Two hundred twenty-four patients with knee osteoarthritis were randomized to receive different tibial baseplate fixation methods during total knee arthroplasty (TKA). The patients were assigned to three groups: Group 1 received a cemented tibial component (n=97), Group 2 received a pegged porous cementless tibial component (n=87), and Group 3 received a cementless tantalum monoblock porous tibial component (n=90). The primary outcome of interest was survivorship, and secondary outcomes included functional measures such as the Oxford Knee Score, Knee Society Score, and radiological data. Outcomes were assessed up to 10 years post-operatively. The results indicated that, irrespective of tibial fixation method, the overall survivorship was excellent at 99.6%. One knee in Group 2 with cementless fixation and screws required revision for aseptic loosening at 3 years, resulting in a cumulative survivorship of 88% at the end of 10 years. Functional outcomes showed no statistically significant differences between groups. Additionally, radiological outcomes, including zonal osteolysis and the development of radiolucent lines, were similar in all three groups.