Prompt mobilisation after the Fracture neck of femur surgery is one of the important key performance index (‘KPI caterpillar charts’ 2021) affecting the overall functional outcome and mortality. Better control of peri-operative blood pressure and minimal alteration of renal profile as a result of surgery and anaesthesia may have an implication on early post-operative mobilisation. Aim was to evaluate perioperative blood pressure measurements (duration of fall of systolic BP below the critical level of 90mmHg) and effect on the post-operative renal profile with the newer short acting spinal anaesthetic agent (prilocaine and chlorprocaine) used alongside the commonly used regional nerve block. 20 patients were randomly selected who were given the newer short acting spinal anaesthetic agent along with a regional nerve block between May 2019 and February 2020. Anaesthetic charts were reviewed from all patients for data collection. The assessment criteria for perioperative hypotension: Duration of systolic blood pressure less than 90 mm of Hg and change of pre and post operative renal functions. Only one patient had a significant drop in systolic BP less than 90mmHg (25 minutes). 3 other patients had a momentary fall of systolic BP of less than 5 minutes. None of the above patients had mortality and had negligible change in pre and post op renal function. Only one patient in this cohort had elevation of post-operative creatinine levels but did not have any mortality. Only 1 patient died on day 3 post operatively who had multiple comorbidities and was under evaluation for GI cancer. Even in this patient the peri-operative blood pressure was well maintained (never below 90mmHg systolic) and post-operative renal function was also shown to have improved (309 pre-operatively to 150 post-operatively) in this patient. The use of short-acting spinal anaesthesia has shown to be associated with a better control of blood pressure and end organ perfusion, less adverse effects on renal function leading to early mobilisation and a more favourable patient outcome with reduced mortality, earlier mobilisation, shorter hospital stay and earlier discharge in this elderly patient cohort

Background. In recent years, ‘Get It Right First Time (GIRFT)’ have advocated cemented replacements in femoral part of Total hip arthroplasty (THA) especially in older patients. However, many studies were unable to show any difference in outcomes and although cemented prostheses may be associated with better short-term pain outcomes there is no clear advantage in the longer term. It is not clear when and why to do cemented instead of cementless. Aim. To assess differences in patient reported outcomes in uncemented THAs based on patient demographics in order to decide when cementless THA can be done safely. Method. Prospective data collection of consecutive 1079 uncemented THAs performed for 954 patients in single trust between 2010 and 2020. Oxford Hip Score (OHS) and complications were analysed against demographic variables (age, sex, BMI, ASA) and prosthesis features (femoral and acetabular size, offset and acetabular screws). Results. The mean pre-operative OHS was 14.6 which improved to 39.0 at 1 year follow up (P Value=0.000). There was no statistically significant difference between OHS outcome in patients aged over 70 versus younger groups. With a small number of revisable complications increase with age from 50s upwards. Male patients’ OHS score was on average 2.4 points higher than women. Men, however were 2.9 times more likely to experience fractures and high offset hips were 2.5 times more likely to experience dislocations. DAIR, intraoperative calcar fractures, post-operative fractures and dislocations were not associated with worse OHS. Patients with increased BMI had worse pre and post-operative hip functions yet, there was a significant multivariate association between increased BMI and increased improvement in OHS from pre-op to 1 year in women aged 55–80 and men under the age of 60. Femoral stem size increases with age but decreases in male patients over 80. There was no difference found in OHS between bilateral hip replacements and unilateral, nor was there any change found with laterality side of the replacement. Conclusions. This study suggests that ageing >70 is not associated with poorer outcomes despite small number of revisable complication rates that increase with age from 50 upwards. Men had marginally higher average OHS than women At 1 year. Higher BMI or ASA scores are associated with worse pre-operative hips and worse final outcome score. Despite this, the Delta OHS increases with increased BMI shown in the 55–80 year old female patients and male patients under 60. Key Words: THR, Uncemented, Oxford hip score, outcome

