3D-printed personalized osteotomy guides affect mid- to long-term efficacy of unicompartmental knee arthroplasty: mechanisms, evidence, and prospects

• 3D-printed personalized osteotomy guides significantly improve the accuracy of prosthesis placement in unicompartmental knee arthroplasty, reducing coronal and sagittal alignment errors compared to traditional techniques. • These guides improve lower limb alignment and prosthesis survival rates, while reducing mid- to long-term complications such as aseptic loosening, though they may have limitations in tibial rotational alignment and increased costs. • Compared to robotic-assisted surgery, 3D-printed guides offer a shorter learning curve and lower cost, but with slightly lower precision; long-term randomized controlled evidence is still lacking. • Future research should focus on multicenter long-term trials, integration of AI and intraoperative navigation, and real-world data to optimize patient selection and maximize long-term benefits.