AIM: This study aimed to evaluate the short- and long-term outcomes and complications of total knee arthroplasty (TKA) using posterior-stabilized (PS) and cruciate-retaining (CR) prosthesis in patients with osteoarthritis (OA) and valgus knee deformity. METHODS: A retrospective analysis was conducted on 200 patients with OA and valgus knee deformity who underwent TKA between February 2021 and November 2023. The cohort was divided into the PS group (n = 108) and the CR group (n = 92). Clinical outcomes, including Range of Motion (ROM), Hospital for Special Surgery (HSS) knee score, and Visual Analog Scale (VAS) score, were assessed at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Pre- and postoperative valgus angles were measured, and the incidence of complications was recorded. RESULTS: Both groups exhibited significant postoperative improvements in ROM, HSS scores, and VAS scores compared to preoperative (p < 0.001). The CR group demonstrated superior early postoperative outcomes, with higher HSS scores, greater ROM, and lower VAS scores at 1 week, 1 month, and 3 months (p < 0.001). However, no significant differences were observed between the groups at 6 months and 1 year (p > 0.05). Radiographic analysis indicated effective correction of valgus angles in both groups postoperatively (p < 0.001), with no significant intergroup differences (p > 0.05). The complication rate was significantly lower in the CR group compared to the PS group (p < 0.05). CONCLUSIONS: CR and PS prostheses effectively correct valgus deformity, alleviate pain, and improve knee function. However, the CR prosthesis offers advantages in reducing early postoperative pain, swelling, and complications, facilitating faster functional recovery. The selection of the appropriate prosthesis based on patient-specific characteristics is critical to optimizing TKA outcomes.