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Cases: Knee arthroplasty is increasingly common with good clinical results. However, there is a cohort of patients whose native knee anatomy may not marry well with standard implants. The current authors describe two cases (one unicompartmental knee arthroplasty (UKA), one total knee arthroplasty (TKA)), during which deliberately implanting an implant designed for the contra-lateral distal femur (TKA) or contralateral femoral condyle (UKA) respectively, led to a better fit than correct-sided implants. Conclusion: The authors share their experience to raise awareness of a potential solution to such an intra-operative challenge and suggest that implant customisation may ultimately address challenges with grossly abnormal native anatomy.

The article discusses the shift from traditional 'mean value medicine' to personalized medicine in orthopaedics, emphasizing the importance of treating patients as unique individuals rather than averages. It highlights the limitations of standardized treatments in knee osteoarthritis and total knee arthroplasty, advocating for personalized approaches that consider individual factors like anatomy, alignment, and genetics. The use of big data, machine learning, and patient-specific criteria, such as joint alignment, can lead to more precise treatment options and improved patient outcomes in orthopaedic care. [Extracted from the article]

Purpose: The purpose of this study was to compare postoperative patellar tilt at 4 months follow‐up in a consecutive series of randomised patients that received individualised or off‐the‐shelf (OTS) primary total knee arthroplasty (TKA). The hypothesis was that patellar tilt would be lower and less variable in patients who received individualised TKA compared to patients who received OTS TKA. Methods: A consecutive series of 385 patients randomised (1:1) to receive either OTS TKA or individualised TKA were analysed. Pre‐ and postoperative radiographs at 4 months were obtained of weight‐bearing long leg, anterior–posterior and lateral knee views and a skyline view at 30° of flexion. Postoperative patellar tilt was measured between the anterior femoral line and patellar resection surface (β) and the anterior femoral line and mediolateral patellar axis (σ). Postoperative patellar tilt (absolute value) was compared between the individualised and OTS TKA groups based on preoperative phenotypes of their femoral mechanical angle, tibial mechanical angle and hip–knee–ankle angle. Variability in postoperative patellar tilt was compared using the 95% confidence intervals (CIs). Results: Comparisons of baseline patient characteristics revealed no difference between the individualised and OTS TKA groups. Comparison of absolute postoperative patellar tilt revealed significant differences between individualised and OTS TKA (|β|, 1.0° ± 1.0° and 2.5° ± 2.2°, respectively, p < 0.001; |σ|, 1.7° ± 1.6° and 2.8° ± 2.3°, respectively, p < 0.001). The 95% CI of postoperative patellar tilt (|β|) was narrower in patients that received individualised compared to OTS TKA (0.0° to 3.8° and 0.1° to 8.3°, respectively), irrespective of their preoperative phenotype. Conclusion: Patients who underwent individualised TKA had lower and less variable postoperative patellar tilt than those with OTS TKA, irrespective of preoperative phenotype. Individualised TKA allows the decoupling of the tibiofemoral and patellofemoral joints, replicating anatomical trochlear orientation and improving patellar tilt, which could facilitate better clinical outcomes. Clinical Trial Registration: This study constitutes a part of a larger registered randomised controlled trial comparing patient satisfaction following OTS versus individualised TKA (NCT04460989). Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this pilot cross‐sectional study was to compare the operating room (OR) efficiency and intraoperative staff task load when performing individualised versus off‐the‐shelf (OTS) total knee arthroplasty (TKA). Methods: A consecutive series of 28 patients randomised (1:1) to receive either OTS TKA or individualised TKA were included. The OR staff workload was assessed with the NASA Task Load Index (TLX), a subjective grading system assessing mental demand, physical demand, temporal demand, performance, effort and frustration on a scale from 0 (very low) to 20 (very high). The time for patient preparation, surgical time, closure and total OR time was recorded to assess OR efficiency. Effect sizes of differences between OTS and individualised TKA were expressed as mean differences (MDs) with 95% confidence intervals (CIs). Results: Patients in both cohorts were similar in age (OTS vs. individualised TKA (median [IQR]), 67 [63–76] vs. 71 [68–79]; p = 0.207) and body mass index (BMI) (29 [24–33] vs. 29 [26–31]; p = 0.807), and there were no significant differences in other preoperative characteristics. The OR staff perceived individualised TKA as less demanding than OTS TKA: Individualised TKA was rated significantly better across the six domains of the NASA TLX: mental demand by 5.6 points, physical demand by 6.3 points, temporal demand by 5.3 points, performance by 3.6 points, effort by 5.9 points and frustration by 5.8 points. Individualised TKA resulted in statistically significantly shorter mean total OR time (MD, 10 min; p = 0.018). Conclusion: The staff in the OR found that individualised TKA is less mentally, physically and temporally demanding than OTS TKA. The average total time spent in the OR during individualised TKA is 10 min less than during OTS TKA. Clinical Trial Registration: This study constitutes a part of a larger registered randomised controlled trial comparing patient satisfaction following OTS versus individualised TKA (NCT04460989). Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]