PurposeA study was conducted to compare minimum 15-year survivorship and outcome of the Genesis I and II implants for total knee arthroplasty (TKA).MethodsWe retrospectively reviewed 245 consecutive TKA implanted between January 1995 and October 1997. Genesis I was implanted in 156 knees and Genesis II in 89 knees.ResultsAt 15–17 years, 75 patients (31 %) had died, 28 patients (11 %) were lost to follow-up and 11 TKA were revised (4.6 %), including ten Genesis I (6.4 %) and one Genesis II (1.1 %); 131 TKA (53 %) were available for follow-up. Cumulative survivorship was 92.4 % at 15.7 years. Survival in patients <69 years at surgery was lower (88.0 %) compared with patients ≥69 years (98.5 %; p = 0.023). In patients <69 years, Genesis I survival (84.3 %) was worse compared with Genesis II (97.1 %) (p = 0.018). Polyethylene (PE) Insert thickness ≤11 mm had significantly better survivorship (97.1 %) compared with PE >11 mm (56.7 %) (p < 0.0001)ConclusionsAt a minimum of 15 years, the overall (92.4 %) survivorship of Genesis TKA was good, with excellent (98.1 %) survivorship of the Genesis II design. Revision rates were higher with Genesis I in the younger age group and with insert thickness >11 mm, possibly due to longer shelf life of less frequently used sizes.

The aim of the study was to design an objective, transparent, pragmatic, and flexible workflow to assist with patient selection during the initial phase of return to elective orthopedic surgery during the COVID-19 pandemic with the main purpose of enhancing patient safety.Methods: A multidisciplinary working group was formed consisting of representatives for orthopedics, epidemiology, ethics, infectious diseases, cardiovascular diseases, and intensive care medicine. Preparation for upcoming meetings consisted of reading up on literature and testing of proposed methodologies on our own waiting lists.Results: A workflow based on 3 domains, that is, required resources, patient fitness, and time sensitivity of the procedure, was considered most useful. All domains function as standalones, in a specific order, and no sum score is used. The domain of required resources demands input from the surgical team, results in a categorical (yes or no) outcome, and generates a list of potential patients who can be scheduled for surgery under these particular circumstances. The (weighted) items for the domain of patient fitness are the same for every patient, are scored on a numerical scale, but are likely to change during the pandemic as more data become available. Time sensitivity of the procedure is again scored on a numerical scale and becomes increasingly important when returning to elective surgery proves to be acceptably safe. After patient selection, an augmented informed consent, screening, and testing according to local guidelines will take place. Conclusions:Aworkflow is proposed for patient selection aiming for the safest possible return to elective orthopedic surgery during the COVID-19 pandemic.

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