Eight randomized controlled trials with a total of 1,123 patients undergoing a primary total knee arthroplasty for osteoarthritis or rheumatoid arthritis were included in this meta-analysis comparing cemented and cementless fixation. Outcomes of interest included implant survival, Knee Society knee, function, and pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion, incidence of radiolucent lines, and maximum total point motion. Included studies had a minimum follow-up of 8.8 years. Meta-analysis results revealed no significant difference between the two groups in implant survival, clinical scores, or range of motion. However, the incidence of radiolucent lines was significantly lower in the cementless group, whilst maximum total point motion was significantly lower in the cemented group.