This walkthrough takes you through the Total Knee Replacement (TKR) demo case from start to finish: creating the case, reviewing segmentation, planning the femur and the tibia, designing the guides and approving the case. Each step has a short animation so you can follow along on your own screen.
The demo uses a sample scan and runs only in your browser session, so you can try anything without affecting real cases.
Note: Demo cases have no Save button. Your progress is kept in your current browser session only, and approving a demo case does not use a case from your organization's case allowance.
The steps at a glance
Open the demo and create the case.
Review the segmentation.
Plan the femur: Landmarks, Surgery Planning and PSI Design.
Add the tibia and plan it the same way.
Approve the case and review the plan report.
1. Open the demo
On the home page, find Create New Case.
On the Total Knee Replacement card, click Demo in the top-left corner.
The demo opens on the case creation page with the sample scan already loaded. The Segmenting... bar at the top shows simulated segmentation progress while you fill in the case.
2. Create the case
Under Surgery Details, check the sample Surgery Date, the Alignment (Mechanical) and the Operational Side. The side is set by the sample scan. Click Next.
Under Case Details, the Case Output Configuration is Plan and PSI.
Click Create Case in the top-right corner. CustoMED downloads the scan files and opens Segmentation.
3. Review the segmentation
Segmentation shows the 3D model and the CT scan in four views: 3D, Axial, Coronal and Sagittal. The panel on the right lists the segmented bones: Patella, Talus, Fibula, Tibia and Femur, each on the operating side.
Hover a bone in the list to show its eye button, which hides or shows that bone.
Scroll over a CT view to move through the slices. The bone outlines follow each slice.
Use the tools above the list to pan, zoom or change the brightness and contrast (window level) of the CT views.
Drag in the 3D view to rotate the leg.
When the bones look right, click Confirm.
4. Find your way around the editor
After segmentation, the editor opens on the femur. A few controls stay the same in every step:
The icons on the left switch between Femur view, Tibia view and Combined view. Combined view shows the whole leg and the Hip-Knee-Ankle Angle (HKA). It is available on Landmarks. To confirm a step, switch back to a single bone.
Click the step name in the header (for example Landmarks) to open the step menu. It lists every step, and completed steps have a check mark.
The back arrow next to the main button returns to the previous step.
Drag the Internal / Surrounding slider at the top of the 3D view to fade the bone and show the CT scan around the model. Drag it back to Internal to hide the scan again.
Click the arrow on the right edge of the 3D view to show or hide the CT projections (Axial, Coronal and Sagittal) next to the model.
Use Sagittal, Coronal and Axial under the 3D view to jump to a standard viewing angle.
5. Femur: Landmarks
CustoMED places the femur landmarks for you. Review them before you plan.
Check Pre-Op Measurements: Femoral Mechanical-Anatomical Angle (FMAA), mLDFA, External Rotation and Whiteside AP Axis To (TEA and PCA). Some names follow the direction of the value, so you may see mLDFA Valgus or mLDFA Varus, for example.
Expand Femur to see the landmark groups: Anatomical Axis, Knee Joint Line, Trans Epicondylar Axis (TEA) and Posterior Condylar Line, plus Trochlea Center and Notch Center. Expand a group and click a landmark, such as Anatomical Proximal or Lateral Epicondyle, to select it in the 3D view.
Click Confirm Landmarks. CustoMED creates the surgery plan and opens Surgery Planning.
6. Femur: Surgery Planning
Check Post-Op Measurements: FMAA, mLDFA, Flexion, Internal TEA, External PCA, and the lateral and medial Distal Resection (mm) and Posterior Resection (mm).
Use the minus and plus buttons next to a measurement to change it. The femoral component moves to match, and the resection values update.
Expand the femoral component card to change the implant: Manufacturer, Sets, Type and Size, then click Select Template. The card also lists the cutting planes, cutting blocks and K-wires. Click a row to select it in the 3D view.
With the card open, use the dials around the model (Flexion, Rotation and Varus/Valgus) to turn the component one step at a time.
Click Generate PSI.
7. Femur: PSI Design
Look at the guide
Zoom in and rotate the model to look at the femoral guide from every side.
Open the PSI type list (it shows Femoral Surgical Guide) to see the guide types available for this implant.
Check the parts and confirm
Expand Psi to see the guide parts: Psi, Locking K-Wire, Left Distal Leg, Right Distal Leg and Cutting Blade. Click a part to select it in the 3D view.
Click Confirm PSI. CustoMED prepares the export files and opens Approve.
8. Add the tibia
Approve shows the output pack. At this point it holds the femur plan and its PSI, and the tibia is marked Not planned. The main button reads Sign off while a bone is not planned, and Approve Case once every bone is in the pack.
Use the arrows on the preview to step through the plan and PSI previews.
Click Add Tibia. The editor opens on the tibia Landmarks step.
9. Tibia: Landmarks
Review the measurements and landmarks
Check Pre-Op Measurements: MPTA, Posterior Slope and Internal Proximal Rotation.
Expand Tibia to see the landmarks: Anatomical Axis (Anatomical Proximal and Anatomical Distal), Tibial Slope, Lateral Plateau Center, Medial Plateau Center and First Third Medial Tuberosity.
Adjust the tibial slope plane
Click Tibial Slope to select the plane. Dials appear around the model: Flexion, Rotation and Varus/Valgus.
Click a dial arrow to turn the plane one step. Posterior Slope updates with each click. Click the opposite arrow to turn it back.
Check the points and confirm
Click a point, such as Medial Plateau Center or First Third Medial Tuberosity, to select it.
Use Sagittal and Axial under the 3D view to check the landmarks from the side and from above.
Click Confirm Landmarks.
10. Tibia: Surgery Planning
Adjust the measurements
Check Post-Op Measurements: MPTA, Slope, Internal Proximal Rotation and the lateral and medial Proximal Resection (mm).
Use the minus and plus buttons to change a value. The slope name follows its direction, so it reads Anterior Slope or Posterior Slope.
Switch between Pre-Op and Post-Op at the top of the panel to compare the bone before and after the planned cut.
Check the implant and generate the guide
Expand the tibial tray card. Open Size to see the available sizes. To change the implant, pick new values and click Select Template.
Use the Rotation dial on the left of the model to turn the tray one step at a time.
The card also lists the Cutting Plane, the tibial bearing, the cutting block and its K-wires.
Click Generate PSI.
11. Tibia: PSI Design
Look at the guide
Zoom in and rotate the model to look at the tibial guide.
Open the PSI type list (it shows Tibial Surgical Guide) to see the guide types available for this implant.
Check the parts and confirm
Expand Psi to see the guide parts, including the locking and anterior K-wires and the Cutting Blade.
Click Confirm PSI.
12. Approve the case
Check that Output Pack 1 lists both Tibia and Femur, each with its PSI Output.
Step through the previews and expand Files to see the Delivery Note, the Case Files and the Plan Report (SFU).
Click Approve Case.
Read the Responsibility Acknowledgment and click Approve & Acknowledge.
CustoMED then creates the plan report. A Generating Plan Report... bar shows the progress. Keep the tab open until it finishes.
13. After approval
The header shows Approved, and the main button changes to View Only (Approved Case).
The plan report preview appears next to the pack. Use its arrows to turn pages, or click Preview to open the full Plan Report (SFU).
Under Files, preview the Plan Report (SFU) and the Delivery Note, or download the Case Files.
That's the whole TKR workflow. When you're ready, create a real case from the same Total Knee Replacement card.