One hundred fourteen patients with knee osteoarthritis were randomized to receive either a posterior cruciate-retaining (PCR; n=61) or posterior-stabilizing (PS; n=53) implant design in a 12-year double-blind randomized controlled trial. The primary outcome of interest was prosthesis survival, and secondary outcomes included clinical measures such as Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form Health Survey (SF-36), Kujala score, patient satisfaction and radiological assessments. Outcomes were assessed up to an average follow-up of 12.1 years. Overall survival rate was 95.6%, with no significant differences in clinical and radiological outcomes between PCR and PS designs. Of note, in the PS group, 90% of patients (n = 18) were content with the TKA, while in the PCR group, 80% (n = 20) expressed contentment (P = 0.358). Thus, PCR and PS implant designs in TKA provided similar survivorship at 12 years, as well as comparable quality of life, function, knee pain, patient satisfaction, and radiographic outcomes.