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Researchers are evaluating two types of total knee replacement surgeries for patients with knee osteoarthritis: functionally aligned robotically assisted total knee arthroplasty and patient-specific custom made total knee arthroplasty. The study aims to determine which approach provides better clinical outcomes, higher patient satisfaction, and improved operating room efficiency. Patients will be followed for two years after surgery to assess these factors. Participants will receive either a custom made total knee implant from Symbios or a functionally aligned implant using the Triathlon total knee system with the MAKO Rio Robotic Arm. Both procedures involve total knee replacement but use different technologies and alignment philosophies. The study will compare these two devices and surgical methods directly. During their participation, patients will undergo clinical and radiographic evaluations before and after surgery, including CT scanning of the affected limb. Researchers will measure clinical outcomes using the Forgotten Joint Score at 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively. The study will also monitor patient satisfaction and surgical efficiency over the two-year follow-up period.