Operative management of clavicle fractures is increasingly common. In the context of explaining the risks and benefits of surgery, understanding the impact of incisional numbness as it relates to the patient experience is key to shared decision making. This study aims to determine the prevalence, extent, and recovery of sensory changes associated with supraclavicular nerve injury after open reduction and plate internal fixation of middle or lateral clavicle shaft fractures. Eighty-six patients were identified retrospectively and completed a patient experience survey assessing sensory symptoms, perceived post-operative function, and satisfaction. Correlations between demographic factors and outcomes, as well as subgroup analyses were completed to identify factors impacting patient satisfaction. Ninety percent of patients experienced sensory changes post-operatively. Numbness was the most common symptom (64%) and complete resolution occurred in 32% of patients over an average of 19 months. Patients who experienced burning were less satisfied overall with the outcome of their surgery whereas those who were informed of the risk of sensory changes pre-operatively were more satisfied overall. Post-operative sensory disturbance is common. While most patients improve, some symptoms persist in the majority of patients without significant negative effects on satisfaction. Patients should always be advised of the risk of persistent sensory alterations around the surgical site to increase the likelihood of their satisfaction post-operatively

Abstract. Background. The incidence of periprosthetic fractures of the femur around a total knee arthroplasty (TKA) is rising and this is owed to the increased longevity that today's TKA implants allow for, as well as an aging population. These injuries are significant as they are related to increased morbidity and mortality. Methods. We retrospectively reviewed all periprosthetic fractures around a TKA that presented to our NHS Trust between 2011 to 2020. Medical records were reviewed. Treatment, complications and mortality were noted. Results. 37 patients (34 females) with an average age of 84 (range 65–99) met the inclusion criteria for this study. 17 patients (45.9%) underwent open reduction and internal fixation (ORIF), eight patients (21.6%) underwent revision arthroplasty to a distal femoral replacement (DFR) and 12 patients (32.4%) were treated non-operatively. 10 (58.8%) of the 17 patients that were treated with ORIF were discharged from hospital to a rehabilitation facility rather than their usual residence. In comparison, 3 (37.5%) of the patients that were treated with a DFR were discharged to a rehabilitation facility. one-year mortality rate in the ORIF group was 29.4 compared to 12.5% in those that had a DFR. Conclusion. Revision arthroplasty using a DFR should be considered in patients with periprosthetic fractures around a TKR, as it is associated with lower mortality rates and higher immediate post-operative function

Orthopaedic training sessions, vital for surgeons to understand post-operative joint function, are primarily based on passive and subjective joint assessment. However, cadaveric knee simulators, commonly used in orthopaedic research,. 1. could potentially benefit surgical training by providing quantitative joint assessment for active functional motions. The integration of cadaveric simulators in orthopaedic training was explored with recipients of the European Knee Society Arthroplasty Travelling Fellowship visiting our institution in 2018 and 2019. The aim of the study was to introduce the fellows to the knee joint simulator to quantify the surgeon-specific impact of total knee arthroplasty (TKA) on the dynamic joint behaviour, thereby identifying potential correlations between surgical competence and post-operative biomechanical parameters. Eight fellows were assigned a fresh-frozen lower limb each to plan and perform posterior-stabilised TKA using MRI-based patient-specific instrumentation. Surgical competence was adjudged using the Objective Structured Assessment of Technical Skills (OSATS) adapted for TKA. 2. All fellows participated in the in vitro specimen testing on a validated knee simulator,. 3. which included motor tasks – passive flexion (0°-120°) and active squatting (35°-100°) – and varus-valgus laxity tests, in both the native and post-operative conditions. Tibiofemoral kinematics were recorded with an optical motion capture system and compared between native and post-operative conditions using a linear mixed model (p<0.05). The Pearson correlation test was used to assess the relationship between the OSATS scores for each surgeon and post-operative joint kinematics of the corresponding specimen (p<0.05). OSATS scores ranged from 79.6% to 100% (mean=93.1, SD=7.7). A negative correlation was observed between surgical competence and change in post-operative tibial kinematics over the entire range of motion during passive flexion – OSATS score vs. change in tibial abduction (r=−0.87; p=0.003), OSATS score vs. change in tibial rotation (r=−0.76; p=0.02). When compared to the native condition, post-operative tibial internal rotation was higher during passive flexion (p<0.05), but lower during squatting (p<0.033). Post-operative joint stiffness was greater in extension than in flexion, without any correlation with surgical competence. Although trained at different institutions, all fellows followed certain standard intraoperative guidelines during TKA, such as achieving neutral tibial abduction and avoiding internal tibial rotation,. 4. albeit at a static knee flexion angle. However, post-operative joint kinematics for dynamic motions revealed a strong correlation with surgical competence, i.e. kinematic variability over the range of passive flexion post-TKA was lower for more skilful surgeons. Moreover, actively loaded motions exhibited stark differences in post-operative kinematics as compared to those observed in passive motions. In vitro testing on the knee simulator also introduced the fellows to new quantitative parameters for post-operative joint assessment. In conclusion, the inclusion of cadaveric simulators replicating functional joint motions could help quantify training paradigms, thereby enhancing traditional orthopaedic training, as was also the unanimous opinion of all participating fellows in their positive feedback

