Gregori Pietro, Koutserimpas Christos, Giovanoulis Vasileios, Batailler Cécile, Servien Elvire, Lustig Sébastien
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, Lyon, France.
Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Knee Surg Sports Traumatol Arthrosc. 2025 Jun;33(6):2187-2196. doi: 10.1002/ksa.12585. Epub 2025 Jan 17.
Functional alignment (FA) in total knee arthroplasty (TKA) prioritizes soft tissue balancing and anatomical restoration without systematic correction to neutral alignment. Most studies have focused on varus deformity, with little evidence available about FA in valgus deformity. The hypothesis of the present study was that FA in robotic-assisted TKA for valgus deformity would demonstrate correction of the coronal alignment and yield satisfactory short-term outcomes.
This retrospective study included 58 patients with valgus coronal alignment (hip-knee-angle [HKA] ≥ 183°) who underwent robotic-assisted TKA using the FA technique with a minimum of 1-year follow-up. Outcomes were assessed through the Knee Society Score (KSS), Oxford Knee Score (OKS), Forgotten Joint Score (FJS) and radiographic measurements of alignment and phenotypes. Complication and revision rates were also analyzed.
The cohort included 39 females and 19 males with a median age of 70. Post-operatively, 86.2% of cases achieved coronal alignment within the safe zone (HKA 177-183°). Significant improvements were observed in KSS (part 1: 69.5-95, part 2: 65-94, p < 0.001), while OKS and FJS exhibited optimal outcomes. Two complications were recorded: one aseptic loosening (1.7%) and one early infection (1.7%). Kaplan-Meier survival analysis indicated favourable implant survivorship at a median follow-up of 18 months.
FA in image-based robotic TKA is a safe and effective approach for patients with valgus deformity. This procedure resulted in a modest correction of the coronal alignment, where no soft tissue releases were needed. The majority of the cases fell within the target coronal alignment boundaries by only accommodating the individual laxities, suggesting the aim of FA to restore each knee's pre-pathological alignment.
Level IV.
全膝关节置换术（TKA）中的功能对线（FA）优先考虑软组织平衡和解剖结构恢复，而不是系统地矫正至中立对线。大多数研究集中于内翻畸形，关于外翻畸形的FA的证据很少。本研究的假设是，机器人辅助TKA治疗外翻畸形时的FA将显示冠状面的矫正并产生令人满意的短期结果。
这项回顾性研究纳入了58例冠状面外翻对线（髋-膝角[HKA]≥183°）的患者，他们接受了采用FA技术的机器人辅助TKA，且至少随访1年。通过膝关节协会评分（KSS）、牛津膝关节评分（OKS）、遗忘关节评分（FJS）以及对线和表型的影像学测量来评估结果。还分析了并发症和翻修率。
该队列包括39名女性和19名男性，中位年龄为70岁。术后，86.2%的病例在安全区内实现了冠状面对线（HKA 177-183°）。KSS（第1部分：69.5-95，第2部分：65-94，p<0.001）有显著改善，而OKS和FJS显示出最佳结果。记录了2例并发症：1例无菌性松动（1.7%）和1例早期感染（1.7%）。Kaplan-Meier生存分析表明，在中位随访18个月时植入物存活率良好。
基于图像的机器人TKA中的FA对于外翻畸形患者是一种安全有效的方法。该手术导致冠状面对线适度矫正，无需进行软组织松解。大多数病例仅通过适应个体松弛度就落在了目标冠状面对线边界内，这表明FA的目标是恢复每个膝关节的病理前对线。
IV级。
