[Our experience using ligament-balancing robotic-assisted total knee arthroplasty]

In addition to conventional total knee arthroplasty, increasing attention has been directed in the past decade toward approaches that aim to tailor implant positioning to the patient's individual anatomy. The OMNIBotics robotic-assisted system enables ligament tension-guided planning of total knee arthroplasty and its precise, personalized execution.

The aim of this study was to present the intraoperative results of total knee arthroplasties performed with the OMNIBotics robotic-assisted system based on digital ligament tension measurements, and to introduce its next-generation platform, the Apollo system.

Between 2020 and 2023, a total of 416 consecutive robotic-assisted total knee arthroplasties were performed at our institution using the OMNIBotics system. Intraoperative data were automatically recorded in the system's cloud-based database. Changes in limb alignment, range of motion, gap-balance, and final component positions were analyzed.

The mean range of motion showed a moderate improvement (5°-127° vs. -2°-128°), and flexion contracture resolved on average. Limb alignment improved from a mean of 6° varus to 1° varus postoperatively. After ligament balancing, the medial and lateral tibiofemoral gaps differed by less than 1 mm throughout 85% of the range of motion. Soft-tissue release was required in only 2.5% of varus knees.

The dynamic ligament-balancing technique provides a balanced tibiofemoral gap and stable knee kinematics throughout the full range of motion while preserving the surrounding soft tissues and ligaments. Further prospective follow-up studies are required to accurately assess the clinical significance of this approach.

The introduction of ligament-balancing robotic-assisted total knee arthroplasty in Hungary offers new opportunities for personalized patient care and for expanding our understanding of knee joint biomechanics. Orv Hetil. 2026; 167(22): 876-884.