Seventy-two patients with knee osteoarthritis were randomized to receive a cementless 3D-printed cruciate-retaining tibial component (n=36) or a cemented cruciate-retaining tibial component (n=36). The primary outcome was maximum total point motion (MTPM) of the tibial component at 5 years. Secondary outcomes included progression of migration between 2 and 5 years, the proportion of continuously migrating implants, and patient-reported outcomes (KSS, KOOS, FJS). Follow-up assessments were performed at baseline, 3 months, 1, 2, and 5 years. Overall, the results revealed no significant difference in mean MTPM between cementless and cemented groups at 5 years. Progression of migration occurred in the cemented group beyond 2 years, whereas the cementless implants stabilized after early migration. Clinical outcomes were comparable between groups. These findings suggest that cementless 3D-printed tibial components achieve stable fixation after an initial settling phase, performing as well as cemented implants over 5 years.