摘要Background: The conventional method cannot guarantee the precise osteotomies required for a perfect realignment and a better prognosis after total knee arthroplasty (TKA).This study investigated a customized guide plate for osteotomy placement in TKAs with the aid of the statistical shape model technique using weight-bearing lower-extremity X-rays and computed tomography (CT) images of the knee.Methods: From October 2014 to June 2015, 42 patients who underwent a TKA in Guizhou Provincial People's Hospital were divided into a guide plate group (GPG, 21 cases) and a traditional surgery group (TSG, 21 cases) using a random number table method.In the GPG group, a guide plate was designed and printed using preoperative three-dimensional measurements to plan and digitally simulate the operation.TSG cases were treated with the conventional method.Outcomes were obtained from the postoperative image examination and short-term follow-up.Results: Operative time was 49.0 ± 10.5 min for GPG, and 62.0 ± 9.7 min in TSG.The coronal femoral angle, coronal tibial angle, posterior tibial slope, and the angle between the posterior condylar osteotomy surface and the surgical transepicondylar axis were 89.2 ± 1.7°, 89.0 ± 1.1°, 6.6 ± 1.4°, and 0.9 ± 0.3° in GPG, and 86.7 ± 2.9°, 87.6 ± 2.1°, 8.9 ± 2.8°, and 1.7 ± 0.8° in TSG, respectively.The Hospital for Special Surgery scores 3 months after surgery were 83.7 ± 18.4 in GPG and 71.5 ± 15.2 in TSG.Statistically significant differences were found between GPG and TSG in all measurements.Conclusions: A customized guide plate to create an accurate osteotomy in TKAs may be created using lower-extremity X-ray and knee CT images.This allows for shorter operative times and better postoperative alignment than the traditional surgery.Application of the digital guide plate may also result in better short-term outcomes.