{"paper_id":"6838592d-770b-4c18-a344-ce35dd8af249","body_text":"Comparison of the Efficacy of Robot-assisted Total Knee Arthroplasty in Patients with Knee Osteoarthritis with Varying Severity Deformity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of the Efficacy of Robot-assisted Total Knee Arthroplasty in Patients with Knee Osteoarthritis with Varying Severity Deformity Pengfei Xing, Junsong Qu, Shuaijing Feng, Jiarong Guo, Tao Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5245472/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Dec, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 12 You are reading this latest preprint version Abstract AIM : To evaluate the clinical efficacy and imaging outcomes of a domestically produced orthopedic surgical robot for total knee arthroplasty and to explore its applicability in patients with varying degrees of deformity. Methods: This study retrospectively included 120 patients who underwent TKA at our hospital between February 2023 and June 2024. The patients were divided into a control group (conventional TKA surgery) and an observation group (robot-assisted TKA surgery), with 60 patients in each group. On the basis of different lower extremity alignment angles, each group was further subdivided into mild deformities (HKA deviation < 10°) and significant deformities (HKA deviation ≥ 10°). Preoperative and postoperative HKA angles, range of motion (ROM), visual analog scale (VAS) pain scores, and Knee Society (AKS) scores were recorded for both groups. Postoperative measurements included the posterior tibial slope angle (PSA), femoral coronal component angle (FFC), tibial coronal component angle (FTC), and femoral sagittal component angle (LFC), as well as the incidence of abnormal values for each angle, which were analyzed statistically. Results : The operation time in the observation group was longer than that in the control group, but intraoperative blood loss was significantly lower in the observation group (P < 0.05). Postoperatively, the differences in the HKA and PSA angles and the incidence of abnormal values were significantly greater in the robot-assisted group than in the control group (P < 0.05). The other indicators did not significantly differ between the two groups. (P > 0.05). For patients with mild preoperative deformities, those in the robot-assisted group had significantly greater postoperative HKA angle deviations and rates of postoperative HKA angle outliers than did those in the conventional group. For patients with significant deformities, the robot-assisted group presented greater postoperative HKA and PSA angle deviations than did the control group; the postoperative HKA and PSA angle outlier rates were significantly lower in the robot-assisted group (P < 0.05). Conclusion : The TINAVI robotic system demonstrated superior safety and efficacy in TKA surgery. Compared with conventional TKA, the robot-assisted system achieved significantly better outcomes in terms of prosthesis implantation accuracy and lower extremity alignment, with a particular advantage in patients with severe limb alignment deformities. Total knee replacement Robotically assisted operation TINAVI knee system Short-term outcomes Lower extremity force line Figures Figure 1 Figure 2 Figure 3 Introduction As an effective treatment for advanced knee joint diseases, total knee arthroplasty (TKA) has shown remarkable clinical outcomes. The main objective is to restore the patient's neutral mechanical axis [ 1 – 2 ] . However, despite advances in TKA techniques, issues such as inaccurate prosthesis placement and poor mechanical axis restoration persist, leading to decreased patient satisfaction, increased polyethylene wear, and premature prosthesis loosening, which could lead to early revision surgery [ 3 – 5 ] . Therefore, precise prosthesis placement and proper lower extremity alignment are crucial for reducing postoperative complications, extending prosthesis longevity, and improving long-term TKA outcomes [ 6 ] . In conventional TKA, prosthesis placement accuracy heavily relies on the surgeon's experience, resulting in lower precision and reproducibility [ 7 – 9 ] . To overcome these limitations, robotic-assisted systems have been increasingly adopted in TKA surgeries. Studies have shown that robotic systems improve lower extremity alignment and significantly increase the precision of prosthesis placement [ 10 – 11 ] . However, some studies suggest that robot-assisted systems may not yield better clinical outcomes or imaging results than traditional surgeries do [ 12 – 13 ] . Robot-assisted total knee arthroplasty (TKA) technology integrates robotic navigation and 3D reconstruction techniques to achieve precise surgical outcomes. Through precise 3D reconstruction and navigation, the robot can perform highly accurate surgical operations, minimizing intraoperative errors and risks. Additionally, it allows for preoperative planning and simulation, providing more accurate predictions and guidance for surgery [ 14 ] . In this study, we utilized the domestically produced TINAVI (Tianzhihang) orthopedic surgical robot (Fig. 1 ), demonstrating technological advancements in precise positioning, a broad range of indications, and accurate image matching. Its precision can reach submillimeter levels. This study employed a retrospective analysis to validate the effectiveness and safety of the robot-assisted system. This study compared the early clinical outcomes and imaging results of patients with varying degrees of knee osteoarthritis deformity after receiving robot-assisted TKA. This study also explored whether robot-assisted surgery is superior to traditional surgery and evaluated its applicability in patients with different degrees of deformity. Methods and Materials 1. The inclusion and exclusion criteria were as follows: ① age 45–80 years, ② Kellgren–Lawrence grade 4 knee osteoarthritis, and ③ complete clinical and imaging follow-up data. The exclusion criteria for patients were as follows: ① a history of neuromuscular disorders of the knee; ② a history of open knee surgery; ③ preoperative knee joint infection; ④ severe knee valgus deformity (Krackow type III); ⑤ the presence of deep vein thrombosis of the lower extremity; and ⑥ autoimmune or immunodeficiency diseases. On the basis of the above inclusion and exclusion criteria, this study selected 120 patients with knee osteoarthritis treated at our hospital between February 2023 and June 2024. Of these, 60 patients underwent TINAVI robot-assisted TKA. The patients were allocated to the robot-assisted surgery group, whereas 60 patients underwent conventional TKA and were assigned to the conventional surgery group. 2. General Information: In the robot-assisted TKA group, there were 8 males and 52 females, with 32 cases involving the left knee and 28 involving the right knee. The mean age was 64.25 ± 7.01 years, and the body mass index (BMI) was 26.60 ± 3.10 kg/m². In the conventional TKA group, there were 12 males and 48 females, with 28 cases involving the left knee and 32 involving the right knee. The mean age was 65.71 ± 4.91 years, and the BMI was 26.11 ± 2.81 kg/m². Each group was further subdivided based on the degree of knee deformity into severe deformity (HKA ≥ 10°) and mild deformity (HKA < 10°). There were no statistically significant differences between the two groups with respect to sex, age, BMI, preoperative AKS score, side of surgery, preoperative knee range of motion (ROM), or preoperative HKA angle (P > 0.05), indicating that the groups were comparable (Table 1 ). After further stratification on the basis of the severity of deformity within each group, there were no statistically significant differences in preoperative general information (P > 0.05). This study was approved by the Ethics Committee of the First Hospital of China Medical University, and the patients were exempt from informed consent. (Approval No. [2024]528). 3. Surgical Procedures: Both groups underwent surgeries performed by the same skilled surgeon and their team. The conventional group underwent the standard TKA procedure. The TINAVI orthopedic surgical robot was used in the robot-assisted group, and all surgeries used Johnson & Johnson prostheses. All patients underwent surgery under general anesthesia, and a tourniquet was applied to the lower extremity with pressure set at 280 mmHg. The anterior median approach was used for all procedures. A robotic tracker array was inserted into the four finger widths above the patella and four finger widths below the tibial tuberosity, and its position was tested and confirmed. Validation pins were inserted at the anterior proximal medial femoral condyle and the superomedial tibial tuberosity. The hip center was rotated, and the medial and lateral malleoli were marked, after which femoral and tibial registration was completed [ 15 ] . The osteophytes were removed, and the medial and lateral gaps were tested in the extension and flexion positions. The surgical plan was adjusted on the basis of the gap balance. Once satisfactory balance was achieved, the robotic arm performed femoral and tibial osteotomies. After installing the trial components, the alignment of the lower extremity, the flexion–extension gap, and the patellar tracking were confirmed to be satisfactory. 4. Both groups of patients received intravenous and local injections of tranexamic acid during surgery, followed by anti-inflammatory, analgesic, and anticoagulant medications postoperatively [ 16 – 17 ] . Rehabilitation exercises, such as knee flexion extension and ambulation, were performed according to the patient’s condition [ 18 ] . Within 7 days postsurgery, all patients underwent anterior‒posterior and lateral X-ray imaging of the knee to measure the posterior tibial slope angle (PSA), frontal femoral component angle (FFC), frontal tibial component angle (FTC), and lateral femoral component angle (LFC, optimum 9°, on the basis of the characteristics of the prosthesis used in this trial) (Fig. 2 ). Preoperatively and 12 weeks postoperatively, weight-bearing full-length X-rays of the lower extremity were taken to measure the hip–knee–ankle (HKA) angle. Two professional radiologists independently measured these angles, and the average value was taken. A deviation of ± 3° from the neutral position for each angle was considered acceptable; deviations beyond this range may increase the risk of early prosthesis failure [ 19 – 21 ] . The final analysis included the deviation (absolute value) from the neutral position and the rate of abnormalities. Clinical effectiveness was assessed by comparing the AKS score, VAS score, and range of motion (ROM) before and 12 weeks after surgery. Any complications were also recorded. 5. Statistical analysis was performed via SPSS 26.0 software. The Kolmogorov‒Smirnov test was employed to evaluate whether the variables conformed to a normal distribution. Normally distributed data are represented by the mean ± standard deviation (x ± s), whereas the median represents skewed data. Categorical data are expressed as percentages. Data that followed a normal distribution were assessed via Student’s t test, whereas skewed data were evaluated via the Wilcoxon test. Categorical data, on the other hand, were analyzed via the chi-square (χ²) test. A P value < 0.05 was considered statistically significant. RESULT There were no notable distinctions between the groups in terms of the preoperative statistical data or imaging parameters, including the AKS score, ROM, sex, surgical side, age, BMI, preoperative HKA angle, or VAS score. Both groups successfully underwent the operation, with the robot-assisted surgery group experiencing a longer tourniquet time but significantly less intraoperative blood loss than the conventional surgery group did (P < 0.05). A CUSUM analysis was conducted to evaluate the learning curve, with the linear regression equation being y = -0.61*x + 1.27E2. The CUSUM curve reached a plateau in the 17th case and began to decline in the 26th case (Fig. 3 ). The postoperative HKA deviation angle in the robot-assisted group was 2.07 ± 0.90°, whereas it was 2.86 ± 0.85° in the conventional group, which was a statistically significant difference (P < 0.001). The postoperative PSA angle was 3.04 ± 0.67° in the robot-assisted group and 4.18 ± 2.16° in the conventional group, indicating a statistically significant difference (P < 0.001). In the robot-assisted surgery group, 2 cases of poor postoperative incision healing were observed, whereas 3 cases occurred in the conventional group. No instances of lower extremity venous thrombosis were reported in either group. No statistically significant differences in complication rates were observed between the two groups (P > 0.05). The postoperative VAS, AKS, ROM, LFC, FTC, and FFC scores were also not significantly different between the groups (P > 0.05) (Table 2 ). There were no statistically significant differences in the abnormal rates of LFC, FTC, or FFC between the two groups (P > 0.05). However, the postoperative PSA abnormal rates were 0% and 10%, and the HKA abnormal rates were 8.3% and 35% in the robot-assisted and conventional groups, respectively, with a statistically significant