Ninety-eight patients with advanced knee osteoarthritis were randomized to receive total knee arthroplasty with either CT-based patient-specific instrumentation (n=54) or MRI-based patient-specific instrumentation (n=44). The primary outcome was mid-term survival of the prosthesis, and secondary outcomes included patient-reported outcome measures (PROMs) like the Oxford Knee Score, WOMAC, and the Forgotten Joint Score. Outcomes were assessed over a mean follow-up period of 5.8 years. Overall, the study found no significant differences in survival rates between the two groups. Clinical outcomes were comparable, except for the EQ-5D-VAS, which significantly favored the MRI group. These findings suggest both modalities are effective and result in satisfactory outcomes.