Fifty-five patients scheduled for a total knee arthroplasty were randomized to receive implant positioning with patient-specific instrumentation (PSI) or conventional instrumentation. Outcomes of interest included radiographic alignment outcomes, EQ-5D-3L scores, EQ-5D Visual Analog Scale (VAS) scores, Oxford Knee Scores (OKS), Pain Catastrophizing Scale scores, VAS pain scores, VAS satisfaction scores, UCLA activity scores, operative time, length of hospital stay, and the incidence of complications. Follow up was performed up to 2 years post-operation. Results revealed a significantly favourable tibial sagittal angle in the PSI group compared to the conventional group. 1 year post-operation, the improvement in EQ-VAS scores was significantly greater in the conventional group, however baseline scores were significantly lower in the conventional group compared to the PSI group. Otherwise, no significant differences were observed between the PSI and conventional groups.