Abstract
Total knee arthroplasty (TKA) is a maturing technology, and the focus for improvement
centers on optimizing patient satisfaction and further reducing revisions. It is commonly
assumed that achieving closer-to-normal knee mechanics in a TKA will result in further
improvement in outcomes and revision rates. Fixed-bearing TKA designs with asymmetric
pivoting articulations are designed to provide more natural joint stability and kinematics.
These designs have been used for more than 20 years and there is a substantial body
of literature characterizing their performance. This article reviews the various design
types of fixed-bearing pivoting TKA designs, and recounts their clinical, functional,
and patient-preference performance from peer-reviewed studies. To date, the evidence
suggests there is measurable benefit to providing closer-to-normal joint stability
and kinematics, and that fixed-bearing, pivoting TKA designs may decrease instability-related
revisions and improve patient satisfaction.
Keywords
total knee arthroplasty - implant design - kinematics - function - satisfaction
