Intraoperative joint balancing procedure using an imageless robotic assisted technique does not necessarily result in kinematically aligned bicruciate stabilized total knee arthroplasty.

The primary aim of this study was to retrospectively evaluate the hip- knee- ankle. (HKA) angle and prosthetic alignment with three-dimensional computed tomography (3DCT) measurements in patients who underwent robotic-assisted (RA) TKA, with consideration of the soft tissue envelope via an intraoperative joint-balancing procedure. We hypothesized that intraoperative consideration of soft tissue laxity in individual patients using imageless RA technology will not necessarily result in kinematically aligned bicruciate stabilized total knee arthroplasty (KA TKA). This retrospective study included consecutive patients who underwent RA TKA between 2019 and 2020. The indication for TKA was varus osteoarthritis of the knee. During this period, 60 RA bi-cruciate stabilized TKAs were performed. Prosthetic alignments were measured using computer software with 3DCT. We determined prosthetic positioning and bone resection volume with consideration of the soft tissue envelope using an intraoperative full range of motion joint-balancing procedure during RA TKA. 3DCT scans of the entire lower extremity were taken before and after surgery. Postoperative varus HKA alignment occurred in 58% of patients who underwent RA TKA, 31% of knees were in femoral valgus alignment and tibial varus alignment, and 42% had femoral components in internal rotation among knees with femoral valgus alignment and tibial varus alignment. The mean thickness of the osteotomized medial and lateral posterior condyles of the femur were 11.2 and 9.1 mm, respectively, based on 3DCT measurements. Intraoperative consideration of soft tissue laxity in individual patientsusing an imageless RA technique does not necessarily result in KA bicruciate TKA.