Rotator cuff injuries represent a significant burden to the health care system, affecting more than 30% of the population over the age of sixty. Despite the advanced surgical techniques that are available, poor results are sometimes seen in a subset of patients receiving surgical treatment for their rotator cuff disease. The reasons for this failure of treatment remain unclear, particularly if the surgery was ‘technically’ successful. An increasing body of evidence has demonstrated a strong correlation between pre-operative psychological factors and functional outcome following several orthopaedic procedures. This association, however, has not been fully demonstrated or effectively investigated in the context of rotator cuff treatment. The main objective for this study was to conduct a systematic review to determine the impact of psychosocial factors on the outcome of treatment in patients with rotator cuff disease. A systematic search was conducted of Medline, CINAHL, and PsychInfo databases for articles published from database inception until September 2018. The titles and abstracts were screened for all of the studies obtained from the initial search. Inclusion and exclusion criteria were applied, and a full text review was conducted on those studies meeting the eligibility criteria. A total of 1252 studies were identified. Following removal of duplicates and application of the inclusion and exclusion criteria, 46 studies underwent a full-text review. Ten studies were included in the final analysis. A total of 1,206 patients, with a mean follow-up of 13 months, were included. Three studies examined patient expectations prior to treatment. All three found that higher expectations prior to treatment led to a significantly improved outcome following both operative and non-operative treatment. Three studies assessed the association between pre-operative general psychological measures and post-operative pain and function. All three studies found patients with worse pre-operative general psychological scores demonstrated increased post-operative pain. Two of the studies also found a negative association with post-operative function, while one of the studies found no association with post-operative function. Three studies assessed the impact of pre-operative anxiety and depression on outcomes following surgical treatment of rotator cuff disease. Only one of the studies found a negative association with post-operative pain and function. The remaining two studies found no association between anxiety or depression and any outcomes following surgery. Finally, one study examined the impact of general distress on outcomes following the surgical treatment of rotator cuff disease and found no association with post-operative levels of pain or function. The results of this systematic review indicate that there is somewhat conflicting and contradictory evidence within the literature. Overall, however, there does appear to be an association between pre-operative psychological factors and post-operative function and pain, in that higher levels of pre-operative psychological dysfunction are predictive of poorer function and increased pain following the treatment of rotator cuff disease

