109 patients scheduled for total knee arthroplasty were randomized to surgery with either the use of patient-specific cutting guides or conventional intra- and extramedullary guides. Patients were assessed for overall lower limb alignment, femoral component alignment in the coronal, sagittal, and axial planes, tibial component alignment in the coronal and sagittal planes, and patient-reported outcome measures and knee range of motion over a 2-year follow-up. Results demonstrated no statistically significant differences between groups in the rate of outliers (>3deg deviation from planned alignment) in any alignment comparison, or in any patient-reported outcome measure or range of motion over a 2-year follow-up.