116 patients scheduled for total knee arthroplasty were randomized to receive either a cruciate-substituting, highly congruent implant or a posterior-stabilized implant. Surgical data, such as tourniquet and blood loss, were recorded, and patients were followed up for 5 years for clinical and radiographic outcomes, as well as mechanical adverse events. No significant differences between groups were observed in clinical or radiographic outcomes. The incidence of mechanical clicking, clunking, and catching was significantly lower in the CS highly congruent group compared to the PS group.