Research progress of robot-assisted total knee arthroplasty for valgus knee from perspective of precision medicine_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Chengji ¹ , YOU Hai ¹ ,  ZHANG Rui ²

1. School of Clinical Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou Gansu, 730000, P. R. China;
2. Department of Joint Orthopedics Ⅰ, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou Gansu, 730050, P. R. China;

Corresponding?author：

ZHANG Rui, Email: 13919466172@163.com

Keywords：

Robot-assisted surgery; total knee arthroplasty; precise osteotomy; valgus knee; soft tissue balance

DOI：

10.7507/1002-1892.202512014

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically summarize the application and research progress of robot-assisted total knee arthroplasty (TKA) in the treatment of valgus knee from the perspective of precision medicine in recent years, so as to provide a reference for the clinical treatment of valgus knee. Methods Relevant domestic and foreign literature, including clinical studies and evidence-based evaluations regarding robot-assisted TKA versus conventional TKA for valgus knee, was reviewed. A systematic analysis was performed focusing on technical advantages, efficacy differences and existing controversies. Results Conventional TKA is limited by surgeons’ experiences, leading to insufficient accuracy in alignment correction, great challenges in soft tissue balance, and postoperative residual deformity. Robot-assisted TKA is significantly superior to conventional approaches in terms of alignment correction accuracy, joint function improvement, and reduction of postoperative complication rates, with confirmed short-term effectiveness. Nevertheless, controversies remain concerning the limitations of robot applicability, prolonged operation time and uncertain long-term effectiveness. Conclusion Robot-assisted TKA provides a precision-oriented therapeutic option for valgus knee with remarkable short-term effectiveness. Further large-sample studies with long-term follow-up are still required to verify its efficacy and facilitate its clinical popularization.

Citation： QIN Chengji, YOU Hai, ZHANG Rui. Research progress of robot-assisted total knee arthroplasty for valgus knee from perspective of precision medicine. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(4): 675-680. doi: 10.7507/1002-1892.202512014 Copy

