Purpose In recent years, the medial pivot (MP) type total knee arthroplasty (TKA) implant has been developed and marketed for achieving more natural kinematics with MP. However, little is known about the pivot pattern during walking after MP type TKA. This study aimed to determine the kinematics and center of axial rotation during walking after MP type TKA. Methods This randomized prospective study enrolled 40 patients with MP type TKA, 20 with cruciate-substituting TKA (MP-CS group), 20 with posterior-stabilized TKA (MP-PS group), and 10 healthy volunteers (control group). The kinematics and center of axial rotation during overground walking were measured by a three-dimensional motion analysis system. The six-degrees-of-freedom kinematics of the knee were calculated by the point cluster method. Results The amount of change in knee flexion in early stance phase was significantly lower in the MP-CS and MP-PS groups than in the control group. The femur showed anterior translation during early stance phase in all three groups. The median center of axial rotation in the transverse plane was predominantly on the lateral side of the knee during stance in all groups. Conclusions Kinematics during gait are thought to be determined by physical posture, the kinetic chain during weight-bearing, and the kinematic features of adjacent structures, such as the behavior of the biarticular muscles. MP-CS and MP-PS did not necessarily induce rotational motion centered on the medial ball-in-socket component during walking; translational and lateral pivoting movements were also observed. Long-term follow-up is needed to monitor for polyethylene wear and implant loosening.