difference (P < 0.001) (Table 3 ). Table 1 Characteristics of included patients RA-TKA CM-TKA statistic P Value N 60 60 Age 64.25 ± 7.01 65.71 ± 4.91 t = 1.326 0.187 PreHKA deviation 9.81 ± 3.59 9.21 ± 3.90 t=−0.888 0.376 PreVAS 4.44 ± 2.50 4.28 ± 2.69 t=−1.455 0.148 SEX Male 8 12 X 2 = 0.960 0.327 Female 52 48 Side Left 32 28 X 2 = 0.533 0.465 Right 28 32 BMI 26.60 ± 3.10 26.11 ± 2.81 t=−1.356 0.178 ROM 92.20 ± 16.10 91.61 ± 17.40 t=−0.526 0.600 PreAKS F 48.58 ± 11.23 47.30 ± 12.02 t=−1.059 0.292 PreAKS J 52.20 ± 10.67 53.91 ± 9.79 t = 1.789 0.076 RA-TKA Robot-assisted total knee arthroplasty, CM-TKA conventional manual total knee arthroplasty,ROM range of motion,VAS 10cm visual analog scale,AKS-F the American Knee Society clinical rating system of Knee,AKS-J the American Knee Society clinical rating system of Function. Table 2: Comparison of intraoperative clinical index between the two groups RA-TKA CM-TKA statistic(t/z) P Value Time 117.98 ± 20.90 98.06 ± 22.98 −9.098 0.000 Blood 274.28 ± 66.35 370.03 ± 94.59 24.616 0.000 Post HKA deviation 2.07 ± 0.90 2.86 ± 0.85 3.674 0.001 Post PSA 3.04 ± 0.67 4.18 ± 2.16° 5.854 0.000 LFC 9.31 ± 1.47 10.01 ± 1.64 1.120 0.265 FFC deviation 1.17 ± 0.45 1.67 ± 0.76 0.298 0.566 FTC deviation 1.10[0.90;1.45] 1.96[1.60;2.40] 0.281 0.587 Post AKS-K 82.61 ± 10.47 83.83 ± 9.91 0.168 0.969 Post AKS-F 74.08 ± 7.52 73.03 ± 7.44 −0.768 0.444 Post ROM 103.03 ± 11.39 104.33 ± 12.58 1.297 0.197 Post VAS 2.44 ± 1.70 2.65 ± 1.77 0.192 0.927 RA-TKA Robot-assisted total knee arthroplasty, CM-TKA conventional manual total knee arthroplasty, HKA hip-knee-ankle, FFC frontal femoral component, FTC frontal tibial component, LFC lateral femoral component,PSA posterior tibial slope angle Table 3: Comparison of imaging findings between the two groups postoperatively RA-TKA(%) CM-TKA(%) Statistic P Value PSA 0 10.0 6.316 0.027 HKA 8.3 35.0 12.570 0.000 LFC 10 13.3 0.323 0.570 FFC 0 8.3 5.217 0.202 FTC 0 6.66 0.162 0.262 To determine whether the degree of preoperative deformity affects postoperative lower extremity alignment, we first conducted univariate linear regression analyses on general data (such as age, preoperative AKS score, ROM, sex, surgical side, and surgical method), imaging data (preoperative HKA angle deviation), and operative time. The study findings indicated that preoperative deviations in the HKA angle (P < 0.001), preoperative range of motion (ROM) (P = 0.016), AKS function (P = 0.009), and surgical method (P < 0.001) markedly influenced postoperative HKA angle deviations (Table 4 ). The multivariate linear regression analysis included preoperative deviation in the HKA angle, preoperative AKS function, surgical method, and preoperative range of motion (ROM). Statistical analysis revealed that the surgical method (P < 0.001) and preoperative HKA angle deviation (P < 0.001) were statistically significant (Table 5 ). According to the multivariate linear regression analysis results, for every 1° increase in preoperative HKA angle deviation, postoperative HKA angle deviation increased by 0.348° (β = 0.348;95% CI 0.048–0.125; P < 0.001). When the surgical method was changed from conventional surgery to robotic surgery, the postoperative HKA angle deviation decreased by 0.327° (β = -0.327; 95% CI: -0.887–0.321; P < 0.001). Other factors concerning postoperative HKA angle deviation (P > 0.05) were not statistically significant. We further subdivided patients into severe deformity (HKA > 10) and mild deformity (HKA < 10) groups and analyzed their imaging parameters and clinical outcomes. No significant differences in preoperative statistical data or imaging parameters were observed between the severe and mild deformity groups. Table 4 Results of single-factor linear regression analysis β 95%CI Statistic P Value Age 0.076 −0.039to0.016 0.833 0.407 Sex −0.003 −0.459to0.445 −0.031 0.976 Side −0.039 −0.409to0.264 −0.429 0.669 Pre-HKA deviation 0.375 0.051–0.134 4.388 0.000 Time −0.079 −0.016to0.006 −0.866 0.388 ROM −0.219 −0.061to−0.006 −2.441 0.016 AKS-J −0.151 −0,058to0.005 −1.656 0.100 AKS-F −0.325 −0.069to−0.021 −3.729 0.000 VAS 0.179 0.001–0.055 1.978 0.054 Surgery method −0.320 −0.911to−0.273 −3.674 0.009 BMI 0.069 −0.053to0.118 0.748 0.456 Table 5 Results of multiple linear regression analysis β 95%CI Statistic P Value Pre HKA deviation 0.348 0.048–0.125 4.423 0.000 Surgery method −0.327 −0.087to−0.321 −4.222 0.000 ROM 0.026 −0.022to0.030 0.330 0.742 AKS-F −0.064 −0.052to−0.013 −1.153 0.051 Among patients with mild preoperative lower extremity deformities, those in the robot-assisted surgery group experienced a longer tourniquet time but significantly less intraoperative blood loss than did those in the conventional surgery group did (P < 0.05). The postoperative HKA angle deviation was 1.18 ± 0.69° in the robot-assisted group and 2.24 ± 0.75° in the conventional surgery group, indicating a statistically significant difference (P < 0.05). However, the two groups had no statistically significant differences in postoperative FFC, FTC, LFC, or PSA angle deviations (P > 0.05). The postoperative AKS functional score, AKS knee score, ROM, and VAS score were also not significantly different between the two groups (P > 0.05) (Table 6 ). There were no statistically significant differences in the rates of abnormal FTC, FFC, LFC, or PSA between the two groups (P > 0.05). The percentage of HKA abnormalities was 3.3% in the robot-assisted group and 23.3% in the conventional group, which was a statistically significant difference (P = 0.022) (Table 7 ). Table 6 Comparison of intraoperative clinical index among patients with slight preoperative lower extremity alignment deviation RA-TKA(<10) CM-TKA(<10) Statistic(t/z) P Value Time 116.70 ± 19.91 95.46 ± 23.38 −7.240 0.000 Blood 251.36 ± 46.33 362.26 ± 67.31 21.648 0.000 Post HKA 1.18 ± 0.69 2.24 ± 0.75 3.458 0.017 Post PSA 2.97 ± 0.48 3.46 ± 1.04° 1.952 0.055 LFC 9.10 ± 1.32 9.56 ± 1.43 1.126 0.275 FFC deviation 1.15 ± 0.44 1.67 ± 0.75 2.304 0.172 FTC deviation 1.02[0.87;1.35] 1.62[1.31;2.10] 0.371 0.368 Post AKS-K 83.01 ± 9.26 84.01 ± 9.39 1.148 0.255 Post AKS-F 74.23 ± 8.03 75.40 ± 7.68 1.136 0.261 Post ROM 104.73 ± 10.78 103.23 ± 11.14 −1.949 0.056 Post VAS 2.43 ± 1.63 2.50 ± 1.67 0.396 0.694 Table 7 Comparison of imaging findings among patients with slight preoperative lower extremity alignment deviation RA-TKA(%) CM-TKA(%) Statistic P Value PSA 0 0 - 1.000 HKA 3.3 23.3 6.405 0.022 LFC 6.6 10.0 0.218 0.640 FFC 0 6.6 2.069 0.150 FTC 0 0 - 1.000 For patients with severe preoperative lower extremity deformities, the robot-assisted surgery group had a longer tourniquet time but significantly less intraoperative blood loss than did the conventional surgery group did (P < 0.05). The robot-assisted group had a postoperative HKA angle deviation of 2.35 ± 1.01°, which was significantly lower than the deviation in the conventional surgery group of 3.07 ± 1.15° (P = 0.003). The postoperative PSA angle in the robot-assisted group was 3.05 ± 0.47°, whereas it was significantly greater than that in the conventional group (4.31 ± 1.84°) (P < 0.001). There were no statistically significant differences in postoperative FFC, FTC, or LFC angle deviations between the two groups (P > 0.05). There were no statistically significant differences between the groups in terms of postoperative AKS functional score, AKS knee score, ROM, or VAS score (P > 0.05) (Table 8 ). The comparison of postoperative FTC, FFC, and LTC abnormal rates between the two groups revealed no statistically significant differences (P > 0.05). The percentage of patients with abnormal HKAs was 13.3% in the robot-assisted group and 46.6% in the conventional group, which was a statistically significant difference (P = 0.005). The postoperative PSA abnormality rate was 0% in the robot-assisted group and 10% in the conventional group, with a statistically significant difference (P < 0.05) (Table 9 ). Table 8 Comparison of intraoperative clinical index among patients with severe preoperative lower extremity alignment deviation RA-TKA(≥10) CM-TKA(≥10) Statistic(t/z) P Value Time 118.91 ± 21.03 101.66 ± 23.67 −5.791 0.000 Blood 281.80 ± 81.84 377.20 ± 101.51 19.678 0.000 Post HKA 2.35 ± 1.01° 3.07 ± 1.15° 3.139 0.003 Post PSA 3.05 ± 0.47° 4.31 ± 1.84 5.695 0.000 LFC 9.42 ± 1.52 10.16 ± 1.41 1.977 0.333 FFC deviation 1.18 ± 0.46 1.66 ± 0.76 2.119 0.191 FTC deviation 1.15[0.95;1.50] 1.99[1.60;2.30] 0.335 0.717 Post AKS-K 81.91 ± 9.79 92.87 ± 9.42 0.938 0.493 Post AKS-F 73.23 ± 8.68 71.69 ± 7.12 −2.392 0.120 Post ROM 102.99 ± 10.73 104.91 ± 11.02 0.599 0.648 Post VAS 2.49 ± 1.74 2.70 ± 1.73 0.471 0.689 Table 9 Comparison of imaging findings among patients with severe preoperative lower extremity alignment deviation RA-TKA(%) CM-TKA(%) Statistic P Value PSA 0 10.0 6.667 0.010 HKA 13.3 46.6 6.648 0.005 LFC 13.3 16.6 0.131 0.718 FFC 0 10 3.158 0.076 FTC 0 13.3 4.086 0.061 DISCUSSION In contrast to traditional surgery, robot-assisted surgery eliminates the need for intramedullary femoral alignment, significantly reducing intraoperative blood loss. In a retrospective study conducted by Hasaan Khan, patients who underwent robot-assisted TKA had a 23.7% decrease in blood loss compared with those who underwent conventional surgery. Furthermore, the risk of needing a blood transfusion was reduced by 83%. This is also related to the fact that robot-assisted patients do not require excessive soft tissue balance. In a study by Vivek Singh, robot-assisted and conventional instruments were used for knee replacements in cadavers. In all robot-assisted cases, soft tissues were undamaged, and precision in terms of resection accuracy and coronal plane prosthesis positioning was greater [ 23 ] . However, robot-assisted surgery also increases the operative time. Prolonged tourniquet application and extended incision exposure may increase the risk of postoperative infection and tissue ischemic necrosis. This is thought to be partly due to the additional time required for installing tracking arrays and performing precise femoral and tibial registration. Using CUSUM to analyze the surgical learning curve, we found that the surgeon reached proficiency after 17 cases, and by the 26th case, the operative time was significantly reduced. However, even after the learning curve was passed, the differences in operative time between the two groups persisted. This may be due to repeated gap balancing and multiple osteotomy adjustments in patients with severe deformities. With the continuous optimization of surgical procedures and increasing proficiency, the operation time of robot-assisted surgery is expected to approach that of conventional surgery. This retrospective study revealed significant differences in postoperative HKA and PSA deviation between the two groups. With a deviation of ± 3° from the neutral position as the standard, the robot-assisted group had significantly lower rates of postoperative HKA and PSA abnormalities than did the conventional surgery group. This finding indicates that, compared with conventional surgery, the robotic system offers superior postoperative prosthesis placement and lower extremity alignment. Studies have reported that when prosthesis positioning and limb alignment deviate by more than 3° from neutral, the failure and revision rates for TKA increase significantly [ 24 ] . In traditional total knee arthroplasty (TKA), the accurate alignment of distal femoral intramedullary and proximal tibial extramedullary osteotomies relies heavily on the surgeon's expertise, leading to postoperative dissatisfaction in 10–20% of patients [ 25 – 26 ] . Moreover, long-term follow-up studies indicate that patients with a postoperative HKA angle deviation of less than 3° have significantly higher American Knee Society (AKS) scores than those with deviations exceeding 3° [ 27 ] . Therefore, restoring postoperative limb alignment and ensuring accurate prosthesis placement is crucial in a study by Jia Zheng Xu involving 34 robot-assisted and 31 conventional TKA procedures. They reported that the robot-assisted group achieved better postoperative limb alignment and lower deviation rates in femoral and tibial prosthesis placement [ 28 ] . While robotic systems help improve limb alignment and prosthesis placement, no consensus exists on their impact on postoperative knee function and range of motion. Philip Winnock de Grave reported that the introduction of robot-assisted surgery improved clinical outcomes in TKA [ 29 ] , whereas Run Tian [ 30 ] conducted a prospective analysis and reported that robot-assisted surgery did not result in better knee scores postoperatively. This finding is consistent with our findings. This study revealed that patients with varying degrees of preoperative deformity presented different postoperative outcomes and limb alignment. We conducted a multivariate linear regression analysis of factors influencing postoperative outcomes, which revealed that the surgical method and preoperative HKA deviation impacted these outcomes. We further subdivided each group based on preoperative HKA deviation into mild deformity (deformity angle < 10°) and severe deformity (deformity angle ≥ 10°). The results revealed no significant differences in