Customization of cutting blocks: Can this address the problem?

Recent literature has challenged the notion that neutral coronal alignment is a requirement for long-term survivorship of TKAs. However a preponderance of classic and contemporary evidence supports increased failure rates with malalignment, especially varus. Patient-specific custom cutting guides are an attractive alternative to traditional instrumentation and computer navigation in achieving accurate alignment of total knee arthroplasties. The logistical benefits include possible decreased operating room time, decreased turnover time, less time spent sterilizing and preparing trays, less inventory, less strain on surgical technicians and nurses, and no capital cost associated with computer navigation. Patient benefits include potentially less tourniquet time, less surgical exposure, no requirement of intramedullary canal preparation, and improved mechanical alignment, which may translate to increased implant longevity. Surgeon benefits include potentially more accurate landmark registration than computer navigation, more efficient surgery, decreased intraoperative stress due to less required decision making, and the ability to perform more surgeries due to time saved.