Introduction: Bicruciate-retaining total knee arthroplasty (BCR TKA) results in kinematics closer to the native knee and in greater patient satisfaction but information concerning its outcome and complications is lacking. The goal of this study is to report the clinical and radiological outcomes of BCR prothesis implanted using a spacer-based gap balancing technique and to assess if some preoperative factors are associated with a worse prognosis. Methods: A cohort of 207 knees in 194 patients who underwent BCR TKA, with a minimum one-year follow-up, was retrospectively analyzed. Patients were followed at six weeks, six months, one year, and then every following year post-operatively, and filled questionnaires (Knee Society and KOOS) at every visit. Clinical and radiological assessments included ROM, knee alignment, pain, and complications as defined by the Knee Society’s Standardized list and definition of Complication of Total Knee Arthroplasty. Results: Forty-three knees (20.8%) suffered major complications. Twenty-one knees (10.1%) underwent revision at an average of 32.1 months after the index procedure. Revision-free survival at 100 months was 85.7%. Revision was performed for aseptic tibial loosening in eight knees (3.9%) and stiffness in five knees (2.4%). There were twenty-nine reoperations other than revision (14.0%), the most frequent procedure being manipulation under anesthesia (MUA) in 14 knees (6.8%). Minor complications included tendonitis (20.8%), persistent synovitis (6.8%), and superficial wound infections (6.3%). All outcomes scores were greatly improved at the one-year follow-up compared to preoperatively (p<0.001). However, maximum flexion at the last follow-up was significantly reduced compared to preoperatively (mean maximum flexion ± standard deviation: 119.9 ± 15.6 vs 129.9 ± 14.4, p<0.001). Aseptic tibial loosening was associated with a hypercorrection in varus of preoperative valgus knees (p=0.012). Conclusion: BCR TKA can give functional results similar to other types of protheses but involves a substantial risk of complications. Important factors that can explain failed BCR TKA and guide its use were identified, more particularly knee alignment and its role in aseptic tibial loosening.