Eighty knees in forty patients with bilateral osteoarthritis were randomized to receive either cementless TKA (n=40) or cemented TKA (n=40). The primary outcome measured was the Forgotten Joint Score (FJS) for each knee. Secondary outcomes included the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, range of motion, pain levels, operative times, radiographic assessment, and any complications. Outcomes were monitored for a minimum of two years. Overall, the study found similar clinical and functional outcomes between cemented and cementless TKAs, although cementless patellar components exhibited a slight but stable migration without loosening. In conclusion, cementless TKA achieved comparable results to cemented TKA but raised concerns about patellar component migration, suggesting a cautious approach to cementless patellar resurfacing.