Total knee arthroplasty: latest robotics implantation techniques","volume":"107","author":"R Pailh\u00e9","year":"2021","journal-title":"Orthop Traumatol Surg Res"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/j.otsr.2019.07.005","article-title":"Mechanical alignment: the end of an era!","volume":"105","author":"C Rivi\u00e8re","year":"2019","journal-title":"Orthop Traumatol Surg Res"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"102773","DOI":"10.1016\/j.otsr.2020.102773","article-title":"What you need to know about kinematic alignment for total knee arthroplasty","volume":"107","author":"C Rivi\u00e8re","year":"2021","journal-title":"Orthop Traumatol Surg Res"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1120908","DOI":"10.3389\/fsurg.2023.1120908","article-title":"Overview of the different personalized total knee arthroplasty with robotic assistance, how choosing?","volume":"10","author":"M W Morcos","year":"2023","journal-title":"Front Surg"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"3585","DOI":"10.1007\/s00167-020-06283-z","article-title":"MAKO CT-based robotic arm-assisted system is a reliable procedure for total knee arthroplasty: a systematic review","volume":"29","author":"C Batailler","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/CORR.0000000000000916","article-title":"Does robotic-assisted TKA result in better outcome scores or long-term survivorship than conventional TKA? A randomized, controlled trial","volume":"478","author":"Y H Kim","year":"2020","journal-title":"Clin Orthop Relat Res"},{"issue":"12","key":"ref11","doi-asserted-by":"crossref","first-page":"5446","DOI":"10.1007\/s00167-023-07590-x","article-title":"Improved accuracy of implant placement with an imageless handheld robotic system compared to conventional instrumentation in patients undergoing total knee arthroplasty: a prospective randomized controlled trial using CT-based assessment of radiological outcomes","volume":"31","author":"P Bollars","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11701-023-01786-6","article-title":"MAKO versus ROSA: comparing surgical accuracy in robotic total knee arthroplasty","volume":"18","author":"H D Rajgor","year":"2024","journal-title":"J Robot Surg"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1007\/s00590-023-03798-2","article-title":"Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials","volume":"34","author":"R Alrajeb","year":"2024","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"12","key":"ref14","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00402-021-04048-y","article-title":"Concepts and techniques of a new robotically assisted technique for total knee arthroplasty: the ROSA knee system","volume":"141","author":"C Batailler","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1007\/s00167-018-5138-5","article-title":"Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning","volume":"27","author":"B Kayani","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jot.2021.12.004","article-title":"HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment - a prospective randomized and multicenter study","volume":"33","author":"Z Li","year":"2022","journal-title":"J Orthop Translat"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1111\/os.14008","article-title":"Safety and effectiveness of robotic-arm assisted total knee arthroplasty","volume":"16","author":"M Yuan","year":"2024","journal-title":"Orthop Surg"},{"issue":"08","key":"ref18","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1016\/j.arth.2019.04.007","article-title":"Robot-assisted total knee arthroplasty does not improve long-term clinical and radiologic outcomes","volume":"34","author":"S W Jeon","year":"2019","journal-title":"J Arthroplasty"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1302\/0301-620X.93B5.25893","article-title":"The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction","volume":"93","author":"M T Hirschmann","year":"2011","journal-title":"J Bone Joint Surg Br"},{"issue":"11","key":"ref20","doi-asserted-by":"crossref","first-page":"3349","DOI":"10.1007\/s00402-021-04163-w","article-title":"Influence of axial limb rotation on radiographic lower limb alignment: a systematic review","volume":"142","author":"M D Ahrend","year":"2022","journal-title":"Arch Orthop Trauma Surg"},{"issue":"08","key":"ref21","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1302\/0301-620X.102B8.BJJ-2020-0054.R1","article-title":"Migration of a novel 3D-printed cementless versus a cemented total knee arthroplasty: two-year results of a randomized controlled trial using radiostereometric analysis","volume":"102-B","author":"S Hasan","year":"2020","journal-title":"Bone Joint J"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s43019-021-00111-5","article-title":"Bone remodeling and implant migration of uncemented femoral and cemented asymmetrical tibial components in total knee arthroplasty - DXA and RSA evaluation with 2-year follow up","volume":"33","author":"M Yilmaz","year":"2021","journal-title":"Knee Surg Relat Res"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1055\/s-0040-1715571","article-title":"Improved component placement accuracy with robotic-arm assisted total knee arthroplasty","volume":"35","author":"O Mahoney","year":"2022","journal-title":"J Knee Surg"},{"issue":"420","key":"ref24","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/00003086-200403000-00030","article-title":"An anteroposterior axis of