PSI in orthopaedics Market Size, Share, Growth, Trends, and Global Industry Analysis: By Joint Type (Knee, Hip, Shoulder, Spine, and Ankle), By Imaging Modality (MRI-based PSI and CT-based PSI), By Application (Primary Joint Replacement, Revision Surgery, Osteotomies, Tumor Resection, and Others), and Region Forecast 2020-2031

PSI in orthopaedics Market size was valued at US$ 1,739.4 million in 2024 and is projected to reach US$ 2,829.8 million by 2031 at a CAGR of 7.2% from 2025-2031. Patient?specific instrumentation (PSI) refers to custom?designed surgical guides and tools—typically 3D?printed based on CT or MRI scans tailored to a patient’s unique anatomy to improve surgical accuracy in orthopaedic procedures like total knee arthroplasty.

Demand for precision-guided orthopaedic surgery has fueled interest in PSI, particularly for total knee arthroplasty (TKA). Surgeons value PSI for its potential to reduce operative steps, limit intramedullary drilling, and provide alignment matching patient anatomy. PSI often shortens surgical time slightly (by around 4?min) and reduces perioperative blood loss, while minimizing instrument tray usage especially helpful in high-volume or remote settings. Early studies also suggested fewer alignment outliers in femoral components using MRI?based systems, which may aid less experienced surgeons.

However, PSI faces significant hurdles. Meta-analyses show that while mechanical axis alignment sometimes improves, the tibial component alignment may actually be worse risking up to ~30% higher outlier rates. Clinical outcomes like function scores and complication rates remain statistically equivalent to conventional instrumentation (CI) at mid?term follow?up. Additional burdens include MRI or CT scan costs, planning time, and backup instruments in about 10% of cases. As a result, routine use of PSI remains limited, especially given inconsistent clinical benefits.

Facts & Figures

• Studies show PSI can reduce total surgical time by approximately 4–5 minutes per case, on average.
• Blood loss during TKA using PSI is reduced by 30–50 mL, with some variation based on surgical technique.
• MRI-based PSI demonstrates higher femoral alignment accuracy, while CT-based PSI may lead to 30% higher tibial component outliers.
• In about 10% of surgeries, backup conventional instrumentation is still required even when PSI is used.

Key Developments

• In May 2024, Zimmer Biomet announced the expansion of its ROSA Knee robotic platform with enhanced PSI compatibility, enabling more precise bone resections and improved surgical planning for personalized knee alignment.
• In March 2024, Stryker introduced a software update in its Mako SmartRobotics™ platform, integrating patient-specific surgical plans into hybrid workflows for hip and knee replacements.
• In January 2024, Materialise NV launched a cloud-based PSI planning solution optimized for orthopaedic clinics in emerging markets, providing remote planning capabilities using AI-assisted segmentation.
• In October 2023, Conformis Inc. began commercial distribution of its new iTotal PSRT system—a posterior-stabilized, patient-specific knee implant designed to enhance joint mechanics and personalization in TKA.

PSI in orthopaedics Market Segmentation

Based on the joint type

• Knee
• Hip
• Shoulder
• Spine
• Ankle

Knee arthroplasty remains the most widely adopted procedure using PSI, particularly in total knee replacement (TKA). PSI allows for preoperative customization of cutting blocks and bone alignment, based on a patient’s unique femoral and tibial anatomy. MRI is often preferred in knee procedures to capture cartilage contours, improving rotational and coronal alignment. The technology is especially helpful in kinematic alignment techniques that seek to restore native joint kinematics rather than impose a generic mechanical axis. With growing demand for patient-centered outcomes, PSI in TKA is positioned as a bridge between conventional surgery and full robotic systems, especially in outpatient or mid-volume settings.

Based on the imaging modality

• MRI-based PSI
• CT-based PSI

MRI-based PSI systems are favored for their ability to capture both bony landmarks and cartilage surfaces, which are critical for accurate femoral guide construction. This is particularly useful in kinematic alignment techniques, where soft tissue preservation and natural joint lines are emphasized. MRI-based PSI also avoids radiation exposure and offers superior accuracy in younger or active patients. However, it’s more expensive and prone to image artifacts. Despite this, surgeons adopting kinematic workflows often prefer MRI-based PSI for its anatomical fidelity, especially when used with cloud-based surgical planning platforms that allow simulation of various implant positions and resections.

Based on the application

• Primary Joint Replacement
• Revision Surgery
• Osteotomies
• Tumor Resection
• Others

Primary joint replacement—particularly in total knee arthroplasty (TKA) is the most common application of PSI in orthopaedics. It involves the use of preoperative MRI or CT scans to create patient-specific cutting blocks and alignment guides tailored to the patient's anatomical structure. This approach helps surgeons execute precise bone resections and restore mechanical or kinematic alignment more accurately. PSI offers potential benefits in operative consistency, reduced intraoperative instrumentation, and decreased surgical time, especially when implanting knee and hip prostheses. While large-scale studies have shown that functional outcomes are not significantly better than conventional techniques, PSI remains valuable in cases where standard alignment techniques are difficult due to anatomical anomalies or deformities. It is especially beneficial in minimally invasive joint surgeries or outpatient joint programs.