This systematic review and meta-analysis identified 14 trials, which included 926 evaluable total knee arthroplasties. These studies examined the effect of hydroxyapatite (HA)-coating on tibial implant durability in primary total knee arthroplasty (TKA), in comparison other forms of tibial fixation. The primary outcomes in the selected studies were durability, function, and acute adverse events. Results indicated that the functionality between the types of implants were comparable, but durability with the HA-coated tibial implant may be better than other tibial implants in patients >65 years. There were no differences in adverse events between HA coated implants and other forms of tibial fixation.