Orthopedic 3D Planning Software Compared (2026)

Key takeaways

No single orthopedic 3D planning platform wins on every axis, and the field has split into distinct categories. Cleared, cloud-native automation is led by Formus Labs (FDA-cleared automated total hip planning, partnered with Zimmer Biomet) and AlgoSurg (Y Combinator-backed, OEM white-label 3D planning and PSI). Cleared, procedure-specific specialists include CustomSurg/OrthoPlanner (software-only browser fracture planning) and Bodycad (personalized osteotomy plating). Measurement, not planning, is the domain of ImageBiopsy Lab (FDA-cleared 2D knee-OA grading and leg-alignment measurement). Established digital templating remains PeekMed, mediCAD, and TraumaCad. Engineering-grade segmentation is Materialise Mimics; free research flexibility is 3D Slicer and Presurgeo/SkeletonPlanner for osteotomy. Robotic systems such as Mako (Stryker) are a separate, capital-heavy, implant-tied category (covered separately). Within the newest browser-based, client-side category, Salnus is positioned around automated CPAK coronal-plane alignment, multiligament-knee PSI, and zero-upload processing, currently Research Use Only (RUO), not a cleared device. For surgeons, the right choice depends on three questions: is it cleared for your procedure, where does patient data go, and does it fit your existing DICOM workflow without a separate upload step.

Why Comparison Matters in 2026

Preoperative planning has moved from acetate templates to AI-assisted 3D reconstruction (see our 2026 planning guide). But the market is now crowded, and the platforms differ less in whether they do 3D planning than in how they handle segmentation accuracy, data governance, regulatory clearance, and clinical workflow.

Surgeons evaluating tools rarely get a like-for-like comparison. Vendor pages highlight strengths and omit trade-offs. This article compares the leading options on the axes that actually affect clinical use, with sources, and is explicit about what each does well and where it falls short. A newer angle that increasingly separates tools is alignment philosophy: whether a planner works only in the classic mechanical-alignment frame or can express a patient's native coronal phenotype through the CPAK classification introduced by MacDessi and colleagues.

The Comparison at a Glance

Regulatory status changes; verify current clearance for your jurisdiction and procedure before clinical use.

Platform by Platform

Formus Labs

A New Zealand company that received FDA 510(k) clearance for Formus Hip, described as the first automated radiological image-processing software for hip-replacement preoperative planning. It combines AI and computational biomechanics to go from scan to a 3D plan automatically, marketed as "under an hour," and it is partnered with Zimmer Biomet for global commercialization. This is a genuine milestone: cleared, automated, cloud-based THA planning. The trade-offs are the server-side model (imaging is processed in the cloud, with the attendant KVKK/GDPR/HIPAA obligations) and, at least initially, close alignment to a specific implant system rather than a broadly implant-agnostic layer. (Formus Labs, FDA clearance coverage)

AlgoSurg

A Y Combinator-backed company building AI software for 3D surgical planning, patient-specific instrumentation and implant design, and robotics/AR integration. Its Tabplan3D product is a cloud-based planner, and notably it also offers X-ray-to-3D reconstruction (Tabplan3D/X3DPSI) as an alternative to CT-based modeling. AlgoSurg's differentiator is its OEM/white-label positioning: its technology is licensed by implant manufacturers, 3D-printing companies, and robotic-navigation providers. The trade-off is that it is delivered largely as an embedded, cloud-based B2B platform rather than a surgeon-facing standalone, and clearance status varies by module and region. (AlgoSurg, AlgoSurg on Y Combinator)

CustomSurg / OrthoPlanner

A Swiss company whose OrthoPlanner is a software-only, browser-based fracture-planning tool that received FDA 510(k) clearance in 2025; its patient-specific bone-fracture reconstruction technology also holds FDA Breakthrough Device Designation. It takes CT imaging and produces a step-by-step surgical plan for orthopedic trauma surgeons. This is the closest architectural cousin to a browser-native planner, but it is procedure-focused on trauma/fracture fixation and remains server-side (imaging is uploaded for processing). (CustomSurg OrthoPlanner, Swiss medtech clearance coverage)

Bodycad

A Canadian company that received FDA 510(k) clearance for BC Fine Osteotomy, described as a personalized planning-and-plating system for osteotomies around the knee. It pairs proprietary planning software with a 3D-printed patient-specific guide and a custom plate, indicated for open- and closed-wedge osteotomies of the distal femur and proximal tibia. Bodycad is a cleared, hardware-plus-software osteotomy specialist; the trade-off versus a pure planning layer is that the value is bundled with Bodycad's own plates and guides (a "procedure in a box"), not an implant-agnostic planning tool. (Bodycad BC Fine Osteotomy clearance, ORTHOWORLD coverage)