postoperative knee function scores, ROMs, or VAS scores between patients with different degrees of preoperative deformity. In patients with mild deformities, the robot-assisted group demonstrated a notable advantage in postoperative HKA deviation compared with the conventional group, with abnormal rates of 3.3% and 23.3%, respectively. For patients with severe deformities, significant differences were observed in both the postoperative HKA and PSA angles, with abnormal rates of 13.3% and 46.6% for the HKA and 0% and 10% for the PSA in the robot-assisted and conventional groups, respectively. These findings suggest that for patients with mild preoperative deformities, the accuracy of prosthesis placement in the robot-assisted group was not significantly better than that in the conventional group. However, robot-assisted surgery can yield better PSA deviation rates and abnormal PSA rates for patients with significant preoperative deformities. Both mild and severe deformity patients achieved better alignment in the robot-assisted group regarding lower extremity alignment. However, the proportion of severe deformity patients whose alignment was corrected to within ± 3° of neutral was greater. These findings indicate that the robot-assisted TKA system offers prosthesis positioning and alignment recovery advantages for patients with severe preoperative lower extremity deformities. However, follow-up studies on long-term survival rates, knee function scores, ROM, and VAS scores for robot-assisted TKA are lacking. Dong-Yeong Lee demonstrated that, in the short to medium term, robot-assisted surgery does not achieve better clinical outcomes than conventional surgery does [ 31 ] . The potential advantages of the greater precision of RA-TKA may become evident in long-term follow-up studies with larger sample sizes. Therefore, we plan to continue follow-up to observe whether robot-assisted surgery can achieve better clinical outcomes in the medium to long term. CONCLUSION The study demonstrated that the TINAVI robot-assisted system was both safe and effective. For patients with mild preoperative lower extremity deformities, the robot-assisted group exhibited a slight advantage in restoring limb alignment compared with the conventional surgery group, although no significant differences were noted in prosthesis placement accuracy. In contrast, the robot-assisted system significantly improved alignment precision and prosthesis placement for patients with severe preoperative deformities, highlighting its superior efficacy in complex cases. Additionally, we found that preoperative HKA deviation affected postoperative alignment. We recommend the routine use of the robotic system for patients with severe preoperative lower extremity deformities. The robot-assisted group did not have better functional or pain scores in the short-term follow-up. Mid- and long-term results require further follow-up. Declarations Acknowledgments : The authors would like to thank all staff from the participating departments and clinics. Data availability : All data included in this study are available upon request by contacting the corresponding author upon reasonable request. Conflicts of interest : Disclosure The authors declare that there are no conflicts of interest related to the publication of this article. Funding : Not applicable. Ethics : This study was approved by the Ethics Committee of the First Hospital of China Medical University, and the patients were exempt from informed consent. (Approval No. [2024]528). Author contributions : T. H . completed patient recruitment and surgery. P.X. carried out the data collection and wrote the original draft. J.Q. investigated patients’ information. G.J . and F.S . analyzed the clinical trial data. All the authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All the authors read and approved the final version of the manuscript. Consent for publication Applicable. 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[A prospective randomized controlled trial on the short-term effectiveness of domestic robot-assisted total knee arthroplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Oct 15;35(10):1251-1258. Chinese. Laddha M, Gaurav S. Assessment of Limb Alignment and Component Placement After All Burr Robotic-Assisted TKA. Indian J Orthop. 2020 Sep 27;55(Suppl 1):69-75. Mathew KK, Marchand KB, Tarazi JM, Salem HS, DeGouveia W, Ehiorobo JO, Sodhi N, Mont MA. Computer-Assisted Navigation in Total Knee Arthroplasty. Surg Technol Int. 2020 May 28;36:323-330. Fozo ZA, Ghazal AH, Hesham Gamal M, Matar SG, Kamal I, Ragab KM. A Systematic Review and Meta-Analysis of Conventional Versus Robotic-Assisted Total Knee Arthroplasty. Cureus. 2023 Oct 11;15(10):e46845. Bensa A, Sangiorgio A, Deabate L, Illuminati A, Pompa B, Filardo G. Robotic-assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes when compared to conventional TKA: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4680-4691. Lei K, Liu L, Chen X, Feng Q, Yang L, Guo L. Navigation and robotics improved alignment compared with PSI and conventional instrument, while clinical outcomes were similar in TKA: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):721-733. Li Y, Zhang X, Cao L, Sun Y, Ye Y, Xie J, Hu Y, Li Z, Tang B. [A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Nov 15;37(11):1326-1334. Chinese. Chai W, Xie J, Zhang X, He C, Yan T, Liu L, Zhang Y, Zhou Z, Hu Y, Cao L, Chen J, Tang P. A cadaveric experimental study on domestic robot-assisted total knee arthroplasty. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Apr 15;35(4):409-413. Chinese. Su W, Zhou Y, Qiu H, Wu H. The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2022 Mar 21;17(1):175. Lavand'homme PM, Kehlet H, Rawal N, Joshi GP; PROSPECT Working Group of the European Society of Regional AnesthesiaAnaesthesia and Pain Therapy (ESRA). Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur J AnesthesiolAnaesthesiol. 2022 Sep 1;39(9):743-757. Cai L, Liu Y, Wei Z, Liang H, Liu Y, Cui M. Robot-assisted rehabilitation training improves knee function and daily activity ability in older adults following total knee arthroplasty. Res Nurs Health. 2023 Apr;46(2):203-209. Berend ME, Ritter MA, Meding JB, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat R 2004;428:26–34 Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 2002;84a:90–8 Jung HJ, Kang MW, Lee JH, Kim JI. Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in asian patients: a prospective study. BMC Musculoskelet Disord. 2023 Apr 27;24(1):332. doi: 10.1186/s12891-023-06422-w. Erratum in: BMC Musculoskelet Disord. 2023 Jun 21;24(1):505. Khan H, Dhillon K, Mahapatra P, Popat R, Zakieh O, Kim WJ, Nathwani D. Blood loss and transfusion risk in robotic-assisted knee arthroplasty: A retrospective analysis. Int J Med Robot. 2021 Dec;17(6):e2308. Singh V, Teo GM, Long WJ. Versatility and accuracy of a novel image-free robotic-assisted system for total knee arthroplasty. Arch Orthop Trauma Surg. 2021 Dec;141(12):2077-2086. Kim YH, Yoon SH, Park JW. Does Robotic-assisted TKA Result in Better Outcome Scores or Long-Term Survivorship Than Conventional TKA? A Randomized, Controlled Trial. Clin Orthop Relat Res. 2020 Feb;478(2):266-275. Marchand KB, Moody R, Scholl LY, Bhowmik-Stoker M, Taylor KB, Mont MA, et al. The results l. The results l. Results of robotic-assisted versus manual Total knee Arthroplasty at 2-year follow-up. J Knee Surg. 2021. Tang Q, Shang P, Zheng G, Xu HZ, Liu HX. Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12(1):82 Vaidya NV, Deshpande AN, Panjwani T, Patil R, Jaysingani T, Patil P. Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):621-626. Xu JZ, Li LL, Fu J, Xu C, Zhang GQ, Chai W, Hao LB, Li X, Chen JY. Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients. BMC Musculoskelet Disord. 2022 May 4;23(1):418. Winnock de Grave P, Kellens J, Tampere T, Vermue H, Luyckx T, Claeys K. Clinical outcomes in TKA are enhanced by both robotic assistance and patient specific alignment: a comparative trial in 120 patients. Arch Orthop Trauma Surg. 2023 Jun;143(6):3391-3399. Tian R, Duan X, Kong N, Li X, Wang J, Tian H, Shi Z, Yan S, Lyu J, Wang K, Yang P. Robotic-assisted total knee arthroplasty is more advantageous for knees with severe deformity: a randomized controlled trial study design. Int J Surg. 2023 Mar 1;109(3):287-296. Lee DY, Park YJ, Hwang SC, Park JS, Kang DG. No differences in mid- to long-term outcomes of computer-assisted navigation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2020 Oct;28(10):3183-3192. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Dec, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 26 Nov, 2024 Reviews received at journal 26 Nov, 2024 Reviews received at journal 25 Nov, 2024 Reviewers agreed at journal 16 Nov, 2024 Reviewers agreed at journal 14 Nov, 2024 Reviewers agreed at journal 12 Nov, 2024 Reviews received at journal 11 Nov, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers invited by journal 11 Nov, 2024 Editor assigned by journal 15 Oct, 2024 Submission checks completed at journal 14 Oct, 2024 First submitted to journal 11 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5245472\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":383057358,\"identity\":\"896c093e-2ec6-4899-9187-832b19a7cc3f\",\"order_by\":0,\"name\":\"Pengfei Xing\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"China Medical University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pengfei\",\"middleName\":\"\",\"lastName\":\"Xing\",\"suffix\":\"\"},{\"id\":383057359,\"identity\":\"26d1116a-ae86-4b64-95ec-b6d8551b7ac9\",\"order_by\":1,\"name\":\"Junsong Qu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"China Medical University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Junsong\",\"middleName\":\"\",\"lastName\":\"Qu\",\"suffix\":\"\"},{\"id\":383057361,\"identity\":\"2a0ec16c-a125-4574-a12e-10cadf78409f\",\"order_by\":2,\"name\":\"Shuaijing Feng\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"China Medical University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Shuaijing\",\"middleName\":\"\",\"lastName\":\"Feng\",\"suffix\":\"\"},{\"id\":383057363,\"identity\":\"f82aea9a-b859-492e-ad62-d200eb982b09\",\"order_by\":3,\"name\":\"Jiarong Guo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"China Medical University\",\"correspondingAuthor\":false,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jiarong\",\"middleName\":\"\",\"lastName\":\"Guo\",\"suffix\":\"\"},{\"id\":383057365,\"identity\":\"21e229f7-ded2-41ac-9d32-148e331fcbbd\",\"order_by\":4,\"name\":\"Tao Huang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIie3QPwrCMBTH8ZRAp6ddnyDVI0QC/oHexKVZMunuUCQg1EVw9R6Cc+BBJ6FXSG/QA4hYRwdp3BzymfOF3wtjQfCHBOPWtoCQcE7OL4lj1VzGy3R0jLXwTEBKyHZS1DBFr2QxMXOEDaorQbeyyNa9yapkGvGO6kYD61ilt6Z3WMUqnJ3eyTAXkSGfJCpRPbthBxDomXAuLKAU3D/RUWMAU6Tuk3OvW6hu6QF7SM5Eri2y/uRT/tvzIAiC4JsXcPU9RqRJCZkAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"China Medical University\",\"correspondingAuthor\":true,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tao\",\"middleName\":\"\",\"lastName\":\"Huang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-10-11 10:53:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5245472/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5245472/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s13018-024-05372-w\",\"type\":\"published\",\"date\":\"2024-12-24T15:57:19+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":70919119,\"identity\":\"5c684e15-7b4d-4bb2-9ed5-21bef13b92c7\",\"added_by\":\"auto\",\"created_at\":\"2024-12-09 08:26:31\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":274677,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe operating platform and console of the TINAVI orthopedic surgery robot system\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5245472/v1/c50538f1e2eb894a97d61443.png\"},{\"id\":70919117,\"identity\":\"c3d242ef-d4f6-422f-9e2f-e4892a3d5d3e\",\"added_by\":\"auto\",\"created_at\":\"2024-12-09 08:26:31\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":904746,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePostoperative X-ray examination(a)Measurement of the HKA angle(b) Measurement of the femoral coronal component angle (c) Measurement of the tibial coronal component angle(d) Measurement of the femoral sagittal component angle and posterior tibial slope angle\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5245472/v1/e65738960faa8e8ffc04ebfc.png\"},{\"id\":70919619,\"identity\":\"f3d67b64-efcd-4a95-a433-a63700c561f2\",\"added_by\":\"auto\",\"created_at\":\"2024-12-09 08:34:31\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":124514,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eRA-CUSUM analysis of robot-assisted TKA\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5245472/v1/c9972a1d943d3af23e440fdf.png\"},{\"id\":72640761,\"identity\":\"5ecc9660-5e35-4bff-80d2-2e562e3a63d9\",\"added_by\":\"auto\",\"created_at\":\"2024-12-30 16:09:31\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2897587,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5245472/v1/ac2f57d8-f621-423c-9db2-dec66468bb5a.