{
  "abstract": "Objective: To evaluate inter-surgeon variability in mediolateral joint balance assessment during robotic-assisted total knee arthroplasty (TKA) using the robotic surgical assistant (ROSA) Knee System, and to determine whether such variability influences the surgical planning generated by this system. Methods: An observational study was conducted including 101 patients undergoing primary robotic-assisted TKA. Two experienced surgeons independently assessed intraoperative mediolateral laxity by manually applying varus–valgus stress across six predefined flexion angles (0°, 30°, 45°, 60°, 90°, and 120°). Measurements of medial and lateral gaps (mm) and varus–valgus alignment (°) were recorded using the ROSA Knee System. Inter-observer differences were analysed using the Wilcoxon signed-rank test, and reliability was assessed using the intraclass correlation coefficient (ICC). The impact of inter-surgeon variability on surgical planning, including bone resection and compartmental space measurement parameters, was also evaluated. Results: No statistically significant inter-observer differences were observed in mediolateral gap measurements or varus–valgus alignment across all flexion angles (p > 0.05). Inter-observer reliability for varus–valgus measurements was good to excellent in extension and early flexion (ICC 0.86–0.91), decreased to moderate at 90° (ICC 0.68–0.74) and was poor for varus assessment at 120° (ICC 0.46, 95% CI 0.29–0.60). For gap measurements, reliability was excellent for the medial gap and good for the lateral gap in extension (ICC 0.93 and 0.89, respectively), and moderate for both gaps at 90° (ICC 0.71–0.74). No significant inter-observer differences were found in cut or space measurements, with excellent agreement for cut parameters (ICC > 0.95). Conclusions: Inter-surgeon assessment of mediolateral joint balance during robot-assisted TKA showed good-to-excellent reproducibility in extension and early flexion, with reduced reproducibility in deep flexion. Statistically significant inter-observer differences were not observed in the resulting cut and space measurements.",
  "abstract_shown": true,
  "affiliations": [
    "Knee Unit, Department of Orthopaedics and Traumatology, Parc Taulí Hospital Universitari, Institut d’Investigació I Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma Barcelona (UAB), 08208 Sabadell, Spain",
    "3D Surgical Planning Lab, Parc Taulí Hospital Universitari, Institut d’Investigació I Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona (UAB), 08208 Sabadell, Spain",
    "Medicine and Surgery Faculty, Universitat Autonoma de Barcelona, 08193 Bellaterra, Spain"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Giovanni Grillo",
      "orcid": "0000-0001-9526-5666"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Alexandre Coelho Leal",
      "orcid": "0000-0003-1920-1032"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "David Martí"
    },
    {
      "affs": [
        2
      ],
      "name": "Marçal Pineda Tortajada"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Sergi Gil-Gonzalez"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Juan Manuel Peñalver Matamoros",
      "orcid": "0000-0001-6393-4677"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Xavier Pelfort Lopéz"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a4npj5e336b5f.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15207926",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705750/?tool=EBI",
  "id": "a4npj5e336b5f",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/7926",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Total Knee Arthroplasty Outcomes"
    ]
  ],
  "openalex": "W7221761752",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705750/pdf/?tool=EBI",
  "pmcid": "PMC13705750",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/a4npj5e336b5f.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15207926",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/7926"
    },
    {
      "first_seen": "2026-10-30T12:21:34Z",
      "native_id": "PMC:PMC13705750",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13705750"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Total Knee Arthroplasty Outcomes",
      "subfield": "surgery"
    }
  ],
  "title": "Mediolateral Joint Balance Assessment Is Reproducible Between Surgeons, Under No Standardized Varus–Valgus Stress, During Robot-Assisted Total Knee Arthroplasty",
  "title_text": "Mediolateral Joint Balance Assessment Is Reproducible Between Surgeons, Under No Standardized Varus–Valgus Stress, During Robot-Assisted Total Knee Arthroplasty",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:34Z",
  "url": "https://research.draconitic.com/paper/a4npj5e336b5f",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}