All the surgeries were performed by a single surgeon (TKK) using the medial parapatellar approach. All the TKA procedures were performed using either a fixed bearing system (Genesis II Total Knee System; Smith & Nephew, Memphis, TN, USA) or a mobile bearing system (e.motion Total Knee System; B. Braun-Aesculap, Tuttlingen, Germany). A posterior-stabilized design was used in all knees. The selection of the implant was made at the surgeon’s discretion, without any preset selection criteria. The patella was routinely resurfaced, and all the implants were fixed with cement. Postoperative care was delivered according to a standardized clinical pathway.
Genesis 2 total knee system
Manufactured by Smith & Nephew
Sourced in United States
The Genesis II Total Knee System is a modular knee replacement system designed for total knee arthroplasty. It consists of a femoral component, tibial component, and polyethylene insert. The system is intended to restore knee joint function.
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4 protocols using genesis 2 total knee system
1
Single Surgeon Total Knee Arthroplasty
2
Comparative Analysis of Contemporary TKA Femoral Designs
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Digital three-dimensional models of six contemporary TKA femoral component design families from various manufacturers were assessed in this study: (1) Design A: Persona™ The Personalized Knee System (Zimmer, Warsaw, IN); (2) Design B: NexGen® Complete Knee Solution (Zimmer, Warsaw, IN); (3) Design C: Sigma® Knee Solutions (DePuy Synthes, Warsaw, IN); (4) Design D: GENESIS™ II Total Knee System (Smith and Nephew, Memphis, TN); (5) Design E: Triathlon® Knee System (Stryker, Kalamazoo, MI); and (6) Design F: Vanguard® Complete Knee System (Biomet, Warsaw, IN) (Table2 ). Designs A and B have multiple ML size offerings for a specific component AP size. Design A has both standard and narrow ML offerings per AP size, with the finest increment (2 mm) selection in AP sizes amongst all the design families. Design B offers standard and gender sizes in ML widths, each comes with standard and minus sizes in AP dimension. Designs C–F have single ML offerings across component AP size. All available sizes and ML offerings in the design families were included in this study.
Digital three-dimensional models of six contemporary TKA femoral component design families from various manufacturers were assessed in this study: (1) Design A: Persona™ The Personalized Knee System (Zimmer, Warsaw, IN); (2) Design B: NexGen® Complete Knee Solution (Zimmer, Warsaw, IN); (3) Design C: Sigma® Knee Solutions (DePuy Synthes, Warsaw, IN); (4) Design D: GENESIS™ II Total Knee System (Smith and Nephew, Memphis, TN); (5) Design E: Triathlon® Knee System (Stryker, Kalamazoo, MI); and (6) Design F: Vanguard® Complete Knee System (Biomet, Warsaw, IN) (Table
Femoral component design families used in this study
| Design | A | B | C | D | E | F |
|---|---|---|---|---|---|---|
| # AP sizes | 12 | 11* | 7 | 8 | 8 | 9 |
| AP increments (mm) | 2** | 2 | 3–5 | 3–4 | 3–4 | 2–3 |
| # ML size offerings per AP | 1–2 | 1–2 | 1 | 1 | 1 | 1 |
| Aspect ratio (ML/AP) | 1.0–1.3 | 1.0–1.2 | 1.1–1.2 | 1.2–1.3 | 1.1–1.2 | 1.1–1.2 |
| Frontal view | ||||||
| Sagittal view |
* Standard sizes and minus sizes
** For size 1–11
3
Standardized Total Knee Arthroplasty Procedure
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All TKAs were performed by the same medical team composed of three senior surgeons (WJW and HYZ), and surgical procedures were performed according to routine practice. A standard midline skin incision and the medial parapatellar approach were used in the operative procedure, as well as a measured resection technique. All patients received spinal anaesthesia and the same type of cemented prosthesis (Genesis II Total Knee System; Smith & Nephew, Memphis, Tennessee, USA). An intramedullary guide was used for femoral cuts, and an extramedullary guide was used for tibial preparation. Electrocauterization was used to ensure haemostasis throughout the procedure, and no topical chemical haemostatic agents were used. An 80 ml cocktail with 200 mg ropivacaine and 1% epinephrine was injected into the joint space to enhance postoperative pain control prior to capsule closing. We did not use drains postoperatively. All knees were packed with ice immediately after surgery in order to decrease blood loss and alleviate pain. Operating time, tourniquet time, and intraoperative blood loss were recorded by research assistants.
4
Comparing Surgical Approaches for Total Knee Replacement
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All surgical procedures were carried out by two senior subspecialized surgeons with a fellowship in arthroplasty and long experience in TKR using both approaches. The Smith & Nephew Genesis II Total Knee System was the implant used for all patients. The standard procedure and protocol were implemented, with identical techniques used in the two procedures except for the initial approach after the midline incision. For the subvastus approach, the knee was flexed for the incision of the skin and the inferior aspect of the capsule. The muscle belly of the vastus medialis is lifted off the intermuscular septum and dissected with the knee flexed or extended. The patella was not everted but rather subluxated laterally. For the medial parapatellar approach, the knee was flexed for incision, and the quadriceps tendon was incised vertically up to 3 cm above the patellae, dissecting between the vastus medialis and quadriceps tendon. The patella was not everted during the surgery.
The post-operative pain relief for all participants was identical, with the administration of intravenous patient-controlled analgesia for the first 48 hours and oral analgesia subsequently. The post-operative nursing care was similar in the two groups. The rehabilitation of all patients was standardized according to the hospital’s clinical protocol for TKR.
The post-operative pain relief for all participants was identical, with the administration of intravenous patient-controlled analgesia for the first 48 hours and oral analgesia subsequently. The post-operative nursing care was similar in the two groups. The rehabilitation of all patients was standardized according to the hospital’s clinical protocol for TKR.
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