Full-length weight-bearing radiographs and computed tomography show discrepancies in coronal alignment for robotic arm-assisted total knee arthroplasty

Assessment of lower limb coronal plane alignment is crucial in surgical planning of total knee arthroplasty (TKA) and is commonly performed with full-length weight-bearing radiographs (FLWBR). The aim of this study was to determine discrepancies in coronal limb alignment as assessed by conventional FLWBR versus non-weight-bearing computed tomography (CT) modalities in robotic arm-assisted TKA. We retrospectively analyzed 100 consecutive patients with osteoarthritic knees who underwent robotic arm-assisted TKA with preoperative FLWBR and CT assessments of knee alignment. The mechanical axes of the Mako system were established in accordance with the Mako TKA Surgical Guide. The following parameters were compared between the two imaging modalities: (1) mechanical hip-knee-ankle angle (mHKA), (2) medial proximal tibial angle (MPTA), (3) lateral distal femoral angle (LDFA), (4) arithmetic hip-knee-ankle angle (aHKA), (5) joint line obliquity (JLO), and (6) proportion of the Coronal Plane Alignment of the Knee (CPAK) types. Regression analyses were performed to identify potential factors associated with discrepancies in measurements of coronal alignment between these two imaging modalities. There were significant differences in terms of the mHKA between preoperative CT and FLWBR (CT vs. FLWBR, 7.0° vs. 8.5°; p