Fourteen studies (7 randomized controlled trials and 7 non-randomized controlled trials) were included in this meta-analysis and systematic review examining the use of patient specific instrumentation in total knee arthroplasty. Studies were selected if they compared outcomes - including the incidence of outliers (>3 degree deviation from planned alignment), operative time, blood loss, and length of hospital stay - between surgery completed with PSI versus conventional instrumentation. Meta-analysis demonstrated no significant differences between PSI and conventional instrumentation in rate of outliers in mechanical axis or femoral component alignment, and rate of tibial component alignment outliers was significantly higher with PSI in both coronal and sagittal planes.