Mediolateral Joint Balance Assessment Is Reproducible Between Surgeons, Under No Standardized Varus–Valgus Stress, During Robot-Assisted Total Knee Arthroplasty
- 1Knee 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
- 23D Surgical Planning Lab, Parc Taulí Hospital Universitari, Institut d’Investigació I Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona (UAB), 08208 Sabadell, Spain
- 3Medicine and Surgery Faculty, Universitat Autonoma de Barcelona, 08193 Bellaterra, Spain
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.
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BibTeX
@article{grillo2026mediolateral,
title = {{Mediolateral Joint Balance Assessment Is Reproducible Between Surgeons, Under No Standardized Varus–Valgus Stress, During Robot-Assisted Total Knee Arthroplasty}},
author = {Giovanni Grillo and Alexandre Coelho Leal and David Martí and Marçal Pineda Tortajada and Sergi Gil-Gonzalez and Juan Manuel Peñalver Matamoros and Xavier Pelfort Lopéz},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207926},
url = {https://www.mdpi.com/2077-0383/15/20/7926},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Mediolateral Joint Balance Assessment Is Reproducible Between Surgeons, Under No Standardized Varus–Valgus Stress, During Robot-Assisted Total Knee Arthroplasty
AU - Giovanni Grillo
AU - Alexandre Coelho Leal
AU - David Martí
AU - Marçal Pineda Tortajada
AU - Sergi Gil-Gonzalez
AU - Juan Manuel Peñalver Matamoros
AU - Xavier Pelfort Lopéz
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207926
UR - https://www.mdpi.com/2077-0383/15/20/7926
AB - 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.
SN - 2077-0383
ER -