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Partial Knee Replacement: 'Why Do Surgery on Parts That Don't Need To Be Replaced?'

Vijai Manilal believes the start of trouble with his left knee probably dates back to a motorcycle accident he had in 1970 when he was age 18.

“A car hit me head-on, and my left thigh bone (the femur) literally exploded,” he recalls. “As a result of that accident, my left leg is shorter than the right leg by 1-1/2 inches.”

After recovering from the accident, Mr. Manilal resumed his athletic, outdoorsy lifestyle while wearing a “lift” in his left shoe.

“I played tennis and golf, and went swimming and hiking,” he says. “But over the years, especially starting about five years ago, things started deteriorating. There was some bone necrosis – meaning death of the bone tissue – in the femur where it attaches to the knee. I also developed arthritis in the knee. I kept exercising through the pain, but about 2-1/2 years ago, I had to stop playing golf.”

Because he runs his own business, running a hair salon and importing hair care and styling products from Japan, Mr. Manilal travels extensively. His busy travel schedule caused him to delay doing anything about the pain in his knee. Finally, he realized he needed to see a doctor to find a way to ease the pain.

“I was living in Orinda at the time – I now live in Mill Valley – so I went to see an orthopedist who worked near Orinda,” he says. “He treated me with injections of cortisone to reduce inflammation and hyaluronic acid, which is supposed to lubricate the joint. He also had me wear a knee brace. When those treatments didn’t work anymore, he told me I would probably need to have my knee replaced.”

Mr. Manilal’s best friend already had both of his knees replaced, and the friend raved about the results. His orthopedic surgeon was Dr. John Dearborn, who serves as co-medical director with Dr. Alexander Sah at the Washington Hospital Institute for Joint Restoration and Research (IJRR).

“My buddy kept telling me to go see Dr. Dearborn and Dr. Sah,” Mr. Manilal explains. “He said, ‘These guys are so good! At least go talk to them!’ I also read good things about both doctors in the newspaper. By that time, I could barely hobble because it was so painful. I called for an appointment and met with Dr. Sah. He was such a nice man; he has a wonderful way about him. I told him I thought I would need a total knee replacement. Right away, he took x-rays of my entire left leg. Then he explained that I only needed a partial knee replacement because only the inside part of the knee was really damaged.”

One of the most experienced joint replacement surgeons in the Bay Area, Dr. Sah has performed more than 200 partial knee replacement surgeries. Few surgeons in the Bay Area perform partial knee replacements.

“When you are deciding between total knee replacement and partial knee replacement, there are three areas that need to be evaluated – both sides of the knee and under the kneecap,” Dr. Sah explains. “Partial replacement would be an option for patients who have arthritis or damaged cartilage on only one part of the knee. The advantages of partial knee replacement can be substantial. Partial knee replacement is less invasive, and the ligaments in the center of the knee are not removed. Because the ligaments are left intact, the joint feels more like a natural knee. It is a good option especially for younger patients in their 40s, 50s and 60s who are like Mