Thirty-four total knee arthroplasties were performed for severe rheumatoid arthritis in 25 patients younger than 45 years. All patients were available for follow-up evaluation at an average of 7.2 years. According to the Knee Society scoring system, the knee score improved from an average of 21 points preoperatively to 85 points at follow-up (p < 0.001). The average functional score improved from 23 points to 87 points (p < 0.001). Average range of motion improved from 71 degrees to 93 degrees (p < 0.001). Nonprogressive radiolucencies less than 1-mm thick were observed in 6 knees. One knee was revised for severe polyethylene wear; another case was revised for chronic patellar dislocation. Actuarial survivorship analysis estimates a 97% survivorship after 5 years and 90% after after 10 years. In young rheumatoid patients, total knee arthroplasty can therefore be considered as a reliable procedure, with satisfactory results during at least the first 5 to 10 postoperative years.