Patient-specific cutting guides (PSCG) built from imaging of the extremity can improve the accuracy of bone cuts during total knee replacement (TKR). Some reports have suggested that PSCG offer only marginal improvement in the accuracy of alignment and component positioning in TKA. We compared outcomes between TKRs done with PSCG versus standard, intramedullary-based instrumentation. Blood loss, duration of surgery, alignment of the mechanical axis of the leg, and implant position on standing, long-leg, and standard lateral digital radiographs were compared between a CT-guided, custom-built TKA implant (n = 50; ConforMIS iTotal, Boston, MA) implanted with PSCG, versus an off-shelf posterior stabilized TKA implanted with standard instrumentation (n = 50; NKII total knee, Zimmer, Warsaw, IN). The fraction of outliers (>3 degrees) was calculated for the two groups.Introduction:
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