Currently, hip implant designs are evaluated experimentally using mechanical simulators or cadavers, and total hip arthroplasty (THA) postoperative outcomes are evaluated clinically using long-term follow-up. However, these evaluation techniques can be both costly and time-consuming. Neither can provide an assessment of post-operative results at the onset of implant development. More recently, a forward-solution mathematical model was developed that functions as theoretical joint simulator, providing instant feedback to designers and surgeons alike. This model has been validated by comparing the model predictions with kinematic results from fluoroscopy for both implanted and non-implanted hips and kinetics from a telemetric hip. The model allows surgical technique modifications and implant component placement under in vivo conditions. The objective of this study was to further expand the capabilities of the model to function as an intraoperative virtual surgical tool (Figure 1). This new module allows the surgeon to simulate surgery, then predict, compare, and optimize postoperative THA outcomes based on component placement, sizing choices, reaming and cutting locations, and surgical methods. This virtual surgery tool simulates the quadriceps, hamstring, gluteus, iliopsoas, tensor fasciae latae, and an adductor muscle groups, as well as the hip capsular ligament groups. The model can simulate resecting, weakening, loosening, or tightening of soft tissues based on surgical techniques. Additionally, the model can analyze a variety of activities, including gait and deep flexion activities. Initially, the virtual surgery module offers theoretical surgery tools that allow surgeons to alter surgical alignments, component designs, offsets, as well as reaming and cutting simulations. The virtual model incorporates a built-in CT scan bone database which will assist in determining muscle and ligament attachment sites as well as bony landmarks. The virtual model can be used to assist in the placement of both the femoral component and the acetabular cup (Figure 2). Moreover, once the surgeon has decided on the placements of the components, they can use the simulation capabilities to run virtual human body maneuvers based on the chosen parameters. The simulations will reveal force, contact stress, and motion predictions of the hip joint (Figure 3). The surgeon can then choose to modify the positions accordingly or proceed with the surgery. This new virtual surgical tool will allow surgeons to gain a better understanding of possible post-operative outcomes under pre-operative conditions or intra-operatively. Simulations using the virtual surgery model has revealed that improper component placement may lead to non-ideal post-operative function, which has been simulated using the model. Further evaluation is ongoing so that this new module can reveal more information pre-operatively, allowing a surgeon to gain ample information before surgery, especially with difficult and revision cases

Knee replacement is a proven and reproducible procedure to alleviate pain, re-establish alignment and restore function. However, the quality and completeness to which these goals are achieved is variable. The idea of restoring function by reproducing condylar anatomy and asymmetry has been gaining favor. As knee replacements have evolved, surgeons have created a set of principles for reconstruction, such as using the femoral transepicondylar axis (TEA) in order to place the joint line of the symmetric femoral component parallel to the TEA, and this has been shown to improve kinematics. However, this bony landmark is really a single plane surrogate for independent 3-dimensional medial and lateral femoral condylar geometry, and a difference has been shown to exist between the natural flexion-extension arc and the transepicondylar axis. The TEA works well as a surrogate, but the idea of potentially replicating normal motion by reproducing the actual condylar geometry and its involved, individual asymmetry has great appeal. Great variability in knee anatomy can be found among various populations, sizes, and genders. Each implant company creates their specific condylar geometry, or “so called” J curves, based on a set of averages measured in a given population. These condylar geometries have traditionally been symmetric, with the individualised spatial placement of the (symmetric) curves achieved through femoral component sizing, angulation, and rotation performed at the time of surgery. There is an inherent compromise in trying to achieve accurate, individual medial and lateral condylar geometry reproduction, while also replicating size and avoiding component overhang with a set implant geometry and limited implant sizes. Even with patient-specific instrumentation using standard over-the-counter implants, the surgeon must input his/her desired endpoints for bone resection, femoral rotation, and sizing as guidelines for compromise. When all is done, and soft tissue imbalance exists, soft tissue release is the final, common compromise. The custom, individually made knee design goals include reproducible mechanical alignment, patient-specific fit and positioning, restoration of articular condylar geometry, and thereby, more normal kinematics. A CT scan allows capture of three-dimensional anatomical bony details of the knee. The individual J curves are first noted and corrected for deformity, after which they are anatomically reproduced using a Computer-Aided Design (CAD) file of the bones in order to maximally cover the bony surfaces and concomitantly avoid implant overhang. No options for modifications are offered to the surgeon, as the goal is anatomic restoration. In summary, the use of custom knee technology to more closely reproduce an individual patient's anatomy holds great promise in improving the quality and reproducibility of post-operative function. Compromises of fit and rotation are minimised, and implant overhang is potentially eliminated as a source of pain. Early results have shown objective improvements in clinical outcomes. Admittedly, this technology is limited to those patients with mild to moderate deformity at this time, since options like constraint and stems are not available. Yet these are the patients who can most clearly benefit from a higher functional state after reconstruction. Time will reveal if this potential can become a reproducible reality

