To explore the application effect of three dimensional (3D) printed custom osteotomy guide combined with 3D animation guidance in total knee arthroplasty (TKA) for diabetic patients, and to evaluate its impact on postoperative motor function and clinical efficacy.

A prospective randomized controlled trial was conducted. Inclusion criteria: diabetes duration more than five years; knee osteoarthritis of Kellgren-Lawrence grade Ⅲ to Ⅳ; age from 50 to 75 years, body mass index (BMI) 20 to 30 kg/m²; glycated hemoglobin (HbA1c) ≤8.5%. Exclusion criteria: severe vital organs dysfunction; periarticular infection of the knee joint; history of knee surgery or joint deformity; psychiatric disorders or cognitive impairment; allergy to 3D printing materials. A total of 180 diabetic patients with end-stage knee osteoarthritis who met the inclusion criteria were enrolled. They were divided into the observation group (90 cases) and the control group (90 cases) by random number table. The control group underwent TKA using traditional metal osteotomy guides, while the observation group received TKA with 3D-printed custom osteotomy guides combined with 3D animation-assisted surgery and rehabilitation guidance. The two groups were compared by t test, repeated measurement analysis of variance or chi square test in terms of surgery-related indicators (operation time, intraoperative blood loss, incision length, incidence of complications), imaging indicators such as hip-knee-ankle angle (HKA) deviation, differences between prosthetic angles and preoperative planning, knee range of motion (ROM), walking and balance function, and pain visual analogue scale (VAS), Knee Society score (KSS), blood glucose fluctuation.

Regarding the discrepancy between prosthesis angles and preoperative planning, the observation group exhibited significantly lower deviations from preoperative planning in the femoral-tibial angle (FTA), femoral flexion-extension angle (FFE), tibial lateral condylar angle (LTC), and femoral lateral condylar angle (LFC) compared to the control group, with statistically significant intergroup differences (t=5.495,6.524,7.631,4.842, all P<0.01). Knee joint ROM comparison at different time points showed that ROM in both groups exhibited an upward trend over time at one week, one month, and three months after surgery, with statistically significant temporal effects (F=428.615, P<0.001). ROM in the observation group was significantly higher than that in the control group at all the time points, with statistically significant intergroup effects (F=106.932, P<0.001). There was an interaction effect between group and time, with the observation group demonstrating superior ROM improvement (P<0.001). Three months after surgery, the observation group achieved longer distances on the six-minute walk test (6MWT) and shorter durations on the timed standing-up-walking test (TUGT) compared to the control group, with statistically significant intergroup differences (t=11.567,10.892, all P<0.001). The Berg balance scale (BBS) score in the observation group was significantly better than that in the control group (Z=-4.826, P<0.001).

Three dimensional-printed custom osteotomy guide combined with 3D animation guidance can improve the surgical accuracy of TKA in diabetic patients, reduce trauma and complications, promote postoperative motor function recovery, and enhance clinical efficacy, providing an optimized "surgery-rehabilitation" integrated solution for this population.