Total knee replacement (posterior stabilised): Visionaire Genesis II (Smith and Nephew)
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This case illustrates the use of patient specific instrumentation to perform a total knee replacement. The Visionaire technology is from Smith & Nephew, being introduced in 2010. It utilises a single weight bearing AP alignment film of the patient’s leg and a focused MRI of their knee to provide the data for cutting jig and implant design. The information is relayed to technicians who are based in the United States of America who design the knee replacement for you within the parameters you have set for them.
The surgeon sets the sizing constraints for example to upsize unless medial-lateral overhang, the rotational axis, the varus/valgus alignment, the tibial slope and tibial rotation. These usually correspond to the the typical component features used in a standard knee replacement, but can be varied.
Once the implant has been designed the plan is e-mailed to the surgeon and it is then checked and accepted. Printed 3-D printed nylon cutting blocks are manufactured for both the tibial and femoral sides of the knee replacement. The blocks are applied to the patient intra-operatively, cuts made and then the final preparation of the bone is performed using standard instrumentation and the total knee replacement is then implanted.
The use of Visionaire technology is associated with more reproducible implant placement, decreased operative times, fewer equipment trays in theatre, a reduced tourniquet time and reduced blood loss. Technically the Smith and Nephew Visionaire instrumentation is particularly useful in cases where there is difficulty passing standard instrumentation such as the intramedullary femoral rod in cases of femoral mal-union or canal occlusion.
Author: Mr Richard Baker MD, MSc, MB.ChB, FRCS (Tr & Orth)
Institution : The Avon Orthopaedic Centre , Bristol ,UK.