29 patients undergoing primary total knee arthroplasty (TKA) were randomized to receive either mechanically aligned patient-matched instrumentation TKA or standard surgical TKA. This study aimed to compare the accuracy and efficiency of the two TKA approaches by assessing pre- versus post-operative alignment, operative time, surgical incision length, blood loss, number of instrument trays used, tray set-up time, and hospital stay. Post-operative results indicated that the use of patient-matched instrumentation achieves superior mechanical alignment, while requiring less operative time and a shorter hospital stay compared to standard instrumentation. Furthermore, it was noted that no significant difference was found in intraoperative blood loss between groups.