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The use of polymethylmethacrylate bone cement in joint replacement surgery is not without drawbacks. Certain hazards have been appreciated and the bone cement interface may not be as stable in the long run as was once felt. This paper reports the results in 52 knees which were replaced using the uncemented ICLH (Imperial College/London Hospital) tibial component; the average follow up was two years (range six months to four years). The results were compiled with regard to pain as well as clinical examination and X-ray evaluation. The results were comparable to those achieved in knees replaced using bone cement. Roentgenographic evaluation revealed no evidence of loosening nor sinkage of any of these prostheses. Considerations in the development of a knee prosthesis to be utilized without bone cement and the operative technique employed to implant such a prosthesis are presented. The merits of such a system are discussed.