Does the medial pivot knee improve the clinical and radiographic outcome of total knee arthroplasty? A single centre study on two hundred and ninety seven patients

Int Orthop. 2020 Feb;44(2):291-299. doi: 10.1007/s00264-019-04462-3. Epub 2019 Dec 21.


Purpose: Total knee arthroplasty (TKA) is a cost-effective surgery with a survival rate higher than 90% after 15 years. Nevertheless, patients are unsatisfied in more than 15% of cases. Medial pivot (MP) prosthetic designs were introduced in late 90's with the aim to reproduce natural knee kinematics. The purpose of this study is to evaluate the survivorship and clinical outcomes of a novel design of MP knee with a minimum follow-up of five years.

Methods: This is a retrospective review of all patients who underwent primary TKA using the K-Mod dynamic congruence implant (Gruppo Bioimpianti, Peschiera Borromeo, Milan, Italy) between 2012 and 2013 at a single institution. A total of 339 patients (351 knees) were included with a mean age of 74 years (range 41-89). The Knee Society score, the global range of movement, the Western Ontario and McMaster Universities Osteoarthritis score, Forgotten Joint score, and the short-term form 12 health survey were collected. FJS and SF-12 were collected only post-operatively. Radiographic outcomes were evaluated according to the Knee Society's roentgenographic evaluation system. Kaplan-Meyer (KM) curves were performed to evaluate implant survivorship. A two-tailed paired t test was performed to evaluate the differences between pre-operative and post-operative score.

Results: A total 297 patients (315 knees) were available for clinical and radiographic analysis, and the mean follow-up was 66.4 months. A total of 17 patients (17 knees 5.4%) experienced a post-operative complication, and a reoperation was performed in five patients (5 knees 1.6%). Four patients had a periprosthetic joint infection, and two patients had a post-traumatic periprosthetic femoral fracture. The KM survivorship at five years was 98.2% (95% CI 0.96 to 0.99) for revision for any reason. There was a statistically significant improvement (p < 0.05) in all the objective and subjective outcomes measured.

Conclusion: The K-Mod dynamic congruence design has shown an excellent clinical, radiographic, and patient-reported outcome in primary TKAs.

Keywords: Dynamic congruence; K-mod; Knee kinematic; Medial pivot; Total knee arthroplasty.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Arthroplasty, Replacement, Knee* / methods
  • Biomechanical Phenomena
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Diseases / diagnostic imaging
  • Joint Diseases / physiopathology
  • Joint Diseases / surgery*
  • Knee Joint / diagnostic imaging
  • Knee Joint / physiopathology
  • Knee Joint / surgery*
  • Knee Prosthesis*
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Prosthesis Design
  • Range of Motion, Articular
  • Retrospective Studies
  • Treatment Outcome