Two hundred ten patients with end-stage knee osteoarthritis were randomized to receive medial pivot (MP-TKA; n = 101), rotating platform (RP-TKA; n = 57), or posterior stabilized (PS-TKA; n = 52) total knee arthroplasty. The primary outcome of interest was anteroposterior (AP) stability measured at 30°, 60°, and 90° of knee flexion. Secondary outcomes included various patient-reported outcome measures (PROMs), such as EQ-5D, KOOS, OKS, and Kujala scores. Outcomes were assessed at baseline and one year postoperatively. Overall, the results of the study revealed that MP-TKA showed significantly better AP stability at early (30°) and mid-flexion (60°) angles compared to PS- and RP-TKA, though these differences did not translate into improved PROMs. The study suggests that while MP-TKA enhances biomechanical stability, this may not meaningfully impact perceived functional outcomes at one year.