AccScience Publishing / OTE / Online First / DOI: 10.36922/OTE025320009
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ORIGINAL RESEARCH ARTICLE

Comparison of mechanical and restricted kinematic alignment in robotic-assisted total knee arthroplasty: A retrospective single-surgeon study

Akinari Tokiyoshi1* ,  Yusuke Akaoka1
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1 Department of Orthopaedic Surgery, Kugawa Hospital for Orthopaedic Surgery, Shindencho, Kofu, Yamanashi Prefecture, Japan
OTE, 025320009 https://doi.org/10.36922/OTE025320009
Received: 8 August 2025 | Revised: 14 October 2025 | Accepted: 15 October 2025 | Published online: 5 November 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Mechanical alignment (MA) has long been the gold standard in total knee arthroplasty (TKA), ensuring reliable implant survivorship. Recently, restricted kinematic alignment (rKA) has emerged as an alternative designed to restore each patient’s native knee anatomy and potentially enhance functional outcomes. Robotic assistance improves the precision and reproducibility of both alignment strategies. This retrospective study evaluated perioperative outcomes of MA and rKA in robotic-assisted TKA using the ROSA system. Eighty-nine consecutive primary TKA cases were reviewed, including 42 in the MA group and 47 in the rKA group. Patient demographics, operative time, tramadol use, range of motion, and radiographic parameters were analyzed. Baseline demographic variables such as age, sex, body mass index, and pre-operative range of motion were comparable between groups. The mean operative time was 111.9 ± 53.5 min for MA and 98.0 ± 30.3 min for rKA, with no significant difference. Post-operative range of motion was similar between groups, with no significant difference in flexion or extension at discharge. However, mean daily tramadol consumption was significantly higher in the rKA group (46.8 ± 46.9 mg/day) than in the MA group (26.2 ± 37.8 mg/day), possibly reflecting transient differences in periarticular tissue strain. Radiographic analysis showed that rKA more closely restored the patient’s constitutional alignment, while MA maintained a neutral mechanical axis. Robotic-assisted TKA enables both alignment strategies with high accuracy, and despite higher early analgesic requirements with rKA, early functional recovery is comparable.

Graphical abstract
Keywords
Arthroplasty
Replacement
Knee
Robotics
Knee joint
Length of stay
Tramadol
Range of motion
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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