50 patients scheduled for total knee arthroplasty were randomized to bone resection completed with the use of either the iAssist handheld navigation guide or standard intra- and extramedullary instruments. Patients were assessed for coronal alignment of components, and overall mechanical axis, on postoperative radiographs. Results demonstrated no significant difference in mean positions of femoral and tibial components between groups, but a lower incidence of component malalignment, defined as deviation exceeding 3 degrees from neutral, in the iAssist group compared to the conventional group.