389 patients undergoing total knee arthroplasty were randomized to receive a tantalum cementless tibial component (n=135), a traditional modular cemented tibial component (n=135), or a hybrid monoblock component (n=126). The outcomes of interest included survivorship free of revision and survivorship free of reoperation, the risk of aseptic tibial loosening, the rate of non-progressive radiolucent lines, Knee Society Score (KSS) pain and function scores, and range of motion. Outcomes were assessed at 10 years post-operation. The results revealed no differences in survivorship free of revision and reoperation across the three groups. The risk of aseptic tibial loosening was significantly higher in the traditional group, with no cases in the hybrid monoblock and tantalum cementless groups. The rate of non-progressive radiolucent lines was also significantly higher in the traditional group. No differences in KSS pain, KSS function, or range of motion were observed.