ImageBiopsy Lab

An Austrian company whose products are best understood as measurement, not planning. KOALA (Knee Osteoarthritis Labeling Assistant) is FDA-cleared and automatically scores Kellgren-Lawrence grade and minimum joint-space width from knee radiographs; LAMA (Leg Alignment Measurement Assistant) is FDA-cleared for automated length and angle measurements on full-leg X-rays. The portfolio is backed by a large body of publications. These are strong, cleared quantitative-imaging tools, but they report on 2D radiographs and do not perform CT-native 3D surgical planning or implant positioning. (FDA clearance for LAMA long-leg measurements, IB Lab KOALA)

Presurgeo / SkeletonPlanner

A Netherlands-based developer whose SkeletonPlanner automates 3D skeletal-image analysis and quantitative 3D surgical planning from CT, with a focus on osteotomy and deformity correction. It targets the same automated-3D niche as several tools above, is cloud/server-based, and surgeons should verify current regulatory status for their jurisdiction and procedure. (Presurgeo SkeletonPlanner)

Ortoma

A CE-marked, cloud-based platform focused on total hip and knee arthroplasty. It generates a suggested plan (segmentation, landmarks, implant size and position) in minutes, which the surgeon validates and fine-tunes. Its strength is regulatory clearance plus clinical validation in arthroplasty. The trade-off is the server-side model: imaging is processed in the cloud, creating data-processing obligations under KVKK, GDPR, and HIPAA. (Ortoma)

Materialise Mimics

The long-established reference for engineering-grade segmentation, widely used for patient-specific instrumentation and implant design. Segmentation is semi-automated and fully editable, which matters because automated output occasionally misses anatomy or includes artifacts. Mimics offers medical (regulated) variants. The trade-off is cost and workflow weight: it is a dedicated application, not an in-workflow step. A comparative study of 3D segmentation tools for hip planning places Mimics among the accuracy benchmarks.

3D Slicer

Free, open-source, and extraordinarily flexible, the workhorse of academic imaging research. With plugins (including deep-learning segmentation extensions) it can match much of what commercial tools do. The trade-offs: it is Research Use Only, the learning curve is steep, and there is no vendor accountability or clinical support. Ideal for building and validating pipelines, not for routine clinical throughput.

Enhatch

Positions itself as an AI-native cloud planning platform, automating segmentation and implant templating across joints. Cloud architecture enables heavy server-side processing without local hardware; the same trade-off as Ortoma applies: imaging is uploaded to external infrastructure.

PeekMed

One of the most established dedicated orthopedic digital-templating platforms, spanning 2D and 3D planning across trauma, arthroplasty, and deformity correction. Its strength is maturity and regulatory clearance (CE and FDA) plus a large preset implant library and broad society-level adoption. The trade-offs are the server-side/cloud model and a templating-first design centered on implant sizing and positioning rather than CT-native volumetric segmentation depth. (PeekMed)

mediCAD

A long-established digital-planning and templating platform, strong across Europe, spanning 2D templating and a dedicated 3D module. Its strengths are a very large implant library (hundreds of manufacturers), deep regulatory maturity (CE/MDR and MDSAP), and broad hospital adoption. Its heritage is templating-first; the 3D module adds volumetric planning, but the everyday workflow is 2D radiograph-based, and it is a licensed installed or server product rather than a zero-footprint browser tool. (mediCAD)

TraumaCad (Brainlab)

One of the most widely deployed 2D digital-templating systems, covering trauma, arthroplasty, and deformity correction, with automated calibration and a large template library, now part of Brainlab. Its strength is maturity and ubiquity in templating workflows and PACS integration. The trade-offs mirror the other incumbents: it is 2D-templating-centric, with limited CT-native volumetric depth, and it is server or cloud based.

Kinomatic

A US venture-backed entrant building CT-based preoperative planning for knee and hip arthroplasty, paired with a patient-facing pathway/concierge model. Processing is cloud-based and automated. As with other server-side platforms, imaging is processed off-device. Its focus is arthroplasty, with the planning bundled into a broader patient-experience offering. As an early-stage company, verify current regulatory status.

Mako (Stryker)

Not a pure planning tool but a CT-based robotic-arm system that executes a preoperative plan intraoperatively. It is the most clinically entrenched robotic platform for arthroplasty, but it is capital-intensive (a hardware purchase) and tied to the Stryker implant ecosystem. Software-only planning tools are complementary rather than directly competing; we discuss this distinction in Mako and complementary AI planning.

Salnus (browser-based, client-side)

Salnus is a browser-based tool in which DICOM parsing, multiplanar reconstruction, and AI inference run entirely on-device, so no patient imaging leaves the machine. It uses Cornerstone3D for GPU-accelerated reconstruction and ONNX Runtime Web (with an nnU-Net-style segmentation approach) for automated CT bone segmentation. Two things distinguish its positioning. First, it is CPAK-forward: rather than defaulting to mechanical alignment, it aims to compute coronal-plane alignment in the CPAK frame (arithmetic HKA and joint-line obliquity) so the plan reflects native phenotype. Second, it extends into multiligament-knee PSI: the founding team's controlled laboratory study in Orthopaedic Journal of Sports Medicine (2026) showed that 3D-printed patient-specific guides reduced femoral-tunnel convergence in anatomic multiligament reconstruction (see our summary), an application area not addressed by the arthroplasty and osteotomy tools above and connected to our ligament-planning research.

It is implant-agnostic and vendor-neutral, which is useful to OEMs who do not want a planner tied to a competitor's catalog. Because processing is client-side, the honest capability is "scan to plan in minutes, client-side," meaning there is no upload-and-wait round trip to a cloud queue. That is a data-governance and workflow claim, not a cleared-performance benchmark: the honest trade-off is computational headroom, since on-device inference cannot match a cloud GPU cluster for the heaviest full-volume tasks. Critically, and unlike Formus Labs, CustomSurg, Bodycad, or ImageBiopsy, Salnus is currently Research Use Only (RUO) and in pilot; it is not a cleared medical device. For clinical use today, the cleared incumbents are the appropriate choice.

The CPAK and Ligament-PSI Angle

Most planners in this list were built around mechanical alignment or implant templating, and most target arthroplasty or fracture. Two adjacent problems are comparatively underserved.

The first is native coronal phenotype. MacDessi and colleagues' CPAK classification reconstructs a knee's prearthritic alignment from arithmetic HKA and joint-line obliquity and sorts it into nine phenotypes, with only a minority of knees truly neutral. A planner that reports CPAK directly makes it easier to plan toward a patient's constitutional alignment rather than forcing every knee to neutral mechanical. Some incumbents measure alignment (ImageBiopsy's LAMA quantifies leg-alignment angles on X-ray) or plan in the mechanical frame, but automated, CT-native CPAK output in the planning step itself is still uncommon.

The second is multiligament-knee reconstruction. The osteotomy specialists (Bodycad, Presurgeo) and the arthroplasty planners (Formus, Ortoma, Kinomatic) do not target ligament-tunnel geometry, where the risk is femoral-tunnel convergence in anatomic reconstruction. This is the specific problem the OJSM controlled laboratory study addressed with 3D-printed guides. It is a narrow, evidence-backed niche rather than a broad platform claim, and it is where Salnus's research heritage sits.

Neither angle makes Salnus "better" than a cleared incumbent for cleared indications. They describe a different, and currently RUO, part of the map.

The Three Questions That Actually Decide It

1. Is it cleared for your procedure?

A tool cleared for hip arthroplasty (Formus) is not automatically cleared for osteotomy (Bodycad) or trauma (CustomSurg). Regulatory status is procedure-specific. Research Use Only tools (3D Slicer, Salnus today) are valuable for evaluation and research but should not drive clinical decisions without appropriate validation and clearance for the jurisdiction and procedure.

2. Where does patient data go?

Server-side platforms (Formus, AlgoSurg, CustomSurg, Bodycad, Ortoma, Enhatch, Kinomatic, ImageBiopsy) upload imaging to the cloud: powerful, but creating data-processing obligations. Local installs (Mimics, Slicer) keep data on-premises at the cost of hardware and IT. Client-side browser tools (Salnus) keep data on the device entirely. For independent surgeons and clinics without a dedicated IT/governance team, this difference is often decisive.

3. Does it fit your DICOM workflow?

A DICOM-native tool reads pixel spacing and slice thickness automatically, so measurements are physically calibrated, not pixel-estimated. A tool that requires a separate upload-and-wait step adds friction that, in practice, determines whether a tool gets used after the first month.

How to Choose: A Quick Decision Matrix

Map your dominant need to the category, then apply the three questions above:

No category wins outright. The cleared automation players (Formus, CustomSurg, Bodycad, ImageBiopsy) own their cleared indications today; the differentiators for a newer, still-RUO tool are CPAK-native output, ligament-PSI research, data governance, and workflow friction.

Where AI Helps, and Where It Doesn't

Across all these platforms, the evidence is consistent: AI reliably accelerates bone segmentation and geometric measurement, reducing hours of manual work to minutes and lowering inter-observer variability. What AI does not do is replace surgical judgment, and surveys reflect this: roughly 91% of orthopedic surgeons expect AI to act as a complementary tool rather than a replacement (Frontiers, 2025). Platforms that present themselves as autonomous decision-makers, rather than as the surgeon's second pair of eyes, should be approached with caution.

