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Mina W Morcos,1 James L Howard,2 Brent Lanting,2 Steven MacDonald,2 Douglas Naudie,2 Richard McCalden,2 Edward M Vasarhelyi2 1Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; 2Division of Orthopaedic Surgery, Department of Surgery, Western University London Health Sciences Center University Hospital, London, ON, CanadaCorrespondence: Edward M VasarhelyiDivision of Orthopaedic Surgery, Department of Surgery, Western University London Health Sciences Center University Hospital, 339 Windermere Road, PO Box 5339, London, Ontario N6A 5A5, CanadaTel +1 519 663-3413Fax +1 519 663-3417Email edward.vasarhelyi@lhsc.on.caPurpose: The necessity of stemmed components when performing a varus-valgus constrained (VVC) primary total knee arthroplasty (TKA) is unclear. The purpose of this study is to compare the outcomes of primary VVC TKA with and without stems at a minimum of two years.Methods: Patients in our prospectively collected database with primary VVC TKAs were identified. Patient demographics, prosthesis data, time in vivo, characteristics of revision, and radiographs and PROMs were compared between the stemmed and un-stemmed cohorts.Results: Sixty-five patients with 69 primary VVC TKAs were identified; 17 were implanted with stems and 52 without stems. Five of the stemmed TKAs (5/17) required revision at 15.1 years, while only one of the un-stemmed TKA (1/52) required a revision at 21.6 years (p=0.003) for aseptic loosening. Of the 5 stemmed TKAs requiring revision, 3 were for aseptic loosening and 2 were for PPJI. The un-stemmed cohort had a significantly higher final total KSS (p=0.048).Conclusion: There was no increase in aseptic loosening or revision surgery in patients with non-stemmed primary VVC TKA compared to those with stemmed VVC TKA at mid-term follow-up. Utilizing non-stemmed TKA with VVC in appropriate cases is safe and may reduce cost, shorten operative time, and preserve bone-stock.Keywords: total knee arthroplasty, knee instability, stemmed implants, constraints