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Comparison of the Efficacy of Robot-assisted Total Knee Arthroplasty in Patients with Knee Osteoarthritis with Varying Severity Deformity\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eAs an effective treatment for advanced knee joint diseases, total knee arthroplasty (TKA) has shown remarkable clinical outcomes. The main objective is to restore the patient's neutral mechanical axis\\u003csup\\u003e[\\u003cspan\\u003e1\\u003c/span\\u003e–\\u003cspan\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e. However, despite advances in TKA techniques, issues such as inaccurate prosthesis placement and poor mechanical axis restoration persist, leading to decreased patient satisfaction, increased polyethylene wear, and premature prosthesis loosening, which could lead to early revision surgery \\u003csup\\u003e[\\u003cspan\\u003e3\\u003c/span\\u003e–\\u003cspan\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, precise prosthesis placement and proper lower extremity alignment are crucial for reducing postoperative complications, extending prosthesis longevity, and improving long-term TKA outcomes \\u003csup\\u003e[\\u003cspan\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e. In conventional TKA, prosthesis placement accuracy heavily relies on the surgeon's experience, resulting in lower precision and reproducibility \\u003csup\\u003e[\\u003cspan\\u003e7\\u003c/span\\u003e–\\u003cspan\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e. To overcome these limitations, robotic-assisted systems have been increasingly adopted in TKA surgeries. Studies have shown that robotic systems improve lower extremity alignment and significantly increase the precision of prosthesis placement \\u003csup\\u003e[\\u003cspan\\u003e10\\u003c/span\\u003e–\\u003cspan\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e. However, some studies suggest that robot-assisted systems may not yield better clinical outcomes or imaging results than traditional surgeries \\u003csup\\u003edo [\\u003cspan\\u003e12\\u003c/span\\u003e–\\u003cspan\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eRobot-assisted total knee arthroplasty (TKA) technology integrates robotic navigation and 3D reconstruction techniques to achieve precise surgical outcomes. Through precise 3D reconstruction and navigation, the robot can perform highly accurate surgical operations, minimizing intraoperative errors and risks. Additionally, it allows for preoperative planning and simulation, providing more accurate predictions and guidance for surgery \\u003csup\\u003e[\\u003cspan\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e. In this study, we utilized the domestically produced TINAVI (Tianzhihang) orthopedic surgical robot (Fig. \\u003cspan\\u003e1\\u003c/span\\u003e), demonstrating technological advancements in precise positioning, a broad range of indications, and accurate image matching. Its precision can reach submillimeter levels. This study employed a retrospective analysis to validate the effectiveness and safety of the robot-assisted system. This study compared the early clinical outcomes and imaging results of patients with varying degrees of knee osteoarthritis deformity after receiving robot-assisted TKA. This study also explored whether robot-assisted surgery is superior to traditional surgery and evaluated its applicability in patients with different degrees of deformity.\\u003c/p\\u003e\\n\\n\\n\\n\\n\\n\\n\\n\\n\"},{\"header\":\"Methods and Materials\",\"content\":\"\\u003cp\\u003e1. The inclusion and exclusion criteria were as follows: ① age 45–80 years, ② Kellgren–Lawrence grade 4 knee osteoarthritis, and ③ complete clinical and imaging follow-up data.\\u003c/p\\u003e\\u003cp\\u003eThe exclusion criteria for patients were as follows: ① a history of neuromuscular disorders of the knee; ② a history of open knee surgery; ③ preoperative knee joint infection; ④ severe knee valgus deformity (Krackow type III); ⑤ the presence of deep vein thrombosis of the lower extremity; and ⑥ autoimmune or immunodeficiency diseases.\\u003c/p\\u003e\\u003cp\\u003eOn the basis of the above inclusion and exclusion criteria, this study selected 120 patients with knee osteoarthritis treated at our hospital between February 2023 and June\\u003c/p\\u003e\\u003cp\\u003e2024. Of these, 60 patients underwent TINAVI robot-assisted TKA. The patients were allocated to the robot-assisted surgery group, whereas 60 patients underwent conventional TKA and were assigned to the conventional surgery group.\\u003c/p\\u003e\\u003cp\\u003e2. General Information: In the robot-assisted TKA group, there were 8 males and 52 females, with 32 cases involving the left knee and 28 involving the right knee. The mean age was 64.25 ± 7.01 years, and the body mass index (BMI) was 26.60 ± 3.10 kg/m². In the conventional TKA group, there were 12 males and 48 females, with 28 cases involving the left knee and 32 involving the right knee. The mean age was 65.71 ± 4.91 years, and the BMI was 26.11 ± 2.81 kg/m². Each group was further subdivided based on the degree of knee deformity into severe deformity (HKA ≥ 10°) and mild deformity (HKA \\u0026lt; 10°). There were no statistically significant differences between the two groups with respect to sex, age, BMI, preoperative AKS score, side of surgery, preoperative knee range of motion (ROM), or preoperative HKA angle (P \\u0026gt; 0.05), indicating that the groups were comparable (Table\\u0026nbsp;\\u003cspan\\u003e1\\u003c/span\\u003e). After further stratification on the basis of the severity of deformity within each group, there were no statistically significant differences in preoperative general information (P \\u0026gt; 0.05). This study was approved by the Ethics Committee of the First Hospital of China Medical University, and the patients were exempt from informed consent. (Approval No. [2024]528).\\u003c/p\\u003e\\u003cp\\u003e3. Surgical Procedures: Both groups underwent surgeries performed by the same skilled surgeon and their team. The conventional group underwent the standard TKA procedure. The TINAVI orthopedic surgical robot was used in the robot-assisted group, and all surgeries used Johnson \\u0026amp; Johnson prostheses. All patients underwent surgery under general anesthesia, and a tourniquet was applied to the lower extremity with pressure set at 280 mmHg. The anterior median approach was used for all procedures. A robotic tracker array was inserted into the four finger widths above the patella and four finger widths below the tibial tuberosity, and its position was tested and confirmed. Validation pins were inserted at the anterior proximal medial femoral condyle and the superomedial tibial tuberosity. The hip center was rotated, and the medial and lateral malleoli were marked, after which femoral and tibial registration was completed\\u003csup\\u003e[\\u003cspan\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e. The osteophytes were removed, and the medial and lateral gaps were tested in the extension and flexion positions. The surgical plan was adjusted on the basis of the gap balance. Once satisfactory balance was achieved, the robotic arm performed femoral and tibial osteotomies. After installing the trial components, the alignment of the lower extremity, the flexion–extension gap, and the patellar tracking were confirmed to be satisfactory.\\u003c/p\\u003e\\u003cp\\u003e4. Both groups of patients received intravenous and local injections of tranexamic acid during surgery, followed by anti-inflammatory, analgesic, and anticoagulant medications postoperatively \\u003csup\\u003e[\\u003cspan\\u003e16\\u003c/span\\u003e–\\u003cspan\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e. Rehabilitation exercises, such as knee flexion extension and ambulation, were performed according to the patient’s condition \\u003csup\\u003e[\\u003cspan\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e. Within 7 days postsurgery, all patients underwent anterior‒posterior and lateral X-ray imaging of the knee to measure the posterior tibial slope angle (PSA), frontal femoral component angle (FFC), frontal tibial component angle (FTC), and lateral femoral component angle (LFC, optimum 9°, on the basis of the characteristics of the prosthesis used in this trial) (Fig. \\u003cspan\\u003e2\\u003c/span\\u003e). Preoperatively and 12 weeks postoperatively, weight-bearing full-length X-rays of the lower extremity were taken to measure the hip–knee–ankle (HKA) angle. Two professional radiologists independently measured these angles, and the average value was taken. A deviation of ± 3° from the neutral position for each angle was considered acceptable; deviations beyond this range may increase the risk of early prosthesis failure \\u003csup\\u003e[\\u003cspan\\u003e19\\u003c/span\\u003e–\\u003cspan\\u003e21\\u003c/span\\u003e]\\u003c/sup\\u003e. The final analysis included the deviation (absolute value) from the neutral position and the rate of abnormalities. Clinical effectiveness was assessed by comparing the AKS score, VAS score, and range of motion (ROM) before and 12 weeks after surgery. Any complications were also recorded.\\u003c/p\\u003e\\u003cp\\u003e5. Statistical analysis was performed via SPSS 26.0 software. The Kolmogorov‒Smirnov test was employed to evaluate whether the variables conformed to a normal distribution. Normally distributed data are represented by the mean ± standard deviation (x ± s), whereas the median represents skewed data. Categorical data are expressed as percentages. Data that followed a normal distribution were assessed via Student’s t test, whereas skewed data were evaluated via the Wilcoxon test. Categorical data, on the other hand, were analyzed via the chi-square (χ²) test. A P value \\u0026lt; 0.05 was considered statistically significant.\\u003c/p\\u003e\"},{\"header\":\"RESULT\",\"content\":\"\\u003cp\\u003eThere were no notable distinctions between the groups in terms of the preoperative statistical data or imaging parameters, including the AKS score, ROM, sex, surgical side, age, BMI, preoperative HKA angle, or VAS score. Both groups successfully underwent the operation, with the robot-assisted surgery group experiencing a longer tourniquet time but significantly less intraoperative blood loss than the conventional surgery group did (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). A CUSUM analysis was conducted to evaluate the learning curve, with the linear regression equation being y = -0.61*x\\u0026thinsp;+\\u0026thinsp;1.27E2. The CUSUM curve reached a plateau in the 17th case and began to decline in the 26th case (Fig. \\u003cspan\\u003e3\\u003c/span\\u003e). The postoperative HKA deviation angle in the robot-assisted group was 2.07\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.90\\u0026deg;, whereas it was 2.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.85\\u0026deg; in the conventional group, which was a statistically significant difference (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). The postoperative PSA angle was 3.04\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.67\\u0026deg; in the robot-assisted group and 4.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.16\\u0026deg; in the conventional group, indicating a statistically significant difference (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001).\\u003c/p\\u003e\\n\\u003cp\\u003eIn the robot-assisted surgery group, 2 cases of poor postoperative incision healing were observed, whereas 3 cases occurred in the conventional group. No instances of lower extremity venous thrombosis were reported in either group. No statistically significant differences in complication rates were observed between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). The postoperative VAS, AKS, ROM, LFC, FTC, and FFC scores were also not significantly different between the groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) (Table \\u003cspan\\u003e2\\u003c/span\\u003e). There were no statistically significant differences in the abnormal rates of LFC, FTC, or FFC between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). However, the postoperative PSA abnormal rates were 0% and 10%, and the HKA abnormal rates were 8.3% and 35% in the robot-assisted and conventional groups, respectively, with a statistically significant difference (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) (Table \\u003cspan\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eCharacteristics of included patients\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRA-TKA\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCM-TKA\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003estatistic\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e64.25\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e65.71\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003et\\u0026thinsp;=\\u0026thinsp;1.326\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.187\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePreHKA deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9.21\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003et=\\u0026minus;0.888\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.376\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePreVAS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4.28\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003et=\\u0026minus;1.455\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.148\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSEX\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eX\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026thinsp;=\\u0026thinsp;0.960\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.327\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSide\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLeft\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eX\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026thinsp;=\\u0026thinsp;0.533\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.465\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRight\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBMI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26.60\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e26.11\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003et=\\u0026minus;1.356\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.178\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eROM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e92.