Genesis 2 (Smith &Nephew) PS type total knee arthroplasties (TKAs) originally required measured resection technique. Between 2009 and 2013, cemented 102 TKAs were performed with modified gap technique in 29 men and 73 women with a mean age of 75 years at the time of surgery. At the time of final follow up, complications included four DVTs, one knee flexion contracture, two superficial infections. Femoro-tibial angle (FTA) was improved from 110 to 123 degrees, and mean extension of knee was improved from −8.5 to −2.1 degrees. Three TKAs with painful patello-femoral component after un-replaced patellar cases required patellar replacements. There was no radiographic evidence of loosening, osteolysis, or polyethylene wear. When patellar replacement was performed, cemented Genesis 2 PS type offered good gap balancing and excellent early outcomes with modified gap technique.