15 studies including 1101 patents with knee osteoarthritis were included in this systematic review and meta-analysis comparing medial pivot (MP) and posterior-stabilized (PS) total knee arthroplasty (TKA) designs. Pooled outcomes of interest included range of motion (ROM), Knee Society Score (KSS), Knee Society Function Score (KSFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS), Veterans RAND 12 (VR-12) Item Health Survey, Timed Up & Go (TUG) test, mean walking speed (MWS), length of stay (LOS), radiographic alignment, and complication rates. The pooled results demonstrated that MP knees showed comparable ROM with PS design 1, 2, and 4 years postoperatively, with no statistical difference found in patient-reported outcome measures (PROMs), MWS, LOS, radiographic alignment, and complication rates between the two groups. The meta-analysis concluded that the theoretical biomechanical advantage of MP implants does not translate into superior clinical outcomes compared to the traditional PS knees.