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Updated: Dec 24, 2025

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Algorithm based automatic templating is less accurate than manual digital templating in total knee arthroplasty.

Thomas Seaver1, Kenneth McAlpine2, Enrique Garcia3

  • 1Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts.

Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society
|April 16, 2020
PubMed
Summary

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This summary is machine-generated.

Manual digital templating is more accurate than automatic algorithms for total knee arthroplasty (TKA) implant sizing. Automatic templating algorithms showed significantly lower accuracy in predicting correct implant sizes compared to manual methods.

Area of Science:

  • Orthopedic Surgery
  • Medical Imaging
  • Biomechanical Engineering

Background:

  • Accurate preoperative planning is crucial for successful total knee arthroplasty (TKA).
  • Digital templating aims to improve implant size selection accuracy.
  • Commercial automatic algorithms are increasingly used, but their accuracy requires validation against manual methods.

Purpose of the Study:

  • To compare the accuracy of a commercial automatic digital templating algorithm versus manual digital templating in TKA.
  • To assess the influence of patient race and calibration markers on templating accuracy.

Main Methods:

  • A study of 125 primary TKA patients.
  • Manual and automatic (auto-knee algorithm) digital templating were performed.
  • Intraoperative implant sizes were recorded and compared to templated sizes using Pearson χ2 test.
Keywords:
TKAaccuracyautomatic algorithmdigital templating

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Main Results:

  • Manual templating achieved accuracy within one size for femoral and tibial implants at 97.6% and 94.2%, respectively.
  • The automatic algorithm achieved similar accuracy at 51.2% and 71.2% for femoral and tibial implants.
  • Neither patient race nor the presence of a calibration marker affected templating accuracy.

Conclusions:

  • Manual digital templating demonstrates superior accuracy compared to the evaluated automatic algorithm for TKA.
  • Surgeons should exercise caution when relying solely on automatic templating algorithms due to lower accuracy.
  • Further research may be needed to improve automatic templating algorithm performance.