50 patients scheduled for total knee arthroplasty were randomized to have the procedure completed with the use of either patient-specific instruments (PSI) or conventional instruments. Patients allocated to the PSI group underwent preoperative MRI for manufacturing of the instruments. Patients were assessed for intraoperative parameters related to resource utilization, while follow-up at 6 months was used to assessed component migration on radiosterometric analysis and patient-reported outcome measures. Total cost per procedure was also calculated. No significant differences between groups in RSA or PROM results were obtained at 6 months. Overall, cost per procedure increased by over $1700.00 when using PSI versus conventional instruments.