• Philip Winnock de Grave, J Kellens, T Tampere, H Vermue, T Luyckx, and K Claeys.
• Department of Orthopaedic Surgery, AZ Delta Roeselare, Deltalaan 1, 8800, Roeselare, Belgium. philip.winnockdegrave@azdelta.be.
• Arch Orthop Trauma Surg. 2023 Jun 1; 143 (6): 339133993391-3399.

IntroductionRobotically assisted surgery was introduced in total knee arthroplasty (TKA) to increase the precision of implant positioning and optimize clinical outcomes. However, the target implant position or alignment is debated. The aim of this study was twofold: to compare clinical outcomes of conventional TKA vs. robotically assisted TKA in an adjusted mechanically aligned (MA) TKA series, and to analyze the clinical effects of introducing patient-specific alignment (inverse kinematic alignment, iKA) in a robotically assisted TKA cohort.Materials And MethodsA total of 120 patients with end stage osteoarthritis of the knee were enrolled. The first group (n = 40) received conventional adjusted MA TKA. The second group (n = 40) received robotically assisted adjusted MA TKA. The third group (n = 40) received robotically assisted iKA TKA. All patients received cruciate retaining Triathlon TKA with a uniform surgery protocol. The three groups were matched for age, sex, BMI and preoperative osteoarthritis. Preoperative and 1-year postoperative clinical outcomes were documented with the Oxford Knee Score (OKS).ResultsComparison of OKS between the MA groups indicated no significant difference (p = 0.223) between the conventional TKA (group 1; 40.2 ± 5.9) and robotically assisted TKA (group 2; 42.2 ± 6.3) 1 year postoperatively. Comparison of OKS between the robotically assisted groups indicated no significant difference (p = 0.078) between the MA TKA (group 2; 42.2 ± 6.3) and iKA TKA (group 3; 44.8 ± 3.5). Comparison of conventional MA TKA (group 1; 40.3 ± 6.0) with robotically assisted iKA TKA (group 3; 44.8 ± 3.5) indicated a significant difference (p < 0.001).ConclusionsThe results of this study suggest that the introduction of both patient-specific alignment and robotically assisted surgery improve clinical outcomes in TKA surgery. When access to robotic assistance is available, performing patient-specific alignment should be the objective.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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