Rationale and Results for Fixed-Bearing Pivoting Designs in Total Knee Arthroplasty

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.