Rural surgical practice in Australia provides a unique environment to the Orthopaedic Surgeon. Whilst most of the work load mimics that of city practice, the rural surgeon has little choice but to master a broad schema of surgical skills, and keeping up with the current literature and techniques can be challenging.

At our public hospital over the last audited twelve month period, 108 primary total knee replacements were performed by 4 surgeons out of 236 joint replacements including revision surgeries. At the Private hospital a total of 215 joint replacements were performed in the same period including revision surgeries, of which 127 were knee arthroplasties.

It is recognised that the incidence of complications from arthroplasty can be increased in low volume joint replacement surgeons.

This centre is a mid volume centre, but rural and generally underfunded.

In light of this, it is not unreasonable to look at techniques or evolving technologies that may improve the ability of an individual surgeon to position a joint replacement in an optimal position and with economic consideration.

Conventional navigation has a number of factors associated with it that may make its use in a rural centre less attractive. These include capital cost of both hardware and software; Most rural centres do not have the ability to purchase the hardware and thus the issue of transporting hard ware on site, and representative support, may all be issues.

The potential benefit of patient specific implants [PSI] may thus be two-fold in this setting. The surgeon and the patient benefit from the technology, but the technology does not need to be transported to the site.

As a result of these considerations, a single surgeon in a rural centre, commenced using PSI's after gaining initial experience with the implant using traditional techniques.

This early study looks at this experience and attempts to quantify some of the issues around this technology.