The integrity and strength of the posterior cruciate ligament (PCL) in the rheumatoid knee are known to be suboptimal. However, the results of PCL-substituting total knee arthroplasty in rheumatoid patients are not well documented. We reviewed 86 PCL-substituting total knee arthroplasties in 52 rheumatoid patients with grade IV or V radiographic disease. The mean age at surgery was 41.9 years. All patients underwent follow-up evaluation for an average of 7.8 years. Revision was performed for 1 knee because of aseptic loosening of the tibial component, and for 3 knees because of deep infection. An isolated insert exchange was performed on one knee. Using revision of any component for aseptic loosening or radiographic loosening as the end point, the mean 10-year survival rate was 94.0%.