At the Knee Society meeting on March 13, 2010, in New Orleans, Louisiana, there were several papers discussing new techniques for performing knee replacement, including the use of custom-made guides based off preoperative MRI or CT scan, as well as robotically assisted surgical techniques for the placement of unicompartmental replacements. While all of these preliminary reports have been favorable, there remains concern over who will pay for the new technology. Customized cutting guides can cost $1,500 for their production. Robotically assisted surgery can require a machine that can cost anywhere from $750,000 to $1 million dollars. To date there has been no proof that these types of techniques or devices substantially improve the outcome or the durability. In an era of decreasing reimbursement, some of these newer technologies may prove challenging and may require the patient to pay for the increased cost. We are currently evaluating a customized cutting guide for total knee replacement called the Tru-Match system. We have done over 20 of these and the results to date have been very satisfactory. The patients enrolled in this study are not charged for the device as that is part of the inclusion in the study. We will await final results before further discussion of this with patients.