N.N. Priorov Journal of Traumatology and OrthopedicsN.N. Priorov Journal of Traumatology and OrthopedicsВестник травматологии и ортопедии им. Н.Н. Приорова0869-86782658-6738Eco-Vector67818110.17816/vto678181EWPDCOSCIENTIFIC REVIEWSНаучные обзорыReview ArticleModern lower extremity alignment philosophies in total knee arthroplastyСовременные философии выравнивания оси нижней конечности при тотальном эндопротезировании коленного суставаhttps://orcid.org/0000-0001-7507-77727333-6640AirapetovGeorgii A.АйрапетовГеоргий Александрович
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

airapetovga@yandex.ruhttps://orcid.org/0000-0002-6736-97726889-8166ZagorodniyNikolay V.ЗагороднийНиколай Васильевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor, Academician of the Russian Academy of Sciences

д-р мед. наук, профессор, академик РАН

zagorodniy51@mail.ruhttps://orcid.org/0000-0001-6692-09759880-2555DaniliyantsArmen A.ДанильянцАрмен Альбертович
Russian Federation
armendts@mail.ruhttps://orcid.org/0009-0008-4190-31145191-4314DzampaevKonstantin A.ДзампаевКонстантин Асланович
Russian Federation
kostya199921@gmail.comhttps://orcid.org/0009-0005-7329-4446Al KafavinAnjum H.A.Аль КафавинАнджум Хасан Аталлах
Russian Federation
anjum.hasan@mail.ruhttps://orcid.org/0009-0000-3654-2408AkhmatAbdoulaye A.АхматАбдулайе Адам
Russian Federation
dr.ahmataa@gmail.comhttps://orcid.org/0000-0001-5770-7304SamkovichDmitry A.СамковичДмитрий Александрович
Russian Federation
dmitry.samkovitch@gmail.comPeoples' Friendship University of Russia named after Patrice LumumbaРоссийский университет дружбы народов имени Патриса ЛумумбыCity Clinical Hospital № 31 named after Academician G.M. SavelyevaГородская клиническая больница № 31 им. академика Г.М. СавельевойPriorov National Medical Research Center of Traumatology and OrthopedicsНациональный медицинский исследовательский центр травматологии и ортопедии им. Н.Н. Приорова12112025310520263324164270604202516082025Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-Вектор2026Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://journals.eco-vector.com/0869-8678/article/view/678181

Total knee arthroplasty is the primary treatment method for advanced stages of knee osteoarthritis. However, according to the published data, 10%–20% of patients are dissatisfied with the surgical outcome. To improve the results of knee arthroplasty, various lower extremity alignment techniques have been developed and proposed for clinical use over several decades. The review aimed to analyze contemporary techniques of lower extremity alignment in total knee arthroplasty. Scientific data was searched using the Scopus and PubMed databases, the ResearchGate platform, and the eLibrary electronic scientific database. Publications in both Russian and English were retrieved and analyzed. Each alignment philosophy has its own advantages and limitations. The most widely discussed alignment concepts include mechanical alignment, anatomical alignment (systematic techniques aimed at achieving a neutral axis), adjusted mechanical alignment, restricted kinematic alignment (hybrid techniques), kinematic alignment, and functional alignment (personalized techniques). With a more detailed understanding of knee anatomy, kinematics, and the identification of different knee phenotypes, some surgeons advocate the use of hybrid and personalized lower extremity alignment strategies that take into account the constitutional anatomy of the knee joint. Available scientific data indicates that long-term outcomes after total knee arthroplasty using these approaches are either superior to or comparable with those achieved using the classical mechanical alignment philosophy. Nevertheless, the modern alternative axis alignment techniques described in this review are aimed at improving the outcomes of total knee arthroplasty. However, because of insufficient data on long-term implant survivorship, further time and research are required to fully assess the feasibility and appropriateness of their use in orthopedic surgical practice.

