Total knee replacement using the Genesis II prosthesis: a 5-year follow up study of the first 100 consecutive cases

doi:10.1016/j.knee.2004.07.006

The Knee

Volume 12, Issue 3, June 2005, Pages 163-167

https://doi.org/10.1016/j.knee.2004.07.006 Get rights and content

Abstract

One hundred consecutive patients with osteoarthritis undergoing knee replacement using a prosthesis with asymmetrical posterior condyles and an asymmetrical tibial base plate (Genesis II) were followed for a minimum of 5 years after surgery. Mean flexion was 118°. Seventy nine percent of the patients could ascend and descend stairs in a reciprocal manner. A lateral retinacular release was required in only three patients. Post-operative patellar tracking was excellent as determined by both patellar displacement and patellar tilt. There was excellent flexion space stability using this prosthesis configuration without having to resort to external rotation of the femoral component. Tibial coverage was obtainable in >95% of the knees due to the asymmetric configuration of the base plate. Kaplan Meir Survivorship was 98% at 5 years.

Section snippets

Materials and methods

Ninety-six consecutive patients with osteoarthritis (100 knees) underwent a primary knee tricompartmental replacement using the Genesis II (Smith and Nephew, Memphis, TN) cemented prosthesis. In four patients, bilateral knee replacements were performed under the same anesthesia.

The average patient age was 67.5 years, with a range from 52 to 94 years. The average patient weight was 90 kg with a range of from 54 to 125 kg. The mean BMI was 30.1 with a range of from 21.5 to 42.7. The pre-operative

Results

At 5 years after surgery, 77% of the patients had no pain with any activities. Twenty-one percent had mild discomfort usually during inclement weather. Two patients had pain on a daily with weight basis, and were on continuous analgesic medications. No patients had either night or rest pain. The clinical and radiographic findings are noted in Table 2.

Seventy-nine percent of the patients could both ascend and descend stairs in a reciprocal manner. All the remaining patients could ascend stairs

Discussion

This study documents the results using a fourth generation implant for total knee replacement of the arthritic knee. The prosthesis had provisions made for retention of the PCL or its sacrifice and use of a posterior stabilized bearing surface. The tibial base plate was asymmetrical so as to match the cut surface of the tibia. The femoral component geometry was such that flexion space filling was obtainable without having to externally rotate the component. The trochlear groove permitted

Uncited reference

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Cited by (43)

