50 patients scheduled for total knee arthroplasty were randomized to the procedure completed with either patient-specific instrumentation (PSI) or conventional instruments. Patients were assessed for clinical scores, component migration on radiostereometric analysis, operative time, surgical resource consumption and waste production, and overall cost per patient. PSI was associated with no significant differences compared to conventional instruments for clinical scores or migration after 6 months but did demonstrate significantly greater total cost per patient when compared to conventional instruments.