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Imageless kinematic versus CT-based functional alignment in robotic-assisted total knee arthroplasty: A propensity
Yong Ng1,2, Jeremy Tze En Lim1, Ren Yi Kow3
1Department of Orthopaedics, Singapore General Hospital, Singapore Health Services, 1 Hospital Boulevard, Singapore, 168581, Singapore.
Journal of Orthopaedics
|May 25, 2026
Summary
Robotic-assisted total knee arthroplasty (rTKA) using kinematic alignment (KA) and functional alignment (FA) showed similar six-month outcomes. Early ambulation was better with KA-rTKA, but differences were not clinically significant long-term.
Area of Science:
- Orthopedic Surgery
- Robotics in Medicine
- Arthroplasty
Background:
- Robotic-assisted total knee arthroplasty (rTKA) allows personalized alignment strategies like kinematic alignment (KA) and functional alignment (FA).
- Comparative data between imageless KA-rTKA and CT-based FA-rTKA is limited.
- Understanding the comparative effectiveness of these robotic alignment techniques is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare six-month patient-reported outcome measures (PROMs) between imageless KA-rTKA and CT-based FA-rTKA.
- To evaluate early postoperative recovery as secondary outcomes.
- To assess the functional outcomes and patient satisfaction following different robotic alignment strategies in total knee arthroplasty.
Main Methods:
- Retrospective analysis of 206 propensity-matched primary rTKA cases.
- Primary outcomes included six-month Knee Society Scores (KSS), Oxford Knee Score (OKS), Short Form-36 (SF-36), minimal clinically important difference (MCID) achievement, patient satisfaction, and expectation fulfillment.
- Secondary outcomes included postoperative day one (POD1) knee range of motion, pain scores, and ambulation distance.
Main Results:
- Six-month PROMs, MCID achievement, satisfaction, and expectation fulfillment were comparable between KA-rTKA and FA-rTKA groups (P > 0.05).
- The KA-rTKA group showed significantly greater POD1 ambulation distance (22.6 m vs 15.8 m; P = 0.010).
- No significant differences were observed in POD1 pain scores or knee range of motion between the groups.
Conclusions:
- Imageless KA-rTKA and CT-based FA-rTKA yield equivalent six-month functional outcomes in robotic-assisted total knee arthroplasty.
- While KA-rTKA demonstrated improved early ambulation, this did not translate to clinically meaningful differences at six months.
- Both robotic alignment strategies achieve similar short-term outcomes, highlighting their comparable efficacy in total knee replacement.