1.	Alesi D, Meena A, Fratini S, et al. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg, 2022, 106(1): 1-8.
2.	楊德金, 王兆倫, 邊濤, 等. 外翻膝全膝關節置換術后殘留畸形分布及危險因素分析. 中華骨與關節外科雜志, 2020, 13(7): 579-584.
3.	Yang D, Zhou Y, Shao H, et al. Different deformity origins and morphological features in subtypes of valgus knees: A radiological classification system. Orthop Surg, 2022, 14(1): 96-103.
4.	張英豪, 李維全, 陳家禾, 等. 機器人輔助微創全膝關節置換手術系統. 機器人, 2021, 43(4): 386-394.
5.	Greenberg A, Kandel L, Liebergall M, et al. Total knee arthroplasty for valgus deformity via a lateral approach: Clinical results, comparison to medial approach, and review of recent literature. J Arthroplasty, 2020, 35(8): 2076-2083.
6.	Erard J, Olivier F, Kafelov M, et al. Enhancing soft tissue balance: Evaluating robotic-assisted functional positioning in varus knees across flexion and extension with quantitative sensor-guided technology. Knee Surg Sports Traumatol Arthrosc, 2024, 32(9): 2318-2327.
7.	Liow MH, Xia Z, Wong MK, et al. Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty, 2014, 29(12): 2373-2377.
8.	田雪晴, 季紅, 相裕華, 等. 機器人輔助全膝關節置換術與傳統全膝關節置換術效果比較的系統評價再評價. 中國骨傷, 2025, 38(10): 1037-1046.
9.	Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
10.	Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991(273): 9-18.
11.	袁景, 孫效虎, 陳慧, 等. 成人繼發性膝外翻畸形股骨遠端的數字化測量與分析. 中國組織工程研究, 2022, 26(6): 881-885.
12.	Ohno H, Murata M, Kamo T, et al. A new total knee arthroplasty technique for valgus knees that preserves the deep layer of the medial collateral ligament. Acta Orthop Traumatol Turc, 2022, 56(3): 205-209.
13.	MacDessi SJ, Griffiths-Jones W, Harris IA, et al. Coronal Plane Alignment of the Knee (CPAK) classification. Bone Joint J, 2021, 103-B(2): 329-337.
14.	Holland CT, Savov P, Ettinger M, et al. Defining distinct stress curve morphologies for coronal plane alignment of the knee phenotypes using an imageless navigation robotic platform in total knee arthroplasty. J Arthroplasty, 2024, 39(10): 2478-2482.
15.	王云鑫, 許平, 魯寧, 等. 基于膝關節冠狀面對線分型的膝關節生物力學研究. 中國修復重建外科雜志, 2024, 38(12): 1466-1473.
16.	郭新宇, 王直兵, 張峽, 等. 外弓股骨膝內翻患者固有內翻力線的術前計劃. 中華醫學雜志, 2020, 100(15): 1175-1179.
17.	宋平, 吳東, 劉星宇, 等. 一例人工智能三維規劃系統輔助全膝關節置換術. 骨科, 2021, 12(3): 281-283.
18.	何銳. 手術機器人輔助TKA臨床療效與膝關節運動軌跡分析研究. 重慶: 中國人民解放軍陸軍軍醫大學, 2022.
19.	Sarrel K, Weinberg M, Scuderi G. Achieving correct balance in total knee arthroplasty with fixed varus deformity. J Knee Surg, 2024, 37(2): 92-97.
20.	Mizu-Uchi H, Kawahara S, Ishibashi S, et al. Postoperative valgus laxity and medial pivot kinematics are significantly associated with better clinical outcomes. J Arthroplasty, 2022, 37(6S): S187-S192.
21.	王俏杰, 張先龍. 機器人輔助人工全膝關節置換術中下肢對線選擇與軟組織平衡策略. 中國修復重建外科雜志, 2021, 35(10): 1221-1226.
22.	冼達亨, 趙晶, 王英杰, 等. 機器人輔助全膝關節置換術治療合并關節外畸形的外翻膝1例報道及文獻復習. 中華骨與關節外科雜志, 2023, 16(4): 367-371.
23.	Gregori P, Koutserimpas C, De Fazio A, et al. Functional knee positioning in patients with valgus deformity undergoing image-based robotic total knee arthroplasty: Surgical technique. SICOT J, 2025, 11: 7. doi: 10.1051/sicotj/2025001.
24.	李亦丞, 張曉崗, 曹力, 等. 國產機器人輔助與傳統人工全膝關節置換術療效比較: 一項多中心隨機對照研究. 中國修復重建外科雜志, 2023, 37(11): 1326-1334.
25.	范賢成, 馬劍雄, 王穎, 等. 膝關節外翻畸形來源的研究進展. 中華骨科雜志, 2023, 43(13): 915-921.
26.	Young SW, Zeng N, Tay ML, et al. A prospective randomised controlled trial of mechanical axis with soft tissue release balancing vs functional alignment with bony resection balancing in total knee replacement-a study using Stryker Mako robotic arm-assisted technology. Trials, 2022, 23(1): 580. doi: 10.1186/s13063-022-06494-4.
27.	Shatrov J, Foissey C, Kafelov M, et al. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the valgus morphotype using an image based robotic platform and individualized planning. J Pers Med, 2023, 13(2): 212. doi: 10.3390/jpm13020212.
28.	李俊彥, 熊靚, 潘建康, 等. 全膝關節置換術對線理念的研究現狀. 中國矯形外科雜志, 2021, 29(23): 2149-2153.
29.	浦路橋, 徐永清, 齊保闖, 等. 機器人輔助全膝關節置換術治療外翻膝的早期療效分析. 中華創傷骨科雜志, 2023, 25(6): 530-536.
30.	張新星, 趙英杰, 陳超. 計算機輔助骨科手術機器人技術發展及應用綜述. 計算機測量與控制, 2022, 30(4): 1-7, 13.
31.	孫厚義, 鄭愷, 張韋成, 等. OrthoPilot計算機導航輔助全膝關節置換術的早期學習曲線. 中華骨科雜志, 2021, 41(6): 350-358.
32.	祁師亮, 韓樂奇, 楊開祥, 等. 機器人輔助全膝關節置換術治療嚴重內翻畸形膝骨關節炎的療效研究. 生物骨科材料與臨床研究, 2025, 22(2): 35-41.
33.	郭永園, 孫厚義, 張元凱, 等. 鴻鵠機器人輔助全膝關節置換的早期學習曲線. 山東大學學報 (醫學版), 2023, 61(3): 115-120.
34.	Mullaji AB, Khalifa AA. Is it prime time for robotic-assisted TKAs? A systematic review of current studies. J Orthop, 2022, 34: 31-39.
35.	Li Z, Chen X, Wang X, et al. HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment—A prospective randomized and multicenter study. J Orthop Translat, 2022, 33: 31-40.
36.	Daoub A, Qayum K, Patel R, et al. Robotic assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomised controlled trials. J Robot Surg, 2024, 18(1): 364. doi: 10.1007/s11701-024-02048-9.
37.	王洪平, 王明友, 唐茁棟, 等. 兩款不同手術機器人輔助全膝關節置換的回顧性研究. 中國骨傷, 2024, 37(9): 870-877.
38.	Rajan PV, Khlopas A, Klika A, et al. The cost-effectiveness of robotic-assisted versus manual total knee arthroplasty: A markov model-based evaluation. J Am Acad Orthop Surg, 2022, 30(4): 168-176.
39.	楊陽, 楊勇, 劉常宇, 等. 機器人輔助與傳統截骨行全膝關節置換術的早期臨床療效對比. 骨科, 2023, 14(6): 523-529.
40.	Alton TB, Severson EP, Ford MC, et al. VELYS robotic-assisted total knee arthroplasty: Enhanced accuracy and comparable early outcomes versus manual instrumentation during adoption. J Exp Orthop, 2025, 12(1): e70163. doi: 10.1002/jeo2.70163.
41.	Baek JH, Lee SC, Ryu S, et al. Coronal correction for post-traumatic malalignment using robot-assisted total knee arthroplasty: A case series. Orthop Res Rev, 2022, 14: 445-451.
42.	柴偉, 謝杰, 張曉崗, 等. 國產全膝關節置換術輔助機器人系統動物實驗研究. 中國修復重建外科雜志, 2020, 34(11): 1376-1381.
43.	孟晨, 徐永清, 施榮茂, 等. 無影像機器人輔助人工全膝關節置換術在膝骨關節炎合并關節外畸形治療中的早期臨床療效. 中國修復重建外科雜志, 2025, 39(1): 5-12.

