Seventy-six patients with primary knee osteoarthritis undergoing unilateral total knee arthroplasty without patellar resurfacing were randomized to receive either a mobile-bearing (MB) component (n=38) or a fixed-bearing (FB) component (n=38). The primary outcome was the incidence of anterior knee pain (AKP). Secondary outcomes included pain severity on VAS during specific activities, range of motion (ROM), Knee Society Scores (KSKS and KSFS), Forgotten Joint Score (FJS-12), and postoperative complications. Outcomes were assessed over an 18-month follow-up period. Overall, the results revealed no statistically significant difference in AKP incidence between MB and FB groups, but pain severity during functional activities was significantly lower in the MB group. These findings suggest that while MB inserts may not prevent AKP, they may reduce its severity.