Cement remains the "gold standard" for fixation in total knee arthroplasty. Between 1991 and 1998, 128 consecutive knees in 109 patients underwent primary cemented total knee arthroplasty using a surface cementation technique. The average follow-up was 95 (range, 63-155) months. Preoperative range of motion (ROM) averaged 5 degrees to 111 degrees which improved to 1 degrees to 116 degrees postoperatively. Modified Hospital for special surgery score (HSS) scores improved from 61 (range, 47-76) to 97 (range, 81-100) and the corresponding Knee Society Scores from 122 (range, 94-152) to 195 (range, 162-200). No osteolytic lesions were found; however, 3 tibias had radiolucent lines which were asymptomatic, nonprogressive, and not associated with implant failure. The average depth of penetration of cement was 2.7 mm. One knee (1%) required revision surgery for femoral loosening, and 1 required revision of the polyethylene liner. The present cementation technique provides excellent durable results at midterm follow-up.