Total knee arthroplasty (TKA) remains one of the most successful and frequently performed orthopedic procedures. With an aging population and expanding indications, the demand for TKA is expected to rise dramatically. This highlights the increasing clinical and economic impact of TKA and the need to optimize implant selection, surgical efficiency, and patient outcomes. While cemented fixation has long been the gold standard in TKA, cementless fixation has gained popularity due to improved implant technology, biologic coatings with enhanced osseointegration. Current porous materials offer improved initial stability and long-term fixation. Over recent years, registry has supported comparable outcomes with cemented and cementless implants.