FAQ

Which orthopedic 3D planning software is FDA-cleared? Among the tools here, Formus Labs (hip planning), CustomSurg/OrthoPlanner (fracture planning), Bodycad (knee osteotomy), and ImageBiopsy Lab (KOALA and LAMA, measurement) hold FDA clearances, and PeekMed, TraumaCad, and Mako are cleared in their categories. Salnus is Research Use Only and in pilot; it is not a cleared device. Always verify current clearance for your jurisdiction and procedure.

What is the difference between Formus Labs and Salnus? Formus Hip is an FDA-cleared, cloud-based, automated hip-arthroplasty planner partnered with Zimmer Biomet, so imaging is processed server-side. Salnus is a browser-based, client-side tool (imaging stays on the device) positioned around CPAK alignment and multiligament-knee PSI, and it is currently RUO, not cleared. They serve different indications and maturity stages.

Which tool computes CPAK alignment? CPAK (arithmetic HKA plus joint-line obliquity, from MacDessi and colleagues) is an alignment classification, not a single product. ImageBiopsy's LAMA reports leg-alignment angles on X-ray, and several planners work in the mechanical frame. Automated, CT-native CPAK output inside the planning step is still uncommon; Salnus is positioned around it, on an RUO basis.

Do I have to upload patient scans to the cloud? For most cleared planners (Formus, CustomSurg, Bodycad, Ortoma, Kinomatic) and for ImageBiopsy, yes: they are server-side. Browser-based client-side tools such as Salnus process imaging on your device with no upload, which simplifies KVKK/GDPR/HIPAA obligations, but Salnus is RUO.

Can AI replace the surgeon in planning? No. Current evidence and surgeon consensus treat AI as augmentation. It automates measurement and segmentation; the surgical strategy remains the surgeon's.

What are the alternatives to Formus Labs, CustomSurg, or Mako? For cleared hip planning, Ortoma and PeekMed are comparators to Formus; for fracture planning, CustomSurg is the software-only leader; Mako is a robotic system tied to one implant ecosystem and a capital purchase. The emerging research-stage alternative for surgeons who want no upload, no install, and an implant-agnostic, CPAK-forward tool is a client-side browser platform such as Salnus, which is RUO today. Match the choice to your procedure's regulatory requirement, your data-governance capacity, and your existing DICOM workflow.

The Takeaway

There is no universal best. Match the tool to the procedure (regulatory fit), your data-governance capacity (where data lives), and your workflow (DICOM-native, low-friction). For cleared clinical use today, the automation incumbents (Formus Labs, CustomSurg, Bodycad, ImageBiopsy) and the mature templating platforms lead. For privacy-first, CPAK-forward, implant-agnostic research and pilot work without cloud upload, client-side browser tools such as Salnus are the emerging, still-RUO alternative.

Explore the Salnus Surgeon Portal →

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Disclaimer: This article is for educational and research purposes only. Salnus tools are designated for Research Use Only (RUO) and are not cleared medical devices. Mention of third-party products is for educational context only and does not imply endorsement or comparison of clinical equivalence. Clinical decisions should be made by qualified physicians, and regulatory status should be independently verified for your jurisdiction.

References:

• Cirdi YU, Serteser B, Mavi A, Ergun S, Akgun U. 3D-Printed Patient-Specific Guides Reduce Femoral Tunnel Convergence in Anatomic Knee Multiligament Reconstruction: Controlled Laboratory Study. Orthopaedic Journal of Sports Medicine, 2026. DOI 10.1177/23259671261417360.
• MacDessi SJ, et al. Coronal Plane Alignment of the Knee (CPAK) classification: a new system for describing knee phenotypes. Bone & Joint Journal, 2021.
• Formus Labs wins FDA clearance for AI-powered orthopedic surgery planning. MassDevice, 2023.
• AlgoSurg Inc company profile. Y Combinator.
• Swiss medtechs expand regulatory clearances (CustomSurg OrthoPlanner). Startupticker, 2025.
• Bodycad Gains FDA Clearance for BC Fine Osteotomy. ORTHOWORLD.
• FDA clears ImageBiopsy Lab software for automated measurements on long-leg radiographs (LAMA). PR Newswire, 2023.
• Presurgeo SkeletonPlanner product page.
• Comparison of Three 3D Segmentation Software Tools for Hip Surgical Planning. PMC, 2022.
• AI and multimodal imaging in orthopaedics: from technological advances to clinical translation. Frontiers in Medicine, 2025.