Customized patient instrumentation for total knee arthroplasty: preoperative planning and intraoperative technique.

Individual physicians are challenged to decrease their operating costs at the same time they are expected to reduce complication rates. For the orthopedic surgeon who performs total knee arthroplasty (TKA), one way to address operating costs is to increase efficiency in the operating room. Computer-assisted surgery (CAS) has not delivered efficiency the way it was once hoped. Customized patient instrumentation (CPI) takes advantage of computer-based technology but, unlike CAS, does not increase surgical time, does not require a computer in the operating room, and allows critical alignment decisions to be made before entering the operating room. In this article, the preoperative preferences and intraoperative techniques in using CPI technology are described. Keeping in mind key components of the intraoperative technique when using CPI, such as soft tissue removal, especially at cutting block contact points, will ensure successful procedures for both the surgeon and patient.