The purpose of this study was to quantify the effect of sex on the clinical outcome and survivorship of a total knee arthroplasty (TKA) with clinical and radiographic follow-up. Seven thousand three hundred twenty-six primary AGC (Biomet, Warsaw, Ind) cruciate-retaining TKAs were performed from 1987 to 2004. Of these, 59.5% were performed on women. We examined preoperative and postoperative Knee Society knee score, function scores, pain scores, walking ability, stair-climbing ability, flexion, and implant survivorship based on sex. Female sex was associated with lower overall preoperative clinical scores for all parameters (P < .01). Improvement in Knee Society knee score and flexion was greater for women (P = .006), and there were equal pain relief and walking improvements for both sexes (P < .32). Stair and function score improvements were greater for men (P = .002). Implant survival was 98% for women and men at 15 years (P = .4684). We conclude that improvement after TKA is similar for men and women, with few clinically significant differences. Sex-specific implants would appear to offer no clinical advantage.