Introduction. Hoffa fractures are rare, intra-articular fractures of the femoral condyle in the coronal plane and involving the weight-bearing surface of the distal femur. Surgical fixation is warranted to achieve stability, early mobilisation and satisfactory knee function. We describe a unique type of Hoffa fracture in the coronal plane with sagittal split and intra-articular comminution. There is scant evidence in current literature with regards to surgical approaches, techniques and implants. We report of our case with a review of the literature. Case report. A 40 year old male motorcyclist was involved in a high speed road traffic collision. X-rays confirmed displaced unicondylar fracture of the lateral femoral condyle. CT showed sagittal split of the Hoffa fragment and intra-articular comminution. MRI showed partial rupture of the anterior cruciate ligament. The patient underwent definitive surgical treatment via a midline skin incision and lateral parapatellar approach using cannulated screws, headless compression screws and anti-glide plate. Weightbearing was commenced at 8 weeks. Arthroscopy and adhesiolysis was performed at 12 weeks to improve range of motion. The patient was discharged at one year with a pain-free, functional knee. Discussion. Hoffa fractures are high-energy fractures, often seen in young male motorcyclists with flexed and slightly abducted knee. Most papers recommend surgical fixation, however there is no widely accepted surgical method or rehabilitation regime. Varying surgical approaches, screw direction, choice of implants, and post-operative care have been described. Surgical approach depends on the configuration of the fracture. The medial/lateral parapatellar approach is commonly used as it does not compromise future arthroplasty, but it does not allow access to fix posterior comminution. Arthroscopic-assistance may be used with good outcomes and less tissue dissection. AP screws are widely reported in the literature, most likely due to easier access to the fracture site. PA screws may provide better stability, but access is more difficult. Fixation often involves passing screws through the articular surface, therefore the area damaged should be kept to a minimum by using the smallest possible screw; headless compression screws leave a smaller footprint in the articular cartilage. Locking plate augmentation generally gives good outcomes. Conclusion. Hoffa fractures are rare and difficult to treat. Surgical treatment is the best choice for optimum post-operative knee function. There is no consensus on choice of surgical approaches, techniques and implants, as these are dependent on fracture configuration. In this particular case we emphasise the importance of using an anti-glide plate to address the sagittal component. Despite the need for a secondary procedure, the treatment has had positive outcomes and may be used as a guide for treatment of future Hoffa fractures of a similar sub-type

Aims

The aims of this study were to examine the rate at which the positioning of the acetabular component, leg length discrepancy and femoral offset are outside an acceptable range in total hip arthroplasties (THAs) which either do or do not involve the use of intra-operative digital imaging.

Aims

The aims of this study were to determine the proportion of patients with outlier varus or valgus alignment in kinematically aligned total knee arthroplasty (TKA), whether those with outlier varus or valgus alignment have higher forces in the medial or lateral compartments of the knee than those with in-range alignment and whether measurements of the alignment of the limb, knee and components predict compartment forces.

Aims

The purpose of this study was to assess early physical function after total hip or knee arthroplasty (THA/TKA), and the correlation between patient-reported outcome measures, physical performance and actual physical activity (measured by actigraphy).

