{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:46:43Z","timestamp":1783129603933,"version":"3.54.6"},"reference-count":43,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Robotic-assisted systems have transformed total knee arthroplasty (TKA), promising improved accuracy and intraoperative consistency, yet real-world data from non-academic centers remain limited. Objective: This study evaluates five-year clinical integration of a semi-autonomous, CT-based, robotic-arm-assisted TKA at a tertiary non-teaching hospital in Germany, focusing on planning accuracy, gap balancing, and intraoperative outcomes. Methods: We retrospectively analyzed all patients (n = 457) who underwent MAKO-assisted TKA from 2020 to 2025, performed by three orthopedic surgeons using a standardized subvastus approach. We assessed preoperative deformities, intraoperative alignment, implant sizing, and gap balancing. Surgical plans were adapted intraoperatively when indicated. Pre- vs. post-implantation values were compared using slopes to evaluate execution consistency. Results: Median patient age was 67.0 years (IQR: 60.0\u201375.0), with varus in 84.1% (7.0\u00b0, IQR: 4.0\u00b0\u201310.0\u00b0), valgus in 13.2% (3.0\u00b0, IQR: 1.5\u00b0\u20135.8\u00b0), and neutral alignment in 2.7%. Flexion contracture occurred in 80.4% (6.0\u00b0, IQR: 3.0\u201310.0%), hyperextension in 12.7% (2.0\u00b0, IQR: 1.5\u00b0\u20135.0\u00b0). Planning-to-execution consistency was high, even with plan adaptations. Slope values for alignment parameters were: tibial rotation in degrees (slope value: 1.0), femoral sagittal angle in degrees (0.8), tibial sagittal angle in degrees (0.9), coronal posterior condylar angle in degrees (0.9), femoral component size (1.0), tibial component size (1.0). Over 95% of cases showed \u22643.0\u00b0 deviation between planned and final values. Bone resection concordance showed moderate agreement, with slopes from 0.8 (posterior medial femoral cut in mm) to 0.5 (lateral tibial cut in mm). Gap balancing improved at all stages, with reduced variability in medial\/lateral extension and flexion gaps (all p &lt; 0.05). Functional reconstruction showed significant improvements in extension, flexion, and deformities (all p &lt; 0.001). Conclusions: Semi-autonomous, CT-based, robotic-arm-assisted TKA was successfully implemented in this non-academic setting, demonstrating acceptable intraoperative and functional reconstruction outcomes, supporting the feasibility of robotic-assisted surgery outside academic centers.<\/jats:p>","DOI":"10.3390\/jpm15100482","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T12:32:47Z","timestamp":1760099567000},"page":"482","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Real-World Outcomes of Robotic Total Knee Arthroplasty: Five Years\u2019 Experience in a Non-Academic Center"],"prefix":"10.3390","volume":"15","author":[{"given":"Joost","family":"Burger","sequence":"first","affiliation":[{"name":"Paracelsus-Klinik Bremen, 28329 Bremen, Germany"},{"name":"Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Fan","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany"},{"name":"Julius Wolff Institute and Center for Musculoskeletal Surgery, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandy","family":"Gansiniec","sequence":"additional","affiliation":[{"name":"Paracelsus-Klinik Bremen, 28329 Bremen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper","family":"Reinders","sequence":"additional","affiliation":[{"name":"Paracelsus-Klinik Bremen, 28329 Bremen, Germany"},{"name":"Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scarlette","family":"Kienzle","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Gwinner","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianus den","family":"Hertog","sequence":"additional","affiliation":[{"name":"Paracelsus-Klinik Bremen, 28329 Bremen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4556-2993","authenticated-orcid":false,"given":"Arne","family":"Kienzle","sequence":"additional","affiliation":[{"name":"Paracelsus-Klinik Bremen, 28329 Bremen, Germany"},{"name":"Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany"},{"name":"Julius Wolff Institute and Center for Musculoskeletal Surgery, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany"},{"name":"Berlin Institute of Health at Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charit\u00e9 Clinician Scientist Program, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s11701-025-02313-5","article-title":"Trends of robotic total joint arthroplasty utilization in the United States from 2010 to 2022: A nationwide assessment","volume":"19","author":"Gordon","year":"2025","journal-title":"J. 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Today"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/10\/482\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T12:53:51Z","timestamp":1760100831000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/10\/482"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":43,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jpm15100482"],"URL":"https:\/\/doi.org\/10.3390\/jpm15100482","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]}}}