In a prospective study, we evaluated the adaptive bone remodelling pattern of the distal femur using dual energy X-ray absorptiometry (DEXA) after total knee arthroplasty (TKA). Eleven patients underwent TKA with insertion of an Interax total knee system (Howmedica) because of primary osteoarthrosis of the knee. All patients received an uncemented femoral component with an uncoated cast-mesh ingrowth surface. The components had a 20-mm long central peg placed anteriorly just behind the anterior flange. DEXA scans were performed postoperatively at 2 weeks and at 3, 6, 12 and 24 months in the mediolateral plane of the distal femur and in the anteroposterior plane of the distal tibia and fibula. Compared to the immediate 2-week postoperative bone mineral density (BMD) value, we found no significant changes in BMD in 4 regions of interest (ROI) in the distal femur during the 2-year follow-up at 3 months. A temporary but significant decrease in BMD of 11.2% (95% CL, -17.3% to -5.0%) was observed in the most distal ROI just posterior to the fixation peg. Bone mineral content (BMC) of the distal tibia and fibula showed no significant changes in the operated and contralateral legs during the follow-up. The adaptive bone remodelling of the distal femur after TKA using an uncemented femoral component not previously examined by DEXA induced only a very limited and temporary loss of bone mineral.