Knee replacement is a proven and reproducible procedure to alleviate pain, re-establish alignment and restore function. However, the quality and completeness to which these goals are achieved is variable. The idea of restoring function by reproducing condylar anatomy and asymmetry has been gaining favor As knee replacements have evolved, surgeons have created a set of principles for reconstruction, such as using the femoral transepicondylar axis (TEA) in order to place the joint line of the symmetric femoral component parallel to the TEA, and this has been shown to improve kinematics. However, this bony landmark is really a single plane surrogate for 3-dimensional medial and lateral femoral condylar geometry, and a difference has been shown to exist between the natural flexion-extension arc and the TEA. The TEA works well as a surrogate, but the idea of potentially replicating normal motion by reproducing the actual condylar geometry and its involved, individual asymmetry has great appeal. Great variability in knee anatomy can be found among various populations, sizes, and genders. Each implant company creates their specific condylar geometry, or “so called” J curves, based on a set of averages measured in a given population. These condylar geometries have traditionally been symmetric, with the individualised spatial placement of the (symmetric) curves achieved through femoral component sizing, angulation, and rotation performed at the time of surgery. There is an inherent compromise in trying to achieve accurate, individual medial and lateral condylar geometry reproduction, while also replicating size and avoiding component overhang with a set implant geometry and limited implant sizes. Even with patient-specific instrumentation using standard over-the-counter implants, the surgeon must input his/her desired endpoints for bone resection, femoral rotation, and sizing as guidelines for compromise. When all is done, and soft tissue imbalance exists, soft tissue release is the final, common compromise. The custom, individually made knee design goals include reproducible mechanical alignment, patient-specific fit and positioning, restoration of articular condylar geometry, and thereby, more normal kinematics. A CT scan allows capture of three-dimensional anatomical bony details of the knee. The individual J curves are first noted and corrected for deformity, after which they are anatomically reproduced using a Computer-Aided Design (CAD) file of the bones in order to maximally cover the bony surfaces and concomitantly avoid implant overhang. No options for modifications are offered to the surgeon, as the goal is anatomic restoration. Given these ideals, to what extent are patients improved? The concept of reproducing bony anatomy is based on the pretext that form will dictate function, such that normal-leaning anatomy will tend towards normal-leaning kinematics. Therefore, we seek to evaluate knee function based on objective assessments of movement or kinematics. The use of custom knee technology to more closely reproduce an individual patient's anatomy holds great promise in improving the quality and reproducibility of post-operative function. Compromises of fit and rotation are minimised, and implant overhang is potentially eliminated as a source of pain. Early results have shown objective improvements in clinical outcomes. Admittedly, this technology is limited to those patients with mild to moderate deformity at this time, since options like constraint and stems are not available. Yet these are the patients who can most clearly benefit from a higher functional state after reconstruction. Time will reveal if this potential can become a reproducible reality

Aims

The aim of the present study was to compare the 30- and 90-day re-admission rates and complication rates of outpatient and inpatient total shoulder arthroplasty (TSA).

Objectives

The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures.

Aims

To determine the effect of a change in design of a cementless ceramic acetabular component in fixation and clinical outcome after total hip arthroplasty

Aims

The most effective surgical approach for total hip arthroplasty (THA) remains controversial. The direct anterior approach may be associated with a reduced risk of dislocation, faster recovery, reduced pain and fewer surgical complications. This systematic review aims to evaluate the current evidence for the use of this approach in THA.