Эндопротезирование коленного сустава является основным методом лечения поздних стадий гонартроза. При этом, согласно данным литературы, от 10 до 20% пациентов остаются неудовлетворёнными проведённым оперативным лечением. С целью улучшения результатов артропластики коленного сустава в течение многих десятков лет разрабатываются и предлагаются к использованию различные методики выравнивания оси нижней конечности. Целью данной работы является проведение анализа современных методик выравнивания оси нижней конечности при эндопротезировании коленного сустава. Для поиска научных работ использовались базы данных Sсopus, PubMed, платформа ResearchGate, а также электронная научная библиотека eLibrary. Поиск и анализ публикаций проводились на двух языках — русском и английском. Каждый принцип выравнивания имеет свои преимущества и недостатки. К наиболее популярным философиям выравнивания оси относят механическое выравнивание, анатомическое выравнивание (системные методики, формирующие нейтральную ось), отрегулированное механическое выравнивание, ограниченное кинематическое выравнивание (гибридные методики), кинематическое выравнивание, функциональное выравнивание (персонифицированные методики). В связи с более детальным изучением анатомии коленного сустава, его кинематики и описаний различных фенотипов колена ряд хирургов предлагают выполнять гибридные и персонифицированные выравнивания оси нижней конечности, учитывая конституциональное строение коленного сустава. При этом данные литературы свидетельствуют о том, что долгосрочные результаты после эндопротезирования коленного сустава лучше таковых при применении классической механической философии выравнивания оси или сопоставимы с ними. Безусловно, описанные в данной работе современные альтернативные методики выравнивания оси конечности направлены на улучшение результатов эндопротезирования коленного сустава. Однако ввиду недостаточной информации об отдалённых результатах выживаемости имплантатов требуется время для полного понимания целесообразности их применения в практике хирурга-ортопеда.

total knee arthroplastyknee alignment types in total knee arthroplastymechanical alignmentkinematic alignmentfunctional alignmentэндопротезирование коленного сустававиды выравнивания при эндопротезировании коленного суставамеханическое выравниваниекинематическое выравниваниефункциональное выравниваниеMarsh M, Newman S. Trends and developments in hip and knee arthroplasty technology. J Rehabil Assist Technol Eng. 2021;8:2055668320952043. doi: 10.1177/2055668320952043Alrajeb R, Zarti M, Shuia Z, et al. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2024;34(3):1333–1343. doi: 10.1007/s00590-023-03798-2Mathis DT, Hirschmann MT. Why do knees after total knee arthroplasty fail in different parts of the world? J Orthop. 2020;23:52–59. doi: 10.1016/j.jor.2020.12.007DeFrance MJ, Scuderi GR. Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature. J Arthroplasty. 2023;38(3):594–599. doi: 10.1016/j.arth.2022.10.011Oussedik S, Abdel MP, Victor J, et al. Alignment in total knee arthroplasty. Bone Joint J. 2020;102-B(3):276–279. doi: 10.1302/0301-620x.102b3.bjj-2019-1729Hiranaka T. Current concept: personalized alignment total knee arthroplasty as a contrast to classical mechanical alignment total knee arthroplasty. Arthroplasty. 2024;6(1):23. doi: 10.1186/s42836-024-00246-2Karasavvidis T, Pagan Moldenhauer CA, Lustig S, et al. Definitions and consequences of current alignment techniques and phenotypes in total knee arthroplasty (TKA) — there is no winner yet. J Exp Orthop. 2023;10(1):120. doi: 10.1186/s40634-023-00697-7Schelker BL, Moret CS, Sava MP, et al. The impact of different alignment strategies on bone cuts in total knee arthroplasty for varus knee phenotypes. