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Accuracy and reproducibility of posterior tibial slope restoration in robotic-assisted versus conventional total knee arthroplasty: A comparative analysis across alignment strategies
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DOI：10.1016/j.jor.2026.03.041.png)
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Abstract
En 中文
Introduction: Posterior tibial slope (PTS) influences knee kinematics, ligament tension, and polyethylene wear after total knee arthroplasty (TKA). Native PTS varies widely, yet conventional mechanical instrumentation targets a uniform slope of 3-7 degrees. Robotic-assisted TKA has emerged as a promising tool to enhance precision and reproducibility in component positioning, though comparative data on its ability to consistently achieve planned PTS remains limited. We hypothesized that robotic-assisted TKA would demonstrate superior consistency in slope correction. Methods: A retrospective review was performed on 400 primary TKAs by four high-volume fellowship-trained surgeons, using distinct alignment philosophies: robotic restricted kinematic alignment, rKA, mechanical alignment with measured resection, and mechanical alignment with gap balancing. Preoperative and postoperative PTS were measured from standardized lateral radiographs using validated digital tools. Postoperative PTS variance and change from baseline were analyzed using a one-way ANOVA test with significance set to p < 0.05. Results: Preoperative PTS differed significantly among surgeons (p = 0.0112). Postoperatively, all cohorts achieved slopes within a moderate range and inter-surgeon differences persisted (p = 0.0031). The amount of slope reduction also (p = 0.0289). Variance analysis revealed robotic rKA cohort exhibited the lowest variability in slope correction (SD = 3.70 degrees). Despite these differences, all postoperative slopes fell within recommended safe zones. Discussion and conclusion: Restoration of posterior tibial slope may vary more by surgeon and technique than by technology. Robotic rKA improved the reproducibility of planned slope correction, whereas an experienced manual surgeon achieved the most consistent final slopes. These findings support the utility of robotic platforms in achieving consistent, patient-specific restoration in modern TKA.
Keywords:
Posterior tibial slope
Total knee arthroplasty
Robotic-assisted surgery
Restricted kinematic alignment
Mechanical alignment
Component positioning
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