Abstract Purpose To compare early patient‐reported clinical outcomes of patient‐individual total knee arthroplasty (TKA) with individualized trochlear design versus robotic‐assisted TKA using off‐the‐shelf implants in patients with valgus knee phenotypes and pronounced femoral valgus (lateral distal femoral angle LDFA < 85°) at 3 and 12 months postoperatively in a prospective matched case–control study. Methods This prospective matched case–control study based on predefined anatomical criteria included 42 patients who underwent primary TKA between October 2021 and October 2023. Twenty‐one patients received patient‐individual posterior‐stabilized implants. Twenty‐one matched controls underwent robotic‐assisted TKA with off‐the‐shelf implants. All procedures followed restricted kinematic alignment (KA) principles with valgus undercorrection. Primary outcomes were patient‐reported scores (Forgotten Joint Score FJS, Kujala Score, Oxford Knee Score OKS and the Western Ontario and McMaster Universities Arthritis Index WOMAC), assessed preoperatively and at 3 and 12 months. Results Both groups demonstrated comparable preoperative clinical status and comparable degrees of preoperative valgus deformity, with no significant differences in hip–knee–ankle angle (HKA, 185.6 ± 6.3° vs. 188.8 ± 4.1°; p = 0.060) or mechanical LDFA (84.0 ± 0.9° vs. 83.7 ± 1.2°; p = 0.261). At 3 and 12 months, patient‐individual total knee arthroplasty (pTKA) demonstrated significantly better scores across all patient‐reported outcome measures (PROMs) ( p < 0.05). The largest difference was observed in the Kujala score at 12 months (79.5 ± 12.8 vs. 59.7 ± 19.0, p = 0.001). FJS improved more rapidly in the pTKA group (from 9.0 to 49.1 at 3 months, and 52.5 at 12 months) compared to robotic‐assisted total knee arthroplasty (rTKA) (26.9 and 36.0, respectively). One revision for suspected infection occurred in the pTKA cohort; none were reported after rTKA. Conclusions Patient‐individual TKA with individualized trochlear design achieved superior early functional outcomes compared to robotic‐assisted TKA with standard implants in severe valgus morphotypes. Individualized trochlear orientation may improve patellofemoral mechanics and facilitate faster recovery in patients with severe femoral valgus. Level of Evidence Level III.
Tuecking et al. (Thu,) studied this question.