1. Alesi D, Meena A, Fratini S, et al. Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021? Musculoskelet Surg, 2022, 106(1): 1-8.
2. 楊德金, 王兆倫, 邊濤, 等. 外翻膝全膝關節置換術后殘留畸形分布及危險因素分析. 中華骨與關節外科雜志, 2020, 13(7): 579-584.
3. Yang D, Zhou Y, Shao H, et al. Different deformity origins and morphological features in subtypes of valgus knees: A radiological classification system. Orthop Surg, 2022, 14(1): 96-103.
4. 張英豪, 李維全, 陳家禾, 等. 機器人輔助微創全膝關節置換手術系統. 機器人, 2021, 43(4): 386-394.
5. Greenberg A, Kandel L, Liebergall M, et al. Total knee arthroplasty for valgus deformity via a lateral approach: Clinical results, comparison to medial approach, and review of recent literature. J Arthroplasty, 2020, 35(8): 2076-2083.
6. Erard J, Olivier F, Kafelov M, et al. Enhancing soft tissue balance: Evaluating robotic-assisted functional positioning in varus knees across flexion and extension with quantitative sensor-guided technology. Knee Surg Sports Traumatol Arthrosc, 2024, 32(9): 2318-2327.
7. Liow MH, Xia Z, Wong MK, et al. Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. J Arthroplasty, 2014, 29(12): 2373-2377.
8. 田雪晴, 季紅, 相裕華, 等. 機器人輔助全膝關節置換術與傳統全膝關節置換術效果比較的系統評價再評價. 中國骨傷, 2025, 38(10): 1037-1046.
9. Ranawat AS, Ranawat CS, Elkus M, et al. Total knee arthroplasty for severe valgus deformity. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 2): 271-284.
10. Krackow KA, Jones MM, Teeny SM, et al. Primary total knee arthroplasty in patients with fixed valgus deformity. Clin Orthop Relat Res, 1991(273): 9-18.
11. 袁景, 孫效虎, 陳慧, 等. 成人繼發性膝外翻畸形股骨遠端的數字化測量與分析. 中國組織工程研究, 2022, 26(6): 881-885.
12. Ohno H, Murata M, Kamo T, et al. A new total knee arthroplasty technique for valgus knees that preserves the deep layer of the medial collateral ligament. Acta Orthop Traumatol Turc, 2022, 56(3): 205-209.
13. MacDessi SJ, Griffiths-Jones W, Harris IA, et al. Coronal Plane Alignment of the Knee (CPAK) classification. Bone Joint J, 2021, 103-B(2): 329-337.
14. Holland CT, Savov P, Ettinger M, et al. Defining distinct stress curve morphologies for coronal plane alignment of the knee phenotypes using an imageless navigation robotic platform in total knee arthroplasty. J Arthroplasty, 2024, 39(10): 2478-2482.
15. 王云鑫, 許平, 魯寧, 等. 基于膝關節冠狀面對線分型的膝關節生物力學研究. 中國修復重建外科雜志, 2024, 38(12): 1466-1473.
16. 郭新宇, 王直兵, 張峽, 等. 外弓股骨膝內翻患者固有內翻力線的術前計劃. 中華醫學雜志, 2020, 100(15): 1175-1179.
17. 宋平, 吳東, 劉星宇, 等. 一例人工智能三維規劃系統輔助全膝關節置換術. 骨科, 2021, 12(3): 281-283.
18. 何銳. 手術機器人輔助TKA臨床療效與膝關節運動軌跡分析研究. 重慶: 中國人民解放軍陸軍軍醫大學, 2022.
19. Sarrel K, Weinberg M, Scuderi G. Achieving correct balance in total knee arthroplasty with fixed varus deformity. J Knee Surg, 2024, 37(2): 92-97.
20. Mizu-Uchi H, Kawahara S, Ishibashi S, et al. Postoperative valgus laxity and medial pivot kinematics are significantly associated with better clinical outcomes. J Arthroplasty, 2022, 37(6S): S187-S192.
21. 王俏杰, 張先龍. 機器人輔助人工全膝關節置換術中下肢對線選擇與軟組織平衡策略. 中國修復重建外科雜志, 2021, 35(10): 1221-1226.
22. 冼達亨, 趙晶, 王英杰, 等. 機器人輔助全膝關節置換術治療合并關節外畸形的外翻膝1例報道及文獻復習. 中華骨與關節外科雜志, 2023, 16(4): 367-371.