Posterior dislocation of a constrained total knee arthroplasty: A case report
2018, Annals of Medicine and Surgery
Citation Excerpt :
Standing radiographs showed no abnormalities or any sign of loosening with a normal positioning of the insert (Fig. 4). Knee dislocation after TKA is rare but easily overlooked and can lead to serious complications and permanent disability; hence, it must be addressed early and managed appropriately [2] [3] [4], [7] [8], [9]. There are some symptoms that could alert the surgeon of the possibility of knee dislocation or a problem with the insert, such as pain, clicking, locking sensations, or sudden instability [3].
Dislocation of the knee after primary total knee arthroplasty is rare in a posterior stabilized knee and extremely rare in a constrained total knee arthroplasty. Constrained total knee prostheses are used for severe knee deformities and to provide stable and mobile knees.
In this case, we describe a dislocation of a primary constrained total knee arthroplasty using the Genesis II (Smith & Nephew, Memphis Tennessee, USA) prosthesis. Without any significant trauma, the constrained insert dislocated fifteen months after surgery and revision surgery with a bigger insert was needed. Surgical error may have been the cause of dislocation, but we were unable to establish a clear reason behind this dislocation.
Knee dislocation after TKA is rare but easily overlooked and can lead to serious complications and permanent disability. This system should provide stable and mobile knees to correct collateral ligament laxity.
Here, we report the first case, to our knowledge, of dislocation with a constrained prosthesis without any history of trauma.
Total Knee Arthroplasty Using Bicruciate-Stabilized or Posterior-Stabilized Knee Implants Provided Comparable Outcomes at 2 Years: A Prospective, Multicenter, Randomized, Controlled, Clinical Trial of Patient Outcomes
2017, Journal of Arthroplasty
Citation Excerpt :
Gandhi et al, however, included only 2 RCTs in their analysis. Knee flexion ranges of 113° at 2 years and 118° at 5 years have been reported for the PCS [30–32] and between 116° to as much as 129° for the BCS [7,24,33,34]. In our study, knee flexion was approximately 120° for both implants which was less than the 125° reported by Schimmel et al [24] and the 129° reported by Christen et al [33].
The bicruciate-stabilized (BCS) knee arthroplasty was developed to replicate normal knee kinematics. We examined the hypothesis that patients with osteoarthritis requiring total knee arthroplasty (TKA) will have better functional outcome and satisfaction with the BCS implant compared with an established posterior cruciate-stabilized implant.
This multicenter, randomized, controlled trial compared the clinical outcomes of a BCS implant against an established posterior cruciate-stabilized implant with 2-year follow-up. Of the patients awaiting primary knee arthroplasty for osteoarthritis, 228 were randomized to receive either a posterior-stabilized or BCS implant. Primary outcomes were knee flexion and Oxford Knee Score. Secondary outcomes were rate of complications and adverse events (AEs). Tertiary outcomes included Knee Society Score, University of California, Los Angeles, activity score, Patella scores, EQ-5D, 6-minute walk time, and patient satisfaction.
Complete data were recorded for 98 posterior-stabilized implants and 97 BCS implants. Twelve patients had bilateral knee implants. There was no difference between the groups for any of the measures at either 1 or 2 years. At 2 years, knee flexion was 119 ± 0.16 and 120 ± 1.21 degrees for the posterior-stabilized and BCS implants, respectively, (mean, standard error, P = .538) and Oxford Knee Scores were 40.4 ± 0.69 and 40.0 ± 0.67 (P = .828), respectively. There were similar device-related AEs and revisions in each group (AEs 18 vs 22; P = .732; revisions 3 vs 4; P = .618).
There was no evidence of clinical superiority of one implant over the other at 2 years.
Clinical Results and Survivorship of the GENESIS II Total Knee Arthroplasty at a Minimum of 15 Years
2017, Journal of Arthroplasty
Citation Excerpt :
At 2 years, Laskin [12] and Karachalios et al [13] reported 100% prosthesis survival. These excellent results remain consistent at 5-year follow-up, with survival data ranging from 96.4% to 100%, published from multiple institutions [6,14,15]. In addition, our current findings are consistent with previously published midterm results from our institution, where Bourne et al reported 96% ± 2% Kaplan-Meier survivorship of the first 100 GENESIS II TKAs at a mean of 11.9 years follow-up [7].
The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of the GENESIS II total knee arthroplasty (TKA).
Patients who underwent TKA with the GENESIS II system between 1995 and 1999 were retrieved from our institutional database. We report a Kaplan-Meier survival analysis as well as Western Ontario and McMaster Universities Arthritis Index, the Short Form Health Survey-12 (SF-12), and the Knee Society Scores at a mean of 16 years.
Four-hundred sixty-nine TKAs were performed with a mean patient age of 68 years. Patients were followed up prospectively for a mean of 16 years (range, 14.8-19.5 years). The Kaplan-Meier survival analysis at 15 years, with revision for any reason as the end point, was 96.4% (95.5%-97.3%). The Western Ontario and McMaster Universities Arthritis Index and the Knee Society Scores were significantly improved (P < .001) from the preoperative period to the latest follow-up. Patients had a significant improvement (P < .001) from the preoperative to the latest follow-up on the Physical Health Composite Score of the SF-12, but no change was noted on the Mental Health Composite Score of the SF-12.
The unique design features of the GENESIS II TKA system have remained a constant over the duration of its clinical use, a rarity for contemporary TKA systems which are often altered before the publication of long-term results. The GENESIS II continues to demonstrate excellent long-term survivorship and improvements in health-related outcomes at a mean of 15 years, representing the standard for TKA systems at our institution.
Midterm outcomes of high-flexion total knee arthroplasty on Japanese lifestyle
2016, Acta Orthopaedica et Traumatologica Turcica
Citation Excerpt :
First, the study was small and included only 53 patients. The mean age of all patients at the time of operation was 73 years, which is higher than the mean age in Laskin's study (67.5 years)11 and in Bourne's study (68 years).12 In our study, 36 patients were aged >75 years at the time of operation.
To evaluate the clinical outcomes after total knee arthroplasty (TKA) using the Genesis II posterior stabilized prosthesis with a high-flex insert during the mid-term follow-up and to assess its effect on the Japanese lifestyle.
Fifty-three consecutive patients (8 men and 45 women) underwent primary TKA. The mean follow-up time was 76 months (5–9 years). Clinical results were assessed with the Japanese Orthopedic Association osteoarthritis knee rating score (JOA knee score), range of motion, and lifestyle changes.
The postoperative JOA knee score improved significantly compared to the preoperative JOA knee score. The mean preoperative flexion range improved from 112° to 123° postoperatively (p < 0.05). Additionally, our findings showed that 39% of patients enjoyed a floor-sitting life preoperatively, but only 30% of patients enjoyed floor-sitting life postoperatively.
The postoperative range of knee motion and JOA knee score improved after TKA using the Genesis II posterior stabilized prosthesis with a high-flex insert, but the number of patients who enjoyed floor-sitting life decreased from 39% to 30% because of feelings of fear and discomfort.
Level of Evidence: Level IV, Therapeutic study
In Vivo Wear Performance of Cobalt-Chromium Versus Oxidized Zirconium Femoral Total Knee Replacements
2016, Journal of Arthroplasty
This study examines the damage and wear on the polyethylene (PE) inserts from 52 retrieved Genesis II total knee replacements to identify differences in tribological performance between matched pairs of cobalt-chromium (CoCr) and oxidized zirconium (OxZr) femoral components. Observer damage scoring and microcomputed tomography were used to quantify PE damage and wear, respectively. No significant differences were found between CoCr and OxZr groups in terms of PE insert damage, surface penetration, or wear. No severe damage such as cracking or delamination was noted on any of the 52 PE inserts. Observer damage scoring did not correlate with penetrative or volumetric PE wear. The more costly OxZr femoral component does not demonstrate clear tribological benefit over the standard CoCr component in the short term with this total knee replacement design.
Does Insert Type Affect Clinical and Functional Outcome in Total Knee Arthroplasty? A Randomised Controlled Clinical Trial With 5-Year Follow-Up
2015, Journal of Arthroplasty
New insert types have been developed to improve clinical and functional outcome in mobile bearing (MB-TKA) and fixed bearing total knee arthroplasty (FB-TKA). A prospective single blinded randomised controlled clinical trial was performed to evaluate 2 types of MB-TKA inserts and 2 types of FB-TKA inserts of the Genesis II prosthesis (Smith & Nephew) in 146 patients with 5-years follow-up. A significant difference (P = .042) between the MB-TKA inserts was found in KSS function scores, but clinical significance is expected to be limited. Goniometry, temporal gait parameters and QoL were similar in all groups. Survival was significantly better (P = .047) for FB-TKA. The comparable outcome and higher revision rate in MB-TKA indicate that FB-TKA may be preferential for the Genesis II implant system.

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View full text

Total knee replacement using the Genesis II prosthesis: a 5-year follow up study of the first 100 consecutive cases

Abstract

Section snippets

Materials and methods

Results

Discussion

Uncited reference

Knee

Flexion space configuration in total knee replacement

J. Arthroplast.

The Genesis modular total knee replacement with posterior cruciate retention. A three year follow up study

Knee

The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system

Clin. Orthop.

Rationale of the knee society clinical rating system

Clin. Orthop.

Nonparametric estimation from incomplete observations

J. Am. Stat. Assoc.

Total knee replacement with posterior cruciate retention in patients with a fixed varus deformity

Clin. Orthop.

Total knee replacement in the patient without a patella

J. Bone Jt. Surgery

Total knee replacement with posterior cruciate ligament retention in rheumatoid arthritis: problems and complications

Clin. Orthop.

The Genesis total knee prosthesis a ten year follow up study

Clin. Orthop.