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Background: Knee arthritis in the young patient is a challenging problem that may necessitate surgical treatment. We continue to perform hemiarthroplasty with a metallic tibial implant in selected young patients who, for various reasons, are not candidates for osteotomy, unicompartmental arthroplasty, or total knee arthroplasty. The purpose of the present study was to determine the minimum twelve-year results of this procedure in young patients.Methods: The original study group consisted of a consecutive series of twenty-four patients (twenty-six knees) who were managed with McKeever tibial hemiarthroplasty for the treatment of unicompartmental osteoarthritis of the knee. All patients were younger than sixty years of age at the time of the index procedure (average age, 44.6 years). During the study period, two patients died and one was lost to follow-up, leaving twenty-one patients (twenty-three knees) available for review. All patients were followed clinically for a minimum of twelve years or until revision. Knee Society knee and functional scores and Tegner scores were determined, and seven of the ten implants were evaluated radiographically.Results: Thirteen knees were revised at an average of eight years after the index procedures. All thirteen knees had an uncomplicated revision to either a unicompartmental arthroplasty or total knee arthroplasty. Ten retained implants were available for clinical review after an average duration of follow-up of 16.8 years. The mean Knee Society knee scores, functional scores, and Tegner scores, available for nine of these ten knees, were 80, 97, and 4.2, respectively.Conclusions: We believe that the McKeever tibial hemiarthroplasty continues to be a reasonable surgical option for patients who are not candidates for osteotomy and are too young or too active for a unicompartmental or total knee arthroplasty.Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.