23. Gregori P, Koutserimpas C, De Fazio A, et al. Functional knee positioning in patients with valgus deformity undergoing image-based robotic total knee arthroplasty: Surgical technique. SICOT J, 2025, 11: 7. doi: 10.1051/sicotj/2025001.
24. 李亦丞, 張曉崗, 曹力, 等. 國產機器人輔助與傳統人工全膝關節置換術療效比較: 一項多中心隨機對照研究. 中國修復重建外科雜志, 2023, 37(11): 1326-1334.
25. 范賢成, 馬劍雄, 王穎, 等. 膝關節外翻畸形來源的研究進展. 中華骨科雜志, 2023, 43(13): 915-921.
26. Young SW, Zeng N, Tay ML, et al. A prospective randomised controlled trial of mechanical axis with soft tissue release balancing vs functional alignment with bony resection balancing in total knee replacement-a study using Stryker Mako robotic arm-assisted technology. Trials, 2022, 23(1): 580. doi: 10.1186/s13063-022-06494-4.
27. Shatrov J, Foissey C, Kafelov M, et al. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the valgus morphotype using an image based robotic platform and individualized planning. J Pers Med, 2023, 13(2): 212. doi: 10.3390/jpm13020212.
28. 李俊彥, 熊靚, 潘建康, 等. 全膝關節置換術對線理念的研究現狀. 中國矯形外科雜志, 2021, 29(23): 2149-2153.
29. 浦路橋, 徐永清, 齊保闖, 等. 機器人輔助全膝關節置換術治療外翻膝的早期療效分析. 中華創傷骨科雜志, 2023, 25(6): 530-536.
30. 張新星, 趙英杰, 陳超. 計算機輔助骨科手術機器人技術發展及應用綜述. 計算機測量與控制, 2022, 30(4): 1-7, 13.
31. 孫厚義, 鄭愷, 張韋成, 等. OrthoPilot計算機導航輔助全膝關節置換術的早期學習曲線. 中華骨科雜志, 2021, 41(6): 350-358.
32. 祁師亮, 韓樂奇, 楊開祥, 等. 機器人輔助全膝關節置換術治療嚴重內翻畸形膝骨關節炎的療效研究. 生物骨科材料與臨床研究, 2025, 22(2): 35-41.
33. 郭永園, 孫厚義, 張元凱, 等. 鴻鵠機器人輔助全膝關節置換的早期學習曲線. 山東大學學報 (醫學版), 2023, 61(3): 115-120.
34. Mullaji AB, Khalifa AA. Is it prime time for robotic-assisted TKAs? A systematic review of current studies. J Orthop, 2022, 34: 31-39.
35. Li Z, Chen X, Wang X, et al. HURWA robotic-assisted total knee arthroplasty improves component positioning and alignment—A prospective randomized and multicenter study. J Orthop Translat, 2022, 33: 31-40.
36. Daoub A, Qayum K, Patel R, et al. Robotic assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomised controlled trials. J Robot Surg, 2024, 18(1): 364. doi: 10.1007/s11701-024-02048-9.
37. 王洪平, 王明友, 唐茁棟, 等. 兩款不同手術機器人輔助全膝關節置換的回顧性研究. 中國骨傷, 2024, 37(9): 870-877.
38. Rajan PV, Khlopas A, Klika A, et al. The cost-effectiveness of robotic-assisted versus manual total knee arthroplasty: A markov model-based evaluation. J Am Acad Orthop Surg, 2022, 30(4): 168-176.
39. 楊陽, 楊勇, 劉常宇, 等. 機器人輔助與傳統截骨行全膝關節置換術的早期臨床療效對比. 骨科, 2023, 14(6): 523-529.
40. Alton TB, Severson EP, Ford MC, et al. VELYS robotic-assisted total knee arthroplasty: Enhanced accuracy and comparable early outcomes versus manual instrumentation during adoption. J Exp Orthop, 2025, 12(1): e70163. doi: 10.1002/jeo2.70163.
41. Baek JH, Lee SC, Ryu S, et al. Coronal correction for post-traumatic malalignment using robot-assisted total knee arthroplasty: A case series. Orthop Res Rev, 2022, 14: 445-451.
42. 柴偉, 謝杰, 張曉崗, 等. 國產全膝關節置換術輔助機器人系統動物實驗研究. 中國修復重建外科雜志, 2020, 34(11): 1376-1381.
43. 孟晨, 徐永清, 施榮茂, 等. 無影像機器人輔助人工全膝關節置換術在膝骨關節炎合并關節外畸形治療中的早期臨床療效. 中國修復重建外科雜志, 2025, 39(1): 5-12.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of robot-assisted total knee arthroplasty for valgus knee from perspective of precision medicine

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