One hundred thirty-two patients undergoing total knee arthroplasty were randomized intra-operatively to receive either a rotating-platform (RP) mobile-bearing prosthesis (n=68) or a fixed-bearing (FB) prosthesis (n=72). The primary outcome of interest was implant survival. Secondary outcomes included patient satisfaction, range of motion (ROM), and complications requiring revision. Outcomes were assessed over a minimum follow-up period of 20 years. Overall, the results of the study revealed no significant differences between RP and FB inserts in terms of ROM, implant survival, or patient satisfaction. The findings suggest that while both FB and RP inserts are viable, durable options for TKA, RP inserts did not provide a long-term clinical advantage over FB inserts.