Enhancing Surgical Efficiency and Radiological Outcomes Through Advances in Patient-Specific Instrument Design.

: Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) uses preoperative three-dimensional imaging to create cutting blocks tailored to patient anatomy. However, there is debate regarding the additional benefits of PSI in terms of improved alignment or functional outcomes compared to using conventional instruments. Although PSI design has undergone continuous development, the improvements have not been incorporated. Therefore, the aim of this study was to compare the surgical time and radiological outcomes between advanced-design PSI and conventional instruments. : We conducted a retrospective review of 328 patients who underwent primary TKAs using PSI for osteoarthritis and compared them with 328 matched patients who underwent TKA performed with conventional instruments during the same period (March 2023 to August 2024). We compared the surgical time and component alignment between the advanced-design PSI group and the conventional instrument group. : The average surgical time was significantly shorter in the advanced-design PSI group (47.6 ± 12.4 min) compared to the conventional instrument group (59.2 ± 14.2 min, < 0.05). The advanced PSI design group had a significantly lower occurrence of outliers in hip-knee-ankle alignment (7%) compared to the conventional instrument group (36.3%). This trend was also observed in femoral coronal alignment, tibial coronal alignment, and femoral sagittal alignment. : The use of advanced-design PSI demonstrated significantly reduced surgical time and improved alignment compared to conventional instruments. This highlights that proper design is a key factor for PSI to achieve superior biomechanical effects. Our study shows that advanced-design PSI technology has the potential to replace conventional instruments in TKA, though further research is required to determine its clinical outcomes and economic benefits.