112 adults with advanced osteoarthritis who were scheduled to undergo primary uncemented total knee arthroplasty (TKA) were randomly allocated to computed tomography (CT)-based patient-specific instrumentation (PSI) or conventional instrumentation. Radiographic evaluation was performed 12 months postoperatively, and findings revealed no statistically significant differences in coronal or sagittal implant positioning between techniques, except in the frontal tibial component angle (FTC). Patients in the conventional group experienced better FTC than patients in the PSI group.