Background: Kinematic alignment (KA) in total knee arthroplasty (TKA) replicates individual knee joint line orientation and physiological soft tissue balance. There are limited data on the effect of KA on survivorship compared with other methods of implanting a TKA. The aim of this study was to compare the survivorship of the same design of TKA implanted with either patient-specific instrument (PSI) KA or with computer-assisted surgery and conventionally instrumented. Methods: We performed an observational study of data from 2 national joint registries on all patients who underwent a TKA with a Triathlon cruciate-retaining TKA (Stryker, Mahwah, NJ) from January 2011 to December 31, 2013. The outcomes of knees performed with unrestricted KA using patient-specific instrument were compared with computer-assisted surgery and conventionally instrumented Triathlon cruciate-retaining TKA. The principal outcome measure was time to first revision using Kaplan-Meier estimates of survivorship. Cox proportional hazard ratios, adjusted for age and gender, were used to compare the 2 groups. Results: There were 20,512 TKA procedures recorded, of which 416 were performed using KA-PSI. The KA-PSI group was younger (66.8 ± 8.2 vs 68.3 ± 9.2, P = .001), with an identical gender distribution. The cumulative revision rate at 7 years was 3.1% for the KA-PSI Triathlon cohort and 3.0% for the other Triathlon TKA cohort (P = .89). The most common reasons for revision in the KA-PSI group were maltracking, patella erosion, and arthrofibrosis. Conclusion: Kinematically aligned Triathlon TKA using PSI has similar revision rate as all other Triathlon TKA.