Long-Term Follow-Up of Medial Pivot Total Knee Arthroplasty: A Systematic Review of the Current Evidence

Total knee arthroplasty (TKA) is a popular treatment for end-stage knee osteoarthritis. Advances in understanding knee biomechanics have led to the development of medial pivot (MP) prostheses, which aim to replicate natural knee kinematics. While short- and mid-term studies have shown favorable outcomes for MP-TKA, long-term follow-up studies are limited. This systematic review aims to analyze the available evidence on long-term outcomes of MP-TKA, including survivorship, complications, and patient-reported outcome measures (PROMs). A comprehensive search was conducted in PubMed, Embase, and Cochrane Database of Systematic Reviews for English language studies reporting long-term outcomes of primary MP-TKA. Nine studies with an average follow-up of 12.4 years were included. Data on survivorship, complications, and PROMs were collected and analyzed. The overall survivorship of MP-TKA was 98.2% at an average follow-up of 12.4 years. Aseptic loosening and periprosthetic joint infection (PJI) were the most common reasons for revision, with a revision rate of 0.4% for each. The overall complication rate was 6.6%, with secondary anterior knee pain and PJI being the most frequent complications. The reoperation rate was 3.1%, primarily due to PJI and knee instability. PROMs significantly improved postoperatively. MP-TKA demonstrates favorable long-term outcomes with high survivorship, low complication rates, and enhanced PROMs. The procedure provides reliable management for end-stage osteoarthritis, offering patients improved knee function and pain relief. Further research with standardized reporting and larger sample sizes is needed to validate and compare these findings to other implant designs.