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 articular surface and a rotation device receptacle. The first component can be mated to the second component through cooperation of the rotation device and the rotation device receptacle, and the first component can cooperate with the second component in contact of the first and second articular surfaces and in articulation of the joint when the first component is mated to the second component. The implant can be an artificial joint which generally has natural load transfer capability. In a particular embodiment, the joint is a knee prosthesis therein, the first and second components are femoral and tibial components, with the first articular surface a femoral condylar surface and the second articular surface a tibial condylar mating surface. In such a knee, the fore-to-aft component can be considered flexion, with the side-to-side component considered version. As well, a knee prosthesis can be provided with a device to support the patella on a smooth counter surface from full extension to flexion well past 100° and/or with a mechanism to prevent excessive downward travel of the tibial component.
