One hundred fifty-three patients with severe knee osteoarthritis undergoing primary total knee arthroplasty (TKA) were randomized to receive medialized anatomic (MA) (n=47), medialized dome (MD) (n=44), or Gaussian dome (GD) (n=48) patellar components. The primary outcome of interest was the postoperative Kujala score at two years. Secondary outcomes included the Knee Society Scores (KSKS and KSFS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), range of motion, and radiographic parameters such as patellar tilt angle (PTA) and Blackburne-Peel ratio. Outcomes were assessed at 1 month, 3 months, 1 year, and 2 years postoperatively. Overall, the results revealed no significant differences in clinical scores, complications, or range of motion between the three groups. However, the GD group had a higher proportion of outliers in PTA, but this was not clinically significant. The findings suggest that an anatomic patellar design does not offer clinical superiority over dome designs in TKA.