Patient specific cutting guides generated by preoperative Magnetic Resonance Imaging (MRI) of the patient’s extremity have been proposed as a method of improving the consistency of Total Knee Arthroplasty (TKA) alignment and adding efficiency to the operative procedure. The cost of this option was evaluated by quantifying the savings from decreased operative time and instrument processing costs compared to the additional cost of the MRI and the guide. Coronal plane alignment was measured in an unselected consecutive series of 200 TKAs, 100 with standard instrumentation and 100 with custom cutting guides. While the cutting guides had significantly lower total operative time and instrument processing time, the estimated $322 savings was overwhelmed by the $1,500 additional cost of the MRI and the cutting guide. All measures of coronal plane alignment were equivalent between the two groups. The data does not currently support the proposition that patient specific guides add value to TKA.


  • No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    One author (RMN) is a paid consultant for Smith & Nephew Orthopaedics, Wright Medical Technology Inc., Salient Surgical, and CardioMEMS.

    One author (RLB) is a consultant to Stryker (Mahwah, NJ, USA). Each of the remaining authors certify that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

    The authors have full control of all primary data and agree to allow the journal to review data if requested.Each author certifies that his or her institution has approval for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at Washington University in St. Louis, Missouri.

    This paper is based on a study which was presented at the Winter 2011 Current Concepts in Joint Replacement meeting in Orlando, Florida, 7th – 10th December.

  • Received September 19, 2012.
  • Accepted September 19, 2012.
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