OBJECTIVE To compare the complication rates associated with total knee arthroplasty against the types of fixation (hybrid or cemented), using a single total knee design (the anatomic modular knee [AMK] prosthesis). METHODS A prospective, nonrandomized, controlled trial. METHODS University Hospital in London, Ont., a tertiary care teaching centre. METHODS Two groups made up of 484 knees in 395 patients (89 bilateral). METHODS In 260 knees a hybrid configuration (cemented tibia and noncemented femur) was used (group 1). In 224 knees the femoral and tibial components were cemented (group 2). All patellae were cemented in both groups. METHODS Clinical results were assessed by The Knee Society Clinical Rating Scores at 3 months, 6 months and yearly intervals. Radiographic results were determined by 3-foot standing radiographs and at each follow-up visit standing knee radiographs, lateral and skyline views. Radiographs were analysed for alignment, presence or absence of radiolucent lines or changes in the position of the implant. All reoperations and nonoperative complications were recorded. RESULTS At an average follow-up of 4.8 years, 8 knees (1.6%) required reoperation. An analysis of the complications leading to reoperation demonstrated no difference between the 2 groups. CONCLUSIONS There was no difference in outcome whether the femoral component was cemented or not. Medium-term results of the AMK are excellent with a very low reoperation rate.