The use of patient-specific instruments for total knee arthroplasty shifts computer navigation for bone landmark registration and implant positioning from the intraoperative to the preoperative setting. Each system requires preoperative MRI or CT, with specifications determined by the instrument manufacturer. The marketed advantages of patient-specific instruments include greater accuracy in coronal alignment with fewer outliers, no need for instrumentation of the intramedullary canal, reduced surgical time, lower hospital costs, and improved clinical outcomes. The few published results of these instruments suggest minimal gains obtained in hospital logistics variables and minimal evidence of improvement in either alignment or patient outcomes. Disadvantages of patient-specific instruments include increased costs for imaging and instrument fabrication as well as increased preoperative time required for surgical planning and reviewing the instrument plans, and the learning curve for the surgeon to work with the engineers and use these instruments intraoperatively. It is also necessary to have a set of standard instruments available in case the patient-specific instruments do not work properly. Additional data are required before deciding whether these instruments should be recommended.