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;16.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e91.61\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;17.40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003et=\\u0026minus;0.526\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.600\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePreAKS F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e48.58\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.23\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e47.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003et=\\u0026minus;1.059\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.292\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePreAKS J\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e52.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e53.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003et\\u0026thinsp;=\\u0026thinsp;1.789\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.076\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eRA-TKA Robot-assisted total knee arthroplasty, CM-TKA conventional manual total knee arthroplasty,ROM range of motion,VAS 10cm visual analog scale,AKS-F the American Knee Society clinical rating system of Knee,AKS-J the American Knee Society clinical rating system of Function.\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv\\u003e\\n \\u003cdiv align=\\\"char\\\"\\u003eTable 2: Comparison of intraoperative clinical index between the two groups\\u003c/div\\u003e\\n \\u003ctable id=\\\"Taba\\\" border=\\\"1\\\"\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRA-TKA\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCM-TKA\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003estatistic(t/z)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e117.98\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;20.90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e98.06\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;22.98\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;9.098\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBlood\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e274.28\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;66.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e370.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;94.59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e24.616\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost HKA deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.07\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.85\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.674\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost PSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3.04\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.16\\u0026deg;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.854\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10.01\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.265\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFFC deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.17\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.298\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.566\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFTC deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.10[0.90;1.45]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.96[1.60;2.40]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.281\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.587\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost AKS-K\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e82.61\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.47\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e83.83\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.168\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.969\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost AKS-F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e74.08\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e73.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.768\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.444\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost ROM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e103.03\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e104.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.58\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.297\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.197\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost VAS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.65\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.192\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.927\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eRA-TKA Robot-assisted total knee arthroplasty, CM-TKA conventional manual total knee arthroplasty, HKA hip-knee-ankle, FFC frontal femoral component, FTC frontal tibial component, LFC lateral femoral component,PSA posterior tibial slope angle\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv\\u003e\\n \\u003cdiv align=\\\"char\\\"\\u003eTable 3: Comparison of imaging findings between the two groups postoperatively\\u003c/div\\u003e\\n \\u003ctable id=\\\"Tabb\\\" border=\\\"1\\\"\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRA-TKA(%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCM-TKA(%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistic\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.316\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e8.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e35.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12.570\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.323\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.570\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e8.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.217\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.202\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFTC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.162\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.262\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eTo determine whether the degree of preoperative deformity affects postoperative lower extremity alignment, we first conducted univariate linear regression analyses on general data (such as age, preoperative AKS score, ROM, sex, surgical side, and surgical method), imaging data (preoperative HKA angle deviation), and operative time. The study findings indicated that preoperative deviations in the HKA angle (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), preoperative range of motion (ROM) (P\\u0026thinsp;=\\u0026thinsp;0.016), AKS function (P\\u0026thinsp;=\\u0026thinsp;0.009), and surgical method (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) markedly influenced postoperative HKA angle deviations (Table \\u003cspan\\u003e4\\u003c/span\\u003e). The multivariate linear regression analysis included preoperative deviation in the HKA angle, preoperative AKS function, surgical method, and preoperative range of motion (ROM). Statistical analysis revealed that the surgical method (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and preoperative HKA angle deviation (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) were statistically significant (Table \\u003cspan\\u003e5\\u003c/span\\u003e). According to the multivariate linear regression analysis results, for every 1\\u0026deg; increase in preoperative HKA angle deviation, postoperative HKA angle deviation increased by 0.348\\u0026deg; (\\u0026beta;\\u0026thinsp;=\\u0026thinsp;0.348;95% CI 0.048\\u0026ndash;0.125; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). When the surgical method was changed from conventional surgery to robotic surgery, the postoperative HKA angle deviation decreased by 0.327\\u0026deg; (\\u0026beta; = -0.327; 95% CI: -0.887\\u0026ndash;0.321; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Other factors concerning postoperative HKA angle deviation (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) were not statistically significant. We further subdivided patients into severe deformity (HKA\\u0026thinsp;\\u0026gt;\\u0026thinsp;10) and mild deformity (HKA\\u0026thinsp;\\u0026lt;\\u0026thinsp;10) groups and analyzed their imaging parameters and clinical outcomes. No significant differences in preoperative statistical data or imaging parameters were observed between the severe and mild deformity groups.\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 4\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eResults of single-factor linear regression analysis\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026beta;\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95%CI\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistic\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.076\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.039to0.016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.833\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.407\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSex\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.003\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.459to0.445\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.031\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.976\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSide\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.039\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.409to0.264\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.429\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.669\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePre-HKA deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.375\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.051\\u0026ndash;0.134\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.388\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.079\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.016to0.006\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.866\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.388\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eROM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.219\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.061to\\u0026minus;0.006\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;2.441\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.016\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAKS-J\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.151\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0,058to0.005\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;1.656\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.100\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAKS-F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.325\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.069to\\u0026minus;0.021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;3.729\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVAS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.179\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.001\\u0026ndash;0.055\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.978\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.054\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSurgery method\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.320\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.911to\\u0026minus;0.273\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;3.674\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.009\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBMI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.069\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.053to0.118\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.748\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.456\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 