Surgical Technique

Lateral approach in robotic total knee arthroplasty for valgus knees: A step-by-step technique

¹ Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon North University Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
² LIBM-EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69100 Lyon, France
³ Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622 Lyon, France
⁴ Orthopedic and Traumatology Surgery Department, CHU Nîmes, University Montpellier 1, Nîmes, Place du Professeur Robert Debré, 30029 Nîmes, France
⁵ Laboratory LMGC, CNRS UMR 5508, University of Montpellier II, 860 Rue de St – Priest, 34090 Montpellier, France
⁶ Laboratoire de Mécanique et Génie Civile (LMGC), UM 5508 CNRS-UM1, 860 Rue de St – Priest, 34090 Montpellier, France

^* Corresponding author: pietroflaviogregori@gmail.com

Received: 27 February 2025
Accepted: 3 March 2025

Abstract

Total knee arthroplasty (TKA) in valgus knee deformities presents unique challenges, including alignment, soft tissue balance, and implant positioning. The lateral approach offers advantages over the traditional medial approach by improving direct access, patellar tracking, and soft tissue preservation. Robotic-assisted TKA enhances precision, ligament balancing, and patient-specific alignment strategies, such as functional knee positioning (FKP). This study describes a surgical technique integrating the lateral approach with robotic-assisted TKA using FKP principles. The technique is based on an image-based robotic system, ensuring accurate preoperative planning, intraoperative adjustments, and optimized prosthetic placement. Key intraoperative steps, including bone resection strategies, soft tissue balancing, and trial component evaluations, are detailed. The lateral robotic approach with FKP was found to be effective and reproducible, allowing for precise implant alignment and optimized soft tissue balance in valgus knees. This method minimizes the need for extensive lateral releases, preserves vascularity, and ensures postoperative stability. The combination of the lateral approach, robotic-assisted TKA, and FKP represents a promising strategy for valgus knee deformities. Further long-term studies are needed to validate the durability and functional benefits of this technique.