Implant with multi-directional pivoting has a first component including a first articular surface and a fore-to-aft and side-to-side rotation device and a second component including a second articular surface for mating with the first surface and a rotation device receptacle. The first component can be mated to the second through cooperation of the rotation device and receptacle, and the first component can cooperate with the second in articular surface contact. The joint may be a knee prosthesis comprising first femoral and second tibial components, with the first surface a femoral condylar surface and the second surface a tibial condylar surface. Therein, the fore-to-aft component can be considered flexion, with the side-to-side component considered version. A knee prosthesis can also be provided with a patella support on a smooth counter surface from full extension to flexion well past 100 degrees and/or with a mechanism preventing excessive downward tibial component travel.
