Does Robotic-Assisted Functional Knee Positioning Result in Better Functional Outcomes One Year After Surgery
Bibliographic record
Abstract
INTRODUCTION: Robotic-assisted total knee arthroplasty (TKA) allows surgeons to individualize implant placement based on soft tissue and bony anatomy, called functional knee positioning (FKP). We aimed to compare patient-reported outcome measures (PROMs) of mechanically aligned total knee arthroplasty (MA-TKA) with functionally positioned total knee arthroplasty (FP-TKA). MATERIALS AND METHODS: Patients who underwent primary MA-TKA and FP-TKA were propensity score matched 1:1 (145 MA-TKA: 145 FP-TKA cases) using a prospectively collected institutional dataset. For FP-TKA cases, the surgeon followed functional positioning principles, individualizing planned implant position to balance the knee prior to bone cuts while minimizing the need for soft tissue releases. For MA-TKA, cases were mechanically aligned and gap balanced using standard techniques. The postoperative reduced Western Ontario and McMaster Arthritis Score (r-WOMAC) Pain and Function scores were compared at six months and one year using average and t-tests. The length of stay (LOS), as well as knee extension and flexion at six weeks were compared. RESULTS: There was no statistically significant difference in the r-WOMAC pain and r-WOMAC function scores between both groups at six months; however, both trended towards the FP-TKA group. At one year, the r-WOMAC function scores significantly improved for the FP-TKA group compared to controls (2.94 vs. 4.38; p=0.02). There was no significant difference in the r-WOMAC pain scores at one year. The FP-TKA cohort required a shorter LOS compared to those who had MA-TKA (1.75 vs. 2.36; p<0.0001). There was no significant difference in flexion or extension at six weeks between groups (p=0.77 and 0.18, respectively). CONCLUSION: We demonstrate that patients who underwent FP-TKA trended toward functional improvements at six months and significant improvements in function at one year (which did not reach minimally clinical important difference). Functional positioning strategies may improve patient-reported outcomes due to minimizing dissection and personalizing implant position.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".