Two hundred forty-four patients undergoing total knee arthroplasty were randomized to receive functional alignment (n=123) or mechanical alignment (n=121) using robotic-arm assisted technology. The primary outcome of interest was the Forgotten Joint Score (FJS) at one year. Secondary outcomes included patient satisfaction, net promoter score, rates of manipulation under anesthesia, patient-reported outcomes (Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, EuroQol-5Dimensions, and Pain Visual Analog Scale), range of motion, length of stay, and implant survivorship. Outcomes were assessed at six months and one year. Overall, the results revealed no significant difference in FJS between groups at one year (p=0.5). However, FA patients reported a higher net promoter score at six months (p=0.01) and lower rates of manipulation under anesthesia. These findings suggest functional alignment with robotic-assisted TKA offers comparable outcomes to mechanical alignment, with potential benefits in early patient satisfaction and fewer post-operative manipulations.