Background: Metal sensitivity following total joint arthroplasty (TJA) has been of increased concern, but the impact of a patient-reported metal allergy on clinical outcomes has not been investigated. The purpose of this study was to report the incidence and impact of patient-reported metal allergy following total knee (TKA) and total hip arthroplasty (THA). Methods: This was a retrospective, IRB-approved investigation of patients undergoing a primary, elective TJA between 2009 and 2011. All patients completed a pre-operative questionnaire asking about drug and environmental allergies. In January of 2010, a specific question was added regarding the presence of a metal allergy. UCLA Activity, SF-12, Modified Harris Hip (MHHS), and Knee Society (KSS) scores were collected pre-operatively and at most recent follow-up. Overall cohorts of metal allergy and non-metal allergy patients were compared and a 1:2 matching analysis was also performed. Results: 906 primary THAs and 589 primary TKAs were included. The incidence of patient-reported metal allergy was 1.7% before January 2010 and 4.0% after (overall 2.3% of THAs and 4.1% of TKAs). 97.8% of metal allergy patients were female. Following TKA, post-operative KSS function, symptoms, satisfaction, and expectation scores were all decreased in the metal allergy cohort (p<0.001 to 0.002). Following THA, metal allergy patients had a decreased post-operative SF-12 MCS score and less incremental improvement in their SF-12 MCS score versus the non-metal allergy cohort (p<0.0001 and p<0.001). Conclusion: Patient-reported metal allergy is associated with decreased functional outcomes following TKA and decreased mental health scores following THA

Knee replacement is a proven and reproducible procedure to alleviate pain, re-establish alignment and restore function. However, the quality and completeness to which these goals are achieved is variable. The idea of restoring function by reproducing condylar anatomy and asymmetry has been gaining favor. As knee replacements have evolved, surgeons have created a set of principles for reconstruction, such as using the femoral transepicondylar axis (TEA) in order to place the joint line of the symmetric femoral component parallel to the TEA, and this has been shown to improve kinematics. However, this bony landmark is really a single plane surrogate for 3-dimensional medial and lateral femoral condylar geometry, and a difference has been shown to exist between the natural flexion-extension arc and the TEA. The TEA works well as a surrogate, but the idea of potentially replicating normal motion by reproducing the actual condylar geometry and its involved, individual asymmetry has great appeal. Great variability in knee anatomy can be found among various populations, sizes, and genders. Each implant company creates their specific condylar geometry, or “so called” J curves, based on a set of averages measured in a given population. These condylar geometries have traditionally been symmetric, with the individualised spatial placement of the (symmetric) curves achieved through femoral component sizing, angulation, and rotation performed at the time of surgery. There is an inherent compromise in trying to achieve accurate, individual medial and lateral condylar geometry reproduction, while also replicating size and avoiding component overhang with a set implant geometry and limited implant sizes. Even with patient-specific instrumentation using standard over-the-counter implants, the surgeon must input his/her desired endpoints for bone resection, femoral rotation, and sizing as guidelines for compromise. When all is done, and soft tissue imbalance exists, soft tissue release is the final, common compromise. The custom, individually made knee design goals include reproducible mechanical alignment, patient-specific fit and positioning, restoration of articular condylar geometry, and thereby, more normal kinematics. A CT scan allows capture of three-dimensional anatomical bony details of the knee. The individual J curves are first noted and corrected for deformity, after which they are anatomically reproduced using a Computer-Aided Design (CAD) file of the bones in order to maximally cover the bony surfaces and concomitantly avoid implant overhang. No options for modifications are offered to the surgeon, as the goal is anatomic restoration. Given these ideals, to what extent are patients improved? The concept of reproducing bony anatomy is based on the pretext that form will dictate function, such that normal-leaning anatomy will tend towards normal-leaning kinematics. Therefore, we seek to evaluate knee function based on objective assessments of movement or kinematics. In summary, the use of custom knee technology to more closely reproduce an individual patient's anatomy holds great promise in improving the quality and reproducibility of post-operative function. Compromises of fit and rotation are minimised, and implant overhang is potentially eliminated as a source of pain. Early results have shown objective improvements in clinical outcomes. Admittedly, this technology is limited to those patients with mild to moderate deformity at this time, since options like constraint and stems are not available. Yet these are the patients who can most clearly benefit from a higher functional state after reconstruction. Time will reveal if this potential can become a reproducible reality