Thirty patients with end-stage knee osteoarthritis underwent bilateral robotic-assisted total knee arthroplasty and were randomized to receive functional alignment (n=30 knees) or mechanical alignment (n=30 knees). The primary outcome of interest was postoperative joint line orientation relative to the floor. Secondary outcomes of interest included ankle joint line orientation, clinical outcomes (Forgotten Joint Score, KOOS, range of motion), patient satisfaction, and soft tissue release rates. Outcomes were assessed at 1, 3, and 6 months postoperatively. Overall, the results of the study revealed that functional alignment resulted in a knee joint line more parallel to the floor, less need for soft tissue release, higher functional scores, and greater patient satisfaction. These findings suggest that functional alignment in robotic TKA may offer improved biomechanical and clinical benefits over mechanical alignment.