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1840–1850. doi: 10.1007/s00167-023-07351-wRivière C, Iranpour F, Auvinet E, et al. Alignment options for total knee arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2017;103(7):1047–1056. doi: 10.1016/j.otsr.2017.07.010MacDessi SJ, Griffiths-Jones W, Harris IA, et al. Coronal Plane Alignment of the Knee (CPAK) classification. Bone Joint J. 2021;103-B(2):329–337. doi: 10.1302/0301-620x.103b2.bjj-2020-1050.r1Valpiana P, Salvi AG, Ghirardelli S, et al. Asymmetric gap balancing improves knee kinematic following primary total knee arthroplasty. Arthroplasty. 2024;6(1):29. doi: 10.1186/s42836-024-00243-5Insall JN, Binazzi R, Soudry M, et al. Total knee arthroplasty. Clin Orthop Relat Res. 1985;(192):13–22.Аirapetov GA, Yablonskiy PK, Serdobintsev MS, et al. Robot-assisted knee arthroplasty: first experience (a prospective randomized study). Genius of Orthopedics. 2023;29(5):475–480. doi: 10.18019/1028-4427-2023-29-5-475-480 EDN: PXAFKPBegum FA, Kayani B, Magan AA, et al. Current concepts in total knee arthroplasty: mechanical, kinematic, anatomical, and functional alignment. Bone Jt Open. 2021;2(6):397–404. doi: 10.1302/2633-1462.26.bjo-2020-0162.r1Patel N, Waterson HB, Phillips J, et al. 50 years of knee arthroplasty. Bone Jt 360. 2019;8(3):3–7. doi: 10.1302/2048-0105.82.360688Tecame A, Gambineri A, Za P, Adravanti P. Is the femoral intramedullary alignment already actual in total knee arthroplasty? J Exp Orthop. 2023;10(1):16. doi: 10.1186/s40634-022-00563-yWang Q, Zhang X, Shi T, et al. The accuracy of an extramedullary femoral cutting system in total knee arthroplasty in patients with severe coronal femoral bowing: a radiographic study. J Orthop Surg Res. 2022;17(1):257. doi: 10.1186/s13018-022-03140-2Liu K, Liu X, Guan Y, et al. Accuracy and reproducibility analysis of different reference axes for femoral prosthesis rotation alignment in TKA based on 3D CT femoral model. BMC Musculoskelet Disord. 2023;24(1):660. doi: 10.1186/s12891-023-06781-4Ma DS, Wang ZW, Wen L, et al. Improving Tibial Component Coronal Alignment During Total Knee Arthroplasty with the Use of a Double-Check Technique. Orthop Surg. 2019;11(6):1013–1019. doi: 10.1111/os.12570Akagi M, Oh M, Nonaka T, et al. An anteroposterior axis of the tibia for total knee arthroplasty. Clinical Orthopedic Related Research. 2004;(420):213–9. doi: 10.1097/00003086-200403000-00030Tian G, Wang L, Liu L, et al. Kinematic alignment versus mechanical alignment in total knee arthroplasty: An up-to-date meta-analysis. J Orthop Surg (Hong Kong). 2022;30(3):10225536221125952. doi: 10.1177/10225536221125952Khan ZA, Leica A, Sava MP, Hirschmann MT. No difference in postoperative patient satisfaction rates between mechanical and kinematic alignment total knee arthroplasty: A systematic review. J Exp Orthop. 2024;11(3):e12101. doi: 10.1002/jeo2.12101Bae K, Lee BS, Kim JM, et al. Preoperative phenotype has no significant impact on the clinical outcomes and long-term survival of mechanically aligned total knee arthroplasty in Asian patients with osteoarthritis. Bone Joint J. 2024;106-B(5):460–467. doi: 10.1302/0301-620x.106b5.bjj-2023-1110.r1Hommel H, Perka C, Pfitzner T. Preliminary results of a new surgical technique in total knee arthroplasty (TKA) using the native ligament tension for femoral implant positioning in varus osteoarthritis. Arch Orthop Trauma Surg. 2016;136(7):991–997. doi: 10.1007/s00402-016-2480-2Hommel H, Tsamassiotis S, Falk R, Fennema P. Adjusted mechanical alignment: operative technique-Tips and tricks. Orthopade. 2020;49(7):562–569. (In German). doi: 10.1007/s00132-020-03929-1Howell SM, Shelton TJ, Hull M.L. