14 randomized controlled trials (1367 patients) comparing an all-polyethylene tibial (APT) component against a metal-backed tibial (MBT) component for total knee arthroplasty (TKA) were included in this systematic review and meta-analysis. Outcomes of interest included Knee Society Function Scores (KSFS), Knee Society Knee Score (KSKS), range of motion in knee flexion, stair climbing test, femoral component varus-valgus (VV) malalignment, internal-external (IE), and anterior-posterior (AP) rotation, maximum implant subsidence, and the incidence of complications and revision. The APT group showed significantly better stair climb outcomes and maximal implant subsidence with lower rates of revision at 5 years. MBT, on the other hand, resulted in significantly better AP and IE rotation and lower VV malalignment. APT may be a potential alternative for TKA compared to MBT.