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Background: Patient dissatisfaction following total knee replacement (TKR) has been reported as high as 24%. Most previous studies have focused on satisfaction for TKR overall, with few reporting satisfaction for specific implant designs. The purpose of this study was to assess patient satisfaction for TKRs performed using a second generation medial-pivot system (EVOLUTION ® , MicroPort Orthopedics Inc., Arlington, TN, USA)., Methods: Of a single surgeon's first 250 consecutive TKRs performed using the subject system, 224 completed a patient satisfaction assessment, the Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, and radiographs at 2 months follow-up., Results: The overall very satisfied/satisfied rate was 94.6% at 2 months. Following the first 50 TKRs, the satisfied rate improved to 99.4% suggesting a bias towards the initial cases potentially due to learning the system and instrumentation. Overall KOOS, range of motion, and radiographic outcomes were satisfactory at final follow-up., Conclusions: In conclusion, more subjects implanted with a second generation medial-pivot system were satisfied compared to previous reports for TKR., Competing Interests: DA Fitch is an employee of MicroPort Orthopedics Inc., the other author has no conflicts of interest to declare.