215 patients undergoing total knee arthroplasty (TKA) were randomized to receive one of two knee implants to compare differences in the incidence of anterior knee pain (AKP), while also assessing their natural progression in this population. At 10 year follow-up, there was a reduction in the incidence of AKP in both groups when compared to 1st year postoperative measures. It was observed that persistent pain occurred in about 30% of patients who reported AKP at 1 year; whereas, 10% of a symptomatic patients reported pain for the first time at the 10 year follow-up.