5\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eResults of multiple linear regression analysis\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"7\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026beta;\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95%CI\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistic\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePre HKA deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.348\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.048\\u0026ndash;0.125\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.423\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSurgery method\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.327\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.087to\\u0026minus;0.321\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;4.222\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eROM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.026\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.022to0.030\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.330\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.742\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAKS-F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.064\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.052to\\u0026minus;0.013\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;1.153\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.051\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eAmong patients with mild preoperative lower extremity deformities, those in the robot-assisted surgery group experienced a longer tourniquet time but significantly less intraoperative blood loss than did those in the conventional surgery group did (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). The postoperative HKA angle deviation was 1.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.69\\u0026deg; in the robot-assisted group and 2.24\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.75\\u0026deg; in the conventional surgery group, indicating a statistically significant difference (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). However, the two groups had no statistically significant differences in postoperative FFC, FTC, LFC, or PSA angle deviations (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). The postoperative AKS functional score, AKS knee score, ROM, and VAS score were also not significantly different between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) (Table \\u003cspan\\u003e6\\u003c/span\\u003e). There were no statistically significant differences in the rates of abnormal FTC, FFC, LFC, or PSA between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). The percentage of HKA abnormalities was 3.3% in the robot-assisted group and 23.3% in the conventional group, which was a statistically significant difference (P\\u0026thinsp;=\\u0026thinsp;0.022) (Table \\u003cspan\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 6\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eComparison of intraoperative clinical index among patients with slight preoperative lower extremity alignment deviation\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRA-TKA(\\u0026lt;10)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCM-TKA(\\u0026lt;10)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistic(t/z)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e116.70\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;19.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e95.46\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;23.38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;7.240\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBlood\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e251.36\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;46.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e362.26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;67.31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e21.648\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost HKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.24\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.458\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.017\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost PSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.97\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3.46\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.04\\u0026deg;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.952\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.055\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9.10\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9.56\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.43\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.126\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.275\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFFC deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.15\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.67\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.304\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.172\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFTC deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.02[0.87;1.35]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.62[1.31;2.10]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.371\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.368\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost AKS-K\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e83.01\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e84.01\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.148\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.255\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost AKS-F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e74.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e75.40\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.136\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.261\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost ROM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e104.73\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.78\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e103.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;1.949\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.056\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost VAS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.43\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.396\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.694\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab7\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 7\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eComparison of imaging findings among patients with slight preoperative lower extremity alignment deviation\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRA-TKA(%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCM-TKA(%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistic\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e23.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6.405\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0.218\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.640\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.069\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.150\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFTC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e-\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eFor patients with severe preoperative lower extremity deformities, the robot-assisted surgery group had a longer tourniquet time but significantly less intraoperative blood loss than did the conventional surgery group did (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). The robot-assisted group had a postoperative HKA angle deviation of 2.35\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.01\\u0026deg;, which was significantly lower than the deviation in the conventional surgery group of 3.07\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.15\\u0026deg; (P\\u0026thinsp;=\\u0026thinsp;0.003). The postoperative PSA angle in the robot-assisted group was 3.05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.47\\u0026deg;, whereas it was significantly greater than that in the conventional group (4.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.84\\u0026deg;) (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). There were no statistically significant differences in postoperative FFC, FTC, or LFC angle deviations between the two groups (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). There were no statistically significant differences between the groups in terms of postoperative AKS functional score, AKS knee score, ROM, or VAS score (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) (Table \\u003cspan\\u003e8\\u003c/span\\u003e). The comparison of postoperative FTC, FFC, and LTC abnormal rates between the two groups revealed no statistically significant differences (P\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). The percentage of patients with abnormal HKAs was 13.3% in the robot-assisted group and 46.6% in the conventional group, which was a statistically significant difference (P\\u0026thinsp;=\\u0026thinsp;0.005). The postoperative PSA abnormality rate was 0% in the robot-assisted group and 10% in the conventional group, with a statistically significant difference (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) (Table \\u003cspan\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab8\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 8\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eComparison of intraoperative clinical index among patients with severe preoperative lower extremity alignment deviation\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRA-TKA(\\u0026ge;10)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCM-TKA(\\u0026ge;10)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistic(t/z)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e118.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;21.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e101.66\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;23.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;5.791\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBlood\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e281.80\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;81.84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e377.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;101.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e19.678\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost HKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.35\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.01\\u0026deg;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3.07\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.15\\u0026deg;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.139\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.003\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost PSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3.05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.47\\u0026deg;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.84\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5.695\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9.42\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.52\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10.16\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1.977\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.333\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFFC deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.66\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2.119\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.191\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFTC deviation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.15[0.95;1.50]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1.99[1.60;2.30]\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.335\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.717\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost AKS-K\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e81.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e92.87\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;9.42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.938\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.493\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost AKS-F\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e73.