Targeting Functional Deficits: Associations Between Distal Femur Morphology and Passive and Dynamic Frontal Plane Knee Kinematics in Arthroplasty Patients for Personalized Robotic Surgery

6 pages•Published: January 5, 2026

Nadim Ammoury, Stephanie Civiero, Lloyd Roffe, Ispeeta Ahmed, Michael Dunbar, Jennifer Leighton, David Wilson, Glen Richardson and Janie Astephen Wilson

Abstract

Restoring knee function to pre-diseased levels after arthroplasty remains challenging, as common surgical approaches do not easily account for the variability in joint-level function, leaving some patients with unmet functional expectations. Robotic-assisted knee arthroplasty (RAKA) enhances surgical precision and accuracy, but opportunities remain to better consider patient-specific morphological and anatomical variability and its influence on both passive and dynamic joint function in optimizing surgical decisions for the individual. This study examines the relationships between distal femur morphology, joint alignment, intraoperative passive knee kinematics, and active kinematics during walking to inform tailored knee arthroplasty surgical protocols.
Forty patients with end-stage knee osteoarthritis participated to date. Pre-operative gait kinematics were captured using markerless motion analysis. Passive kinematics were recorded intraoperatively under varus-valgus stress conditions with a robotic system. Morphological variables were measured on distal femurs modeled from computed tomography images to which principal component analysis was applied to reduce dimensionality and identify key morphometric shapes among this patient population.
PC1, characterized by wider femurs with elevated anterior condyles, was correlated with higher mean knee adduction angles during gait. PC2, reflecting longer femurs with flatter anterior condylar grooves, correlated with greater frontal plane variability during gait and higher passive angular movement under varus stress at 10° flexion.
These results highlight the influence of femoral morphology on knee mechanics and underscore the potential of integrating anatomical and morphometric variability into RAKA protocols to target functional outcomes. Continued exploration of these relationships could lead to improved post-arthroplasty functional outcomes tailored to individual patient needs.

Keyphrases: distal femur morphology, end stage knee osteoarthritis, knee kinematics, patient variability, principal component analysis, robotic assisted knee arthroplasty

In: Joshua William Giles and Aziliz Guezou-Philippe (editors). Proceedings of The 25th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 8, pages 15-20.

Links:	https://easychair.org/publications/paper/q5nM
	https://doi.org/10.29007/rms9

BibTeX entry

@inproceedings{CAOS2025:Targeting_Functional_Deficits_Associations,
  author    = {Nadim Ammoury and Stephanie Civiero and Lloyd Roffe and Ispeeta Ahmed and Michael Dunbar and Jennifer Leighton and David Wilson and Glen Richardson and Janie Astephen Wilson},
  title     = {Targeting Functional Deficits: Associations Between Distal Femur Morphology and Passive and Dynamic Frontal Plane Knee Kinematics in Arthroplasty Patients for Personalized Robotic Surgery},
  booktitle = {Proceedings of The 25th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Joshua William Giles and Aziliz Guezou-Philippe},
  series    = {EPiC Series in Health Sciences},
  volume    = {8},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {/publications/paper/q5nM},
  doi       = {10.29007/rms9},
  pages     = {15-20},
  year      = {2026}}

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