the tibia for total knee arthroplasty","author":"M Akagi","year":"2004","journal-title":"Clin Orthop Relat Res"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-0602.R2","article-title":"A prospective randomized controlled trial comparing the systemic inflammatory response in conventional jig-based total knee arthroplasty versus robotic-arm assisted total knee arthroplasty","volume":"103-B","author":"B Kayani","year":"2021","journal-title":"Bone Joint J"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-2003.R1","article-title":"Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques","volume":"103-B","author":"D G Deckey","year":"2021","journal-title":"Bone Joint J"},{"issue":"09","key":"ref27","doi-asserted-by":"crossref","first-page":"2351","DOI":"10.1007\/s00264-024-06234-0","article-title":"Comparison of the efficacy and safety of MAKO robot-assisted total knee arthroplasty versus conventional manual total knee arthroplasty in uncomplicated unilateral total knee arthroplasty a single-centre retrospective analysis","volume":"48","author":"N Ma","year":"2024","journal-title":"Int Orthop"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s00167-020-06353-2","article-title":"Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial","volume":"30","author":"N V Vaidya","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"e2505","DOI":"10.1002\/rcs.2505","article-title":"Surgical accuracy and clinical outcomes of image-free robotic-assisted total knee arthroplasty","volume":"19","author":"C TK Lau","year":"2023","journal-title":"Int J Med Robot"},{"issue":"11","key":"ref30","doi-asserted-by":"crossref","first-page":"2851","DOI":"10.1007\/s00264-021-05179-y","article-title":"Imageless robotic-assisted total knee arthroplasty accurately restores the radiological alignment with a short learning curve: a randomized controlled trial","volume":"45","author":"S Thiengwittayaporn","year":"2021","journal-title":"Int Orthop"},{"issue":"12","key":"ref31","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1016\/j.arth.2013.12.010","article-title":"Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study","volume":"29","author":"M HL Liow","year":"2014","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s11999-012-2407-3","article-title":"Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA","volume":"471","author":"E K Song","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"09","key":"ref33","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1111\/os.13323","article-title":"Early clinical and radiographic outcomes of robot-assisted versus conventional manual total knee arthroplasty: a randomized controlled study","volume":"14","author":"J Xu","year":"2022","journal-title":"Orthop Surg"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1055\/s-0038-1641729","article-title":"Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques","volume":"32","author":"E L Hampp","year":"2019","journal-title":"J Knee Surg"},{"issue":"10","key":"ref35","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1016\/j.arth.2019.05.058","article-title":"Intraoperative tibial anteroposterior axis could not be replicated after tibial osteotomy in total knee arthroplasty","volume":"34","author":"K Kawaguchi","year":"2019","journal-title":"J Arthroplasty"},{"issue":"11","key":"ref36","doi-asserted-by":"crossref","first-page":"3517","DOI":"10.1007\/s00167-016-4325-5","article-title":"How to assess femoral and tibial component rotation after total knee arthroplasty with computed tomography: a systematic review","volume":"24","author":"E J De Valk","year":"2016","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/s11701-024-02045-y","article-title":"Comparison of robotic-assisted total knee arthroplasty: an updated systematic review and meta-analysis","volume":"18","author":"X Fu","year":"2024","journal-title":"J Robot Surg"},{"issue":"07","key":"ref38","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1007\/s00264-024-06206-4","article-title":"Robotic assisted total knee arthroplasty (TKA) is not associated with increased patient satisfaction: a systematic review and meta-analysis","volume":"48","author":"A H Hoveidaei","year":"2024","journal-title":"Int Orthop"},{"issue":"11","key":"ref39","doi-asserted-by":"crossref","first-page":"4680","DOI":"10.1007\/s00167-023-07458-0","article-title":"Robotic-assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta-analysis of randomized controlled trials","volume":"31","author":"A Bensa","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"S129","DOI":"10.1016\/j.arth.2022.02.087","article-title":"Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA)","volume":"37","author":"G S Kazarian","year":"2022","journal-title":"J Arthroplasty"},{"issue":"08","key":"ref41","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1002\/ksa.12266","article-title":"Why we should use boundaries for personalised knee arthroplasty and the lack of evidence for unrestricted kinematic alignment","volume":"32","author":"P A Vendittoli","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2664-7551.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T23:47:24Z","timestamp":1767916044000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2664-7551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":41,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,8]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2664-7551","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]}}}