The ten year results of a prospective randomized controlled trial are reviewed. This study enrolled 100 patients undergoing primary total knee arthroplasty (TKA) between May 2010 and February 2012 and randomized them to cemented fixation or cementless fixation using a modular trabecular metal tibial tray. At ten years, 91 patients had known outcomes, including 67 patients who achieved a minimum ten-year clinical follow-up and were included in the per-protocol analysis (36 cemented, 31 cementless). The relevant outcomes included Knee Society Scores (KSS) (clinical and functional) and Oxford Knee Scores (OKS). Other outcomes included implant survivorship, radiographic findings, and revision indications. Outcomes were assessed preoperatively and at 2, 5, and ≥10 years postoperatively. Overall, the results demonstrated no statistically significant differences between cemented and cementless cohorts in Knee Society Scores, Oxford Knee Scores, or implant survivorship at ten years. Cemented fixation was associated with a higher incidence of progressive osteolysis and loosening, whereas cementless fixation demonstrated stable osseointegration with little radiolucency occurrences.