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty. 2018;33(12):3678–3684. doi: 10.1016/j.arth.2018.07.020Lustig S, Sappey-Marinier E, Fary C, et al. Personalized alignment in total knee arthroplasty: current concepts. SICOT J. 2021;7:19. doi: 10.1051/sicotj/2021021Rivière C, Lazic S, Villet L, et al. Kinematic alignment technique for total hip and knee arthroplasty: the personalized implant positioning surgery. EFORT Open Rev. 2018;3(3):98–105. doi: 10.1302/2058-5241.3.170022Luderer V, Strauch M, Hirschmann MT, Graichen H. Independent of the preoperative coronal deformity, adjusted mechanical alignment leads in a high percentage to non-anatomical tibial and femoral bone cuts. Knee Surg Sports Traumatol Arthrosc. 2023;31(9):3784–3791. doi: 10.1007/s00167-023-07337-8Graichen H, Luderer V, Strauch M, et al. Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections. Knee Surg Sports Traumatol Arthrosc. 2023;31(3):768–776. doi: 10.1007/s00167-022-07014-2Sheth NP, Husain A, Nelson CL. Surgical Techniques for Total Knee Arthroplasty: Measured Resection, Gap Balancing, and Hybrid. J Am Acad Orthop Surg. 2017;25(7):499–508. doi: 10.5435/jaaos-d-14-00320Vanlommel L, Vanlommel J, Claes S. Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees. Knee Surg Sports Traumatol Arthrosc. 2013;21:2325–2330. doi: 10.1007/s00167-013-2481-4Waterson H, Walker R, Koopmans P, et al. Gap balanced adjusted mechanical alignment versus measured resection mechanical alignment: a randomised controlled trial. Arch Orthop Trauma Surg. 2023;143(4):2141–2151. doi: 10.1007/s00402-022-04487-1Lei K, Liu LM, Yang PF, et al. Slight femoral under-correction versus neutral alignment in total knee arthroplasty with preoperative varus knees: a comparative study. Arthroplasty. 2022;4(1):7. doi: 10.1186/s42836-021-00105-4Gustke K, Simon P. Two-Year Outcome Comparison of a Matched Set of Total Knee Arthroplasties Performed with Robotic-Arm-Assisted Functional Alignment Balancing or Manual Instrument-Assisted Adjusted Mechanical Alignment. J Arthroplasty. 2025:S0883-5403(25)00179-2. doi: 10.1016/j.arth.2025.02.051Hungerford DS, Krackow KA. Total joint arthroplasty of the knee. Clin Orthop Relat Res. 1985;192:23–33.Hirschmann MT, Moser LB, Amsler F, et al. Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1385–1393. doi: 10.1007/s00167-019-05508-0Yim JH, Song EK, Khan MS, et al. A comparison of classical and anatomical total knee alignment methods in robotic total knee arthroplasty: classical and anatomical knee alignment methods in TKA. J Arthroplasty. 2013;28(6):932–7. doi: 10.1016/j.arth.2013.01.013Howell SM, Howell SJ, Kuznik KT, et al. Does a kinematically aligned total knee arthroplasty restore function without failure regardless of alignment category? Clin Orthop Relat Res. 2013;471(3):1000–1007. doi: 10.1007/s11999-012-2613-zLychagin AV, Gritsyuk AA, Kalinsky EB, et al. Kinematic alignment in robotic total knee arthroplasty. Genius of Orthopedics. 2024;30(6):845–854. doi: 10.18019/1028-4427-2024-30-6-845-854 EDN: VQQOFAArai N, Toyooka S, Masuda H, et al. Kinematic Alignment Achieves a More Balanced Total Knee Arthroplasty Than Mechanical Alignment among CPAK Type I Patients: A Simulation Study. J Clin Med. 2024;13(12):3596. doi: 10.3390/jcm13123596Lozano R, Campanelli V, Howell S, Hull M. Kinematic alignment more closely restores the groove location and the sulcus angle of the native trochlea than mechanical alignment: implications for prosthetic design. Knee Surg Sports Traumatol Arthrosc. 2019;27(5):1504–1513. doi: 10.1007/s00167-018-5220-zTarassoli P, Wood JA, Chen DB, et al. Arithmetic hip-knee-ankle angle and stressed hip-knee-ankle angle: equivalent methods for estimating constitutional lower limb alignment in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2022;30(9):2980–2990. doi: 10.1007/s00167-022-07038-8Hiranaka T, Suda Y, Saitoh A, et al. Current concept of kinematic alignment total knee arthroplasty and its derivatives. Bone Jt Open. 2022;3(5):390–397. doi: 10.1302/2633-1462.35.bjo-2022-0021.r2Nedopil AJ, Delman C, Howell SM, Hull ML. Restoring the Patient’s Pre-Arthritic Posterior Slope Is the Correct Target for Maximizing Internal Tibial Rotation When Implanting a PCL Retaining TKA with Calipered Kinematic Alignment. J Pers Med. 2021;11(6):516. doi: 10.3390/jpm11060516Nedopil AJ, Howell SM, Hull ML. Kinematically Aligned Total Knee Arthroplasty Using Calipered Measurements, Manual Instruments, and Verification Checks. Jul 1, 2020. In: Rivière C, Vendittoli PA, editors. Personalized Hip and Knee Joint Replacement [Internet]. Cham (CH): Springer; 2020. Chapter 24. doi: 10.1007/978-3-030-24243-5_24Elbuluk AM, Jerabek SA, Suhardi VJ, et al. Head-to-head comparison of kinematic alignment versus mechanical alignment for total knee arthroplasty. J Arthroplasty. 2022;37(8S):S849–S851. doi: 10.1016/j.arth.2022.01.052Rivière C, Villet L, Jeremic D, et al. What you need to know about kinematic alignment for total knee arthroplasty. Orthop Traumatol Surg Res. 2021;107(1S):102773. doi: 10.1016/j.otsr.2020.102773Graichen H, Lekkreusuwan K, Eller K, et al. A single type of varus knee does not exist: morphotyping and gap analysis in varus OA. Knee Surg Sports Traumatol Arthrosc. 2022;30(8):2600–2608. doi: 10.1007/s00167-021-06688-4Gao ZX, Long NJ, Zhang SY, et al. Comparison of Kinematic Alignment and Mechanical Alignment in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Clinical Trials. Orthop Surg. 2020;12(6):1567–1578. doi: 10.1111/os.12826Gibbons JP, Zeng N, Bayan A, et al. No Difference in 10-year Clinical or Radiographic Outcomes Between Kinematic and Mechanical Alignment in TKA: A Randomized Trial. Clin Orthop Relat Res. 2025;483(1):140–149. doi: 10.1097/corr.0000000000003193Reinisch F, Ioannou A, Eberle A, Ioannou M. Comparison of Six-Week, Three-Month, and One-Year Postoperative Clinical Results of Kinematic and Mechanical Alignment in Primary Medial Pivot Total Knee Arthroplasty. Cureus. 2024;16(7):e64517. doi: 10.7759/cureus.64517Cognault J, Verdier N, Hirschmann MT. Inappropriate grouping of various kinematic alignment techniques and inconsistent reporting of adverse events invalidate comparison across studies: An umbrella review of meta-analyses. Knee Surg Sports Traumatol Arthrosc. 2025;33(8):2880–2895. doi: 10.1002/ksa.12545Rodríguez AO, Jagota I, Baré J, Shimmin A. Impact of changes in native coronal plane alignment of the knee (CPAK) on patient-reported outcome measures (PROMS). A bilateral single implant study. J Orthop. 2024;65:64–70. doi: 10.1016/j.jor.2024.12.002Blakeney WG, Khan RJ, Palmer JL. Functional outcomes following total knee arthroplasty: a randomised trial comparing computer-assisted surgery with conventional techniques. Knee. 2014;21(2):364–8. doi: 10.1016/j.knee.2013.04.001Longstaff LM, Sloan K, Stamp N, et al. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplasty. 2009;24:570–8. doi: 10.1016/j.arth.2008.03.002Rivière C, Iranpour F, Auvinet E, et al. Alignment options for total knee arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2017;103(7):1047–1056. doi: 10.1016/j.otsr.2017.07.010Cortina G, Za P, Papalia GF, et al. Restricted kinematic alignment is clinically non-inferior to mechanical alignment in the short and mid-term: A systematic review. Knee. 2023;45:137–146. doi: 10.1016/j.knee.2023.10.003Vendittoli P-A, Martinov S, Blakeney WG. Restricted kinematic alignment, the fundamentals, and clinical applications. Front Surg. 2021;8:697020. doi: 10.3389/fsurg.2021.697020Almaawi AM, Hutt JRB, Masse V, et al. The Impact of Mechanical and Restricted Kinematic Alignment on Knee Anatomy in Total Knee Arthroplasty. J Arthroplasty. 2017;32(7):2133–2140. doi: 10.1016/j.arth.2017.02.028Ma R, Chen X, Li H, et al. Computer Navigation Assisted Restricted Kinematic Alignment Improves Short-Term Outcomes in Total Knee Arthroplasty: An Ambispective Cohort Study. Orthop Surg. 2023;15(2):460–470. doi: 10.1111/os.13603Turan K, Camurcu Y, Kezer M, et al. A comparison of robotic-assisted and manual techniques in restricted kinematically aligned total knee arthroplasty: coronal alignment improvement with no significant clinical differences. Knee Surg Sports Traumatol Arthrosc. 2023;31(11):4673–4679. doi: 10.1007/s00167-023-07426-8Shichman I, Hadad A, Brandstetter AS, et al. Better restoration of joint line obliquity in tibia first restricted kinematic alignment versus mechanical alignment TKA. Arch Orthop Trauma Surg. 2024;144(9):4475–4481. doi: 10.1007/s00402-024-05551-8Ettinger M, Tuecking LR, Savov P, Windhagen H. Higher satisfaction and function scores in restricted kinematic alignment versus mechanical alignment with medial pivot design total knee arthroplasty: A prospective randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2024;32(5):1275–1286. doi: 10.1002/ksa.12143Kayani B, Konan S, Tahmassebi J, et al. A prospective double-blinded randomised control trial comparing robotic arm-assisted functionally aligned total knee arthroplasty versus robotic arm-assisted mechanically aligned total knee arthroplasty. Trials. 2020;21(1):194. doi: 10.1186/s13063-020-4123-8Clark G, Steer R, Wood D. Functional alignment achieves a more balanced total knee arthroplasty than either mechanical alignment or kinematic alignment prior to soft tissue releases. Knee Surg Sports Traumatol Arthrosc. 2023;31(4):1420–1426. doi: 10.1007/s00167-022-07156-3Dhungana H, Jangid S, Goyal M. Alignment Techniques in Total Knee Arthroplasty: Where do We Stand Today? Chin Med Sci J. 2024;39(3):217–225. doi: 10.24920/004372Shatrov J, Battelier C, Sappey-Marinier E, et al. Functional Alignment Philosophy in Total Knee Arthroplasty — rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT J. 2022;8:11. doi: 10.1051/sicotj/2022010Shatrov J, Foissey C, Kafelov M, et al. Functional Alignment Philosophy in Total Knee Arthroplasty-rationale and technique for the valgus morphotype using an image based robotic platform and individualized planning. J Pers Med. 2023;13(2):212. doi: 10.3390/jpm13020212Van de Graaf VA, Chen DB, Allom RJ, et al. Functional alignment in total knee arthroplasty best achieves balanced gaps and minimal bone resections: an analysis comparing mechanical, kinematic and functional alignment strategies. Knee Surg Sports Traumatol Arthrosc. 2023;31(11):5118–5127. doi: 10.1007/s00167-023-07567-wMigliorini F, Pilone M, Schäfer L, et al. Functional alignment in robotic-assisted total knee arthroplasty: a systematic review. Arch Orthop Trauma Surg. 2024;144(4):1741–1749. doi: 10.1007/s00402-023-05195-0Gregori P, Koutserimpas C, Giovanoulis V, et al. Functional alignment in robotic-assisted total knee arthroplasty for valgus deformity achieves safe coronal alignment and excellent short-term outcomes. Knee Surg Sports Traumatol Arthrosc. 2025;33(6):2187–2196. doi: 10.1002/ksa.12585Hazratwala K, Gouk C, Wilkinson MPR, O’Callaghan WB. Navigated functional alignment total knee arthroplasty achieves reliable, reproducible and accurate results with high patient satisfaction. Knee Surg Sports Traumatol Arthrosc. 2023;31(9):3861–3870. doi: 10.1007/s00167-023-07327-w