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.68\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e71.69\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.12\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;2.392\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost ROM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e102.99\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e104.91\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.599\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.648\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePost VAS\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.49\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.74\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2.70\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.471\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.689\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable id=\\\"Tab9\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv\\u003eTable 9\\u003c/div\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003eComparison of imaging findings among patients with severe preoperative lower extremity alignment deviation\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"5\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRA-TKA(%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCM-TKA(%)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eStatistic\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eP Value\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePSA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.667\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.010\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHKA\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e46.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e6.648\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.005\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e16.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.131\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.718\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFFC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3.158\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.076\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFTC\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e13.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e4.086\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.061\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eIn contrast to traditional surgery, robot-assisted surgery eliminates the need for intramedullary femoral alignment, significantly reducing intraoperative blood loss. In a retrospective study conducted by Hasaan Khan, patients who underwent robot-assisted TKA had a 23.7% decrease in blood loss compared with those who underwent conventional surgery. Furthermore, the risk of needing a blood transfusion was reduced by 83%. This is also related to the fact that robot-assisted patients do not require excessive soft tissue balance. In a study by Vivek Singh, robot-assisted and conventional instruments were used for knee replacements in cadavers. In all robot-assisted cases, soft tissues were undamaged, and precision in terms of resection accuracy and coronal plane prosthesis positioning was greater \\u003csup\\u003e[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e. However, robot-assisted surgery also increases the operative time. Prolonged tourniquet application and extended incision exposure may increase the risk of postoperative infection and tissue ischemic necrosis. This is thought to be partly due to the additional time required for installing tracking arrays and performing precise femoral and tibial registration. Using CUSUM to analyze the surgical learning curve, we found that the surgeon reached proficiency after 17 cases, and by the 26th case, the operative time was significantly reduced. However, even after the learning curve was passed, the differences in operative time between the two groups persisted. This may be due to repeated gap balancing and multiple osteotomy adjustments in patients with severe deformities. With the continuous optimization of surgical procedures and increasing proficiency, the operation time of robot-assisted surgery is expected to approach that of conventional surgery.\\u003c/p\\u003e \\u003cp\\u003eThis retrospective study revealed significant differences in postoperative HKA and PSA deviation between the two groups. With a deviation of \\u0026plusmn;\\u0026thinsp;3\\u0026deg; from the neutral position as the standard, the robot-assisted group had significantly lower rates of postoperative HKA and PSA abnormalities than did the conventional surgery group. This finding indicates that, compared with conventional surgery, the robotic system offers superior postoperative prosthesis placement and lower extremity alignment. Studies have reported that when prosthesis positioning and limb alignment deviate by more than 3\\u0026deg; from neutral, the failure and revision rates for TKA increase significantly \\u003csup\\u003e[\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e. In traditional total knee arthroplasty (TKA), the accurate alignment of distal femoral intramedullary and proximal tibial extramedullary osteotomies relies heavily on the surgeon's expertise, leading to postoperative dissatisfaction in 10\\u0026ndash;20% of patients\\u003csup\\u003e[\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e. Moreover, long-term follow-up studies indicate that patients with a postoperative HKA angle deviation of less than 3\\u0026deg; have significantly higher American Knee Society (AKS) scores than those with deviations exceeding 3\\u0026deg; \\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, restoring postoperative limb alignment and ensuring accurate prosthesis placement is crucial in a study by Jia Zheng Xu involving 34 robot-assisted and 31 conventional TKA procedures. They reported that the robot-assisted group achieved better postoperative limb alignment and lower deviation rates in femoral and tibial prosthesis placement \\u003csup\\u003e[\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e. While robotic systems help improve limb alignment and prosthesis placement, no consensus exists on their impact on postoperative knee function and range of motion. Philip Winnock de Grave reported that the introduction of robot-assisted surgery improved clinical outcomes in TKA \\u003csup\\u003e[\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e, whereas Run Tian \\u003csup\\u003e[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]\\u003c/sup\\u003e conducted a prospective analysis and reported that robot-assisted surgery did not result in better knee scores postoperatively. This finding is consistent with our findings.\\u003c/p\\u003e \\u003cp\\u003eThis study revealed that patients with varying degrees of preoperative deformity presented different postoperative outcomes and limb alignment. We conducted a multivariate linear regression analysis of factors influencing postoperative outcomes, which revealed that the surgical method and preoperative HKA deviation impacted these outcomes. We further subdivided each group based on preoperative HKA deviation into mild deformity (deformity angle\\u0026thinsp;\\u0026lt;\\u0026thinsp;10\\u0026deg;) and severe deformity (deformity angle\\u0026thinsp;\\u0026ge;\\u0026thinsp;10\\u0026deg;). The results revealed no significant differences in postoperative knee function scores, ROMs, or VAS scores between patients with different degrees of preoperative deformity. In patients with mild deformities, the robot-assisted group demonstrated a notable advantage in postoperative HKA deviation compared with the conventional group, with abnormal rates of 3.3% and 23.3%, respectively. For patients with severe deformities, significant differences were observed in both the postoperative HKA and PSA angles, with abnormal rates of 13.3% and 46.6% for the HKA and 0% and 10% for the PSA in the robot-assisted and conventional groups, respectively. These findings suggest that for patients with mild preoperative deformities, the accuracy of prosthesis placement in the robot-assisted group was not significantly better than that in the conventional group. However, robot-assisted surgery can yield better PSA deviation rates and abnormal PSA rates for patients with significant preoperative deformities. Both mild and severe deformity patients achieved better alignment in the robot-assisted group regarding lower extremity alignment. However, the proportion of severe deformity patients whose alignment was corrected to within \\u0026plusmn;\\u0026thinsp;3\\u0026deg; of neutral was greater. These findings indicate that the robot-assisted TKA system offers prosthesis positioning and alignment recovery advantages for patients with severe preoperative lower extremity deformities. However, follow-up studies on long-term survival rates, knee function scores, ROM, and VAS scores for robot-assisted TKA are lacking. Dong-Yeong Lee demonstrated that, in the short to medium term, robot-assisted surgery does not achieve better clinical outcomes than conventional surgery does \\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e. The potential advantages of the greater precision of RA-TKA may become evident in long-term follow-up studies with larger sample sizes. Therefore, we plan to continue follow-up to observe whether robot-assisted surgery can achieve better clinical outcomes in the medium to long term.\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eThe study demonstrated that the TINAVI robot-assisted system was both safe and effective. For patients with mild preoperative lower extremity deformities, the robot-assisted group exhibited a slight advantage in restoring limb alignment compared with the conventional surgery group, although no significant differences were noted in prosthesis placement accuracy. In contrast, the robot-assisted system significantly improved alignment precision and prosthesis placement for patients with severe preoperative deformities, highlighting its superior efficacy in complex cases. Additionally, we found that preoperative HKA deviation affected postoperative alignment. We recommend the routine use of the robotic system for patients with severe preoperative lower extremity deformities. The robot-assisted group did not have better functional or pain scores in the short-term follow-up. Mid- and long-term results require further follow-up.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e: The authors would like to thank all staff from the participating departments\\u0026nbsp;and clinics.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability\\u003c/strong\\u003e: All data included in this study are available upon request by contacting the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflicts of interest\\u003c/strong\\u003e: Disclosure The authors declare that there are no conflicts of interest related to the publication of this article.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e: Not applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics\\u003c/strong\\u003e: This study was approved by the Ethics Committee of the First Hospital of China Medical University, and the patients were exempt from informed consent. (Approval No. [2024]528).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions\\u003c/strong\\u003e: T. H\\u003cins cite=\\\"mailto:Editor%202\\\" datetime=\\\"2024-10-11T08:40\\\"\\u003e.\\u003c/ins\\u003e completed patient recruitment and surgery. P.X. carried out the data collection and wrote the original draft. J.Q. investigated patients\\u0026rsquo; information.\\u003cins cite=\\\"mailto:Editor%202\\\" datetime=\\\"2024-10-11T08:40\\\"\\u003e\\u0026nbsp;\\u003c/ins\\u003eG.J\\u003cins cite=\\\"mailto:Editor%202\\\" datetime=\\\"2024-10-11T08:40\\\"\\u003e.\\u003c/ins\\u003e and F.S\\u003cins cite=\\\"mailto:Editor%202\\\" datetime=\\\"2024-10-11T08:40\\\"\\u003e.\\u003c/ins\\u003e analyzed the clinical trial data. All the authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All the authors read and approved the final version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication Applicable.\\u003c/strong\\u003e Written informed consent was obtained from the volunteer to publish this report and any accompanying images.\\u003c/p\\u003e\\n\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eCip J, Obwegeser F, Benesch T, Bach C, Ruckenstuhl P, Martin A. Twelve-Year Follow-Up of Navigated Computer-Assisted Versus Conventional Total Knee Arthroplasty: A Prospective Randomized Comparative Trial. J Arthroplasty. 2018 May;33(5):1404-1411.\\u003c/li\\u003e\\n\\u003cli\\u003eZak SG, Yeroushalmi D, Tang A, Meftah M, Schnaser E, Schwarzkopf R. The Use of Navigation or Robotic-Assisted Technology in Total Knee Arthroplasty Does Not Reduce Postoperative Pain. J Knee Surg. 2023 Mar;36(4):439-444.\\u003c/li\\u003e\\n\\u003cli\\u003eZhang J, Ndou WS, Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND. Robotic-arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Aug;30(8):2677-2695.\\u003c/li\\u003e\\n\\u003cli\\u003eBatailler C, Hannouche D, Benazzo F, Parratte S. Concepts and techniques of a new robotically assisted technique for total knee arthroplasty: the ROSA knee system. Arch Orthop Trauma Surg. 2021 Dec;141(12):2049-2058.\\u003c/li\\u003e\\n\\u003cli\\u003eIndelli PF, Salvi AG, Petralia G. Editorial: Alignment options and robotics in total knee arthroplasty (TKA) \\u0026quot;Alignment, alignment, alignment, but TKA fail mainly for infections and instability\\u0026quot;. Front Surg. 2023 Jul 11;10:1247759.\\u003c/li\\u003e\\n\\u003cli\\u003eHamilton DA, Ononuju U, Nowak C, Chen C, Darwiche H. Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA. Arthroplast Today. 2021 Feb 27;8:57-62.\\u003c/li\\u003e\\n\\u003cli\\u003eAdamska O, Modzelewski K, Szymczak J, Świderek J, Maciąg B, Czuchaj P, Poniatowska M, Wnuk A. Robotic-Assisted Total Knee Arthroplasty Utilizing NAVIO, CORI Imageless Systems and Manual TKA Accurately Restore Femoral Rotational Alignment and Yield Satisfactory Clinical Outcomes: A Randomized Controlled Trial. Medicina (Kaunas). 2023 Jan 27;59(2):236.\\u003c/li\\u003e\\n\\u003cli\\u003eYuan M, Shi X, Su Q, Wan X, Zhou Z. [A prospective randomized controlled trial on the short-term effectiveness of domestic robot-assisted total knee arthroplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Oct 15;35(10):1251-1258. Chinese.\\u003c/li\\u003e\\n\\u003cli\\u003eLaddha M, Gaurav S. Assessment of Limb Alignment and Component Placement After All Burr Robotic-Assisted TKA. Indian J Orthop. 2020 Sep 27;55(Suppl 1):69-75.\\u003c/li\\u003e\\n\\u003cli\\u003eMathew KK, Marchand KB, Tarazi JM, Salem HS, DeGouveia W, Ehiorobo JO, Sodhi N, Mont MA. Computer-Assisted Navigation in Total Knee Arthroplasty. Surg Technol Int. 2020 May 28;36:323-330.\\u003c/li\\u003e\\n\\u003cli\\u003eFozo ZA, Ghazal AH, Hesham Gamal M, Matar SG, Kamal I, Ragab KM. A Systematic Review and Meta-Analysis of Conventional Versus Robotic-Assisted Total Knee Arthroplasty. Cureus. 2023 Oct 11;15(10):e46845.\\u003c/li\\u003e\\n\\u003cli\\u003eBensa A, Sangiorgio A, Deabate L, Illuminati A, Pompa B, Filardo G. Robotic-assisted mechanically aligned total knee arthroplasty does not lead to better clinical and radiological outcomes \\u003cins cite=\\\"mailto:Editor\\\" datetime=\\\"2024-10-11T08:41\\\"\\u003e \\u003c/ins\\u003e when compared to conventional TKA: a systematic review and meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4680-4691.\\u003c/li\\u003e\\n\\u003cli\\u003eLei K, Liu L, Chen X, Feng Q, Yang L, Guo L. Navigation and robotics improved alignment compared with PSI and conventional instrument, while clinical outcomes were similar in TKA: a network meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):721-733.\\u003c/li\\u003e\\n\\u003cli\\u003eLi Y, Zhang X, Cao L, Sun Y, Ye Y, Xie J, Hu Y, Li Z, Tang B. [A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Nov 15;37(11):1326-1334. Chinese.\\u003c/li\\u003e\\n\\u003cli\\u003eChai W, Xie J, Zhang X, He C, Yan T, Liu L, Zhang Y, Zhou Z, Hu Y, Cao L, Chen J, Tang P. A cadaveric experimental study on domestic robot-assisted total knee arthroplasty. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Apr 15;35(4):409-413. Chinese.\\u003c/li\\u003e\\n\\u003cli\\u003eSu W, Zhou Y, Qiu H, Wu H. The effects of preoperative rehabilitation on pain and functional outcome after total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2022 Mar 21;17(1):175.\\u003c/li\\u003e\\n\\u003cli\\u003eLavand\\u0026apos;homme PM, Kehlet H, Rawal N, Joshi GP; PROSPECT Working Group of the European Society of Regional AnesthesiaAnaesthesia and Pain Therapy (ESRA). Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations. Eur J AnesthesiolAnaesthesiol. 2022 Sep 1;39(9):743-757.\\u003c/li\\u003e\\n\\u003cli\\u003eCai L, Liu Y, Wei Z, Liang H, Liu Y, Cui M. Robot-assisted rehabilitation training improves knee function and daily activity ability in older adults following total knee arthroplasty. Res Nurs Health. 2023 Apr;46(2):203-209.\\u003c/li\\u003e\\n\\u003cli\\u003eBerend ME, Ritter MA, Meding JB, et al. Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat R 2004;428:26\\u0026ndash;34\\u003c/li\\u003e\\n\\u003cli\\u003eStulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 2002;84a:90\\u0026ndash;8\\u003c/li\\u003e\\n\\u003cli\\u003eJung HJ, Kang MW, Lee JH, Kim JI. Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in asian patients: a prospective study. BMC Musculoskelet Disord. 2023 Apr 27;24(1):332. doi: 10.1186/s12891-023-06422-w. Erratum in: BMC Musculoskelet Disord. 2023 Jun 21;24(1):505.\\u003c/li\\u003e\\n\\u003cli\\u003eKhan H, Dhillon K, Mahapatra P, Popat R, Zakieh O, Kim WJ, Nathwani D. Blood loss and transfusion risk in robotic-assisted knee arthroplasty: A retrospective analysis. Int J Med Robot. 2021 Dec;17(6):e2308.\\u003c/li\\u003e\\n\\u003cli\\u003eSingh V, Teo GM, Long WJ. Versatility and accuracy of a novel image-free robotic-assisted system for total knee arthroplasty. Arch Orthop Trauma Surg. 2021 Dec;141(12):2077-2086.\\u003c/li\\u003e\\n\\u003cli\\u003eKim YH, Yoon SH, Park JW. Does Robotic-assisted TKA Result in Better Outcome Scores or Long-Term Survivorship Than Conventional TKA? A Randomized, Controlled Trial. Clin Orthop Relat Res. 2020 Feb;478(2):266-275.\\u003c/li\\u003e\\n\\u003cli\\u003eMarchand KB, Moody R, Scholl LY, Bhowmik-Stoker M, Taylor KB, Mont MA, et al. The results\\u003cins cite=\\\"mailto:Editor\\\" datetime=\\\"2024-10-11T08:41\\\"\\u003el. The results\\u003c/ins\\u003el. Results of robotic-assisted versus manual Total knee Arthroplasty at 2-year follow-up. J Knee Surg. 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eTang Q, Shang P, Zheng G, Xu HZ, Liu HX. Extramedullary versus intramedullary femoral alignment technique in total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12(1):82\\u003c/li\\u003e\\n\\u003cli\\u003eVaidya NV, Deshpande AN, Panjwani T, Patil R, Jaysingani T, Patil P. Robotic-assisted TKA leads to a better prosthesis alignment and a better joint line restoration as compared to conventional TKA: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2022 Feb;30(2):621-626.\\u003c/li\\u003e\\n\\u003cli\\u003eXu JZ, Li LL, Fu J, Xu C, Zhang GQ, Chai W, Hao LB, Li X, Chen JY. Comparison of serum inflammatory indicators and radiographic results in MAKO robotic-assisted versus conventional total knee arthroplasty for knee osteoarthritis: a retrospective study of Chinese patients. BMC Musculoskelet Disord. 2022 May 4;23(1):418.\\u003c/li\\u003e\\n\\u003cli\\u003eWinnock de Grave P, Kellens J, Tampere T, Vermue H, Luyckx T, Claeys K. Clinical outcomes in TKA are enhanced by both robotic assistance and patient specific alignment: a comparative trial in 120 patients. Arch Orthop Trauma Surg. 2023 Jun;143(6):3391-3399.\\u003c/li\\u003e\\n\\u003cli\\u003eTian R, Duan X, Kong N, Li X, Wang J, Tian H, Shi Z, Yan S, Lyu J, Wang K, Yang P. Robotic-assisted total knee arthroplasty is more advantageous for knees with severe deformity: a randomized controlled trial study design. Int J Surg. 2023 Mar 1;109(3):287-296.\\u003c/li\\u003e\\n\\u003cli\\u003eLee DY, Park YJ, Hwang SC, Park JS, Kang DG. No differences in mid- to long-term outcomes of computer-assisted navigation versus conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2020 Oct;28(10):3183-3192.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-orthopaedic-surgery-and-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"josr\",\"sideBox\":\"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)\",\"snPcode\":\"13018\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13018/3\",\"title\":\"Journal of Orthopaedic Surgery and Research\",\"twitterHandle\":\"@MSKmedBMC\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Total knee replacement, Robotically assisted operation, TINAVI knee system, Short-term outcomes, Lower extremity force line\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5245472/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5245472/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eAIM\\u003c/strong\\u003e: To evaluate the clinical efficacy and imaging outcomes of a domestically produced orthopedic surgical robot for total knee arthroplasty and to explore its applicability in patients with varying degrees of deformity.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e This study retrospectively included 120 patients who underwent TKA at our hospital between February 2023 and June 2024. The patients were divided into a control group (conventional TKA surgery) and an observation group (robot-assisted TKA surgery), with 60 patients in each group. On the basis of different lower extremity alignment angles, each group was further subdivided into mild deformities (HKA deviation \\u0026lt; 10°) and significant deformities (HKA deviation ≥ 10°). Preoperative and postoperative HKA angles, range of motion (ROM), visual analog scale (VAS) pain scores, and Knee Society (AKS) scores were recorded for both groups. Postoperative measurements included the posterior tibial slope angle (PSA), femoral coronal component angle (FFC), tibial coronal component angle (FTC), and femoral sagittal component angle (LFC), as well as the incidence of abnormal values for each angle, which were analyzed statistically.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e: The operation time in the observation group was longer than that in the control group, but intraoperative blood loss was significantly lower in the observation group (P \\u0026lt; 0.05). Postoperatively, the differences in the HKA and PSA angles and the incidence of abnormal values were significantly greater in the robot-assisted group than in the control group (P \\u0026lt; 0.05). The other indicators did not significantly differ between the two groups. (P \\u0026gt; 0.05). For patients with mild preoperative deformities, those in the robot-assisted group had significantly greater postoperative HKA angle deviations and rates of postoperative HKA angle outliers than did those in the conventional group. For patients with significant deformities, the robot-assisted group presented greater postoperative HKA and PSA angle deviations than did the control group; the postoperative HKA and PSA angle outlier rates were significantly lower in the robot-assisted group (P \\u0026lt; 0.05).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e: The TINAVI robotic system demonstrated superior safety and efficacy in TKA surgery. Compared with conventional TKA, the robot-assisted system achieved significantly better outcomes in terms of prosthesis implantation accuracy and lower extremity alignment, with a particular advantage in patients with severe limb alignment deformities.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Comparison of the Efficacy of Robot-assisted Total Knee Arthroplasty in Patients with Knee Osteoarthritis with Varying Severity Deformity\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-12-09 08:26:26\",\"doi\":\"10.21203/rs.3.rs-5245472/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-11-26T20:16:49+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-11-26T16:13:07+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-11-25T17:54:58+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"304168316156372325811592813398657662912\",\"date\":\"2024-11-16T14:59:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"84298024211510109389045199584412168208\",\"date\":\"2024-11-14T20:26:52+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"81835579195466551024830184190675745158\",\"date\":\"2024-11-12T08:23:01+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-11-11T16:56:28+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"288522953073439532490207459391759525318\",\"date\":\"2024-11-11T14:25:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-11-11T13:50:40+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-10-15T06:12:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-10-14T10:25:01+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Journal of Orthopaedic Surgery and Research\",\"date\":\"2024-10-11T10:41:57+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"journal-of-orthopaedic-surgery-and-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"josr\",\"sideBox\":\"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)\",\"snPcode\":\"13018\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13018/3\",\"title\":\"Journal of Orthopaedic Surgery and Research\",\"twitterHandle\":\"@MSKmedBMC\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"215acf71-ac41-4b06-9b79-c0bed48b3827\",\"owner\":[],\"postedDate\":\"December 9th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-12-30T16:04:22+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-5245472\",\"link\":\"https://doi.org/10.1186/s13018-024-05372-w\",\"journal\":{\"identity\":\"journal-of-orthopaedic-surgery-and-research\",\"isVorOnly\":false,\"title\":\"Journal of Orthopaedic Surgery and Research\"},\"publishedOn\":\"2024-12-24 15:57:19\",\"publishedOnDateReadable\":\"December 24th, 2024\"},\"versionCreatedAt\":\"2024-12-09 08:26:26\",\"video\":\"\",\"vorDoi\":\"10.1186/s13018-024-05372-w\",\"vorDoiUrl\":\"https://doi.org/10.1186/s13018-024-05372-w\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5245472\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5245472\",\"identity\":\"rs-5245472\",\"version\":[\"v1\"]},\"buildId\":\"zQwnuV7TCBrMSSSToR1PI\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}