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Second Opinion, Second Lease on Mobility: The Benefits of Partial Knee Replacement

Nancy Strk is a teacher assistant on Long Island who loves taking long walks and traveling with her husband, running after her frisky Shih Tzu puppy and playing with her two young granddaughters. Until recently, though, she needed to put some of her favorite activities on hold. A fall during a trip to Croatia with her husband in 2006 left her with a badly injured knee. She had arthroscopic surgery on Long Island, but her knee only got worse.

"I was in pain 24/7. When I stood up, my knee often buckled, and I felt like I was going to fall," explains Nancy, who's in her fifties and lives in New Hyde Park. She decided to consult with another Long Island doctor and was taken aback when he recommended a total knee replacement.

"As soon as he said 'total knee replacement' I decided to go to Hospital for Special Surgery for another opinion," Nancy explains. "My mother had her knee replaced there about 10 years ago and did well. I wanted another opinion, and I knew I would get the best advice and most appropriate treatment there." A colleague at her school gave Nancy the name of an orthopedic surgeon at HSS. The teacher spoke highly of Geoffrey H. Westrich, MD, who had helped her with a knee problem, and Nancy went to see him.

She's glad she made the trip into Manhattan. As it turns out, Nancy's original knee injury, diagnosed as a torn medial meniscus, had led to bone damage and arthritis. The medial meniscus is the crescent-shaped cartilage in the inner part of the knee joint that cushions the bones.

Dr. Westrich, Co-Director of Joint Replacement Research and an Associate Professor of Orthopedic Surgery, told Nancy that since the damage was limited to the inner area of her knee and did not affect the entire joint, total knee replacement wasn’t necessary. She could have a partial knee replacement, a newer procedure that’s much less invasive and easier on the patient.

The less extensive operation, also called a "unicompartmental" knee replacement, is appropriate for patients whose arthritis is limited to just one area of their knee. But the right diagnosis is key.

"Patients who qualify for a partial joint replacement experience less pain right after surgery, have a quicker recovery and rehabilitation, and have a shorter hospital stay," Dr. Westrich says. "Yet the procedure completely relieves arthritis pain and allows patients to return to activities they were forced to give up." Another advantage is that it preserves the normal bone and cartilage in the rest of the knee that would typically be replaced in a total joint procedure, according to Dr. Westrich, who also sees patients at an office in Fresh Meadows, Queens.

As the knees of active baby boomers and "weekend warrior" athletes start to wear out, he’s seeing more candidates for the less invasive procedure. Generally, these patients are younger than those needing a total joint replacement, and many are eager to return to athletic activities.

To qualify for a partial joint replacement, the arthritis must be confined to a limited area. The knee has three compartments - medial, lateral, and patellofemoral (kneecap region) - and arthritis can involve one, two or all three areas. One would be a candidate for a partial joint replacement if only the inner (medial) or outer (lateral) part of the knee is damaged. Patients whose arthritis is widespread would need a total joint replacement.

Nancy Strk, whose problem was limited to the inner part of her knee, was a perfect candidate for a partial joint replacement. "My knee is doing great, and I feel like a new person," she says. Before the surgery, she wondered if she would sense a foreign object in her knee, but she says it feels completely natural. Just one day after the operation, she was able to put weight on her knee and walk around.

Nancy gives high marks to the hospital and staff. "The entire staff was great," she says. "The care I received, the doctor, the nurses… when you rang the call bell, the nurses came right away."

"I have 100 percent range of motion, and no pain. I can climb the stairs into my attic, take walks with my husband, and my granddaughter is so happy I can pick her up again." Nancy will soon return to work and plans to take the stairs when she travels from classroom to classroom as a teacher assistant.

"If people are having trouble with their knees and a doctor recommends total knee replacement, they should go for a second opinion," Nancy advises. "I went to Dr. Westrich and it turned out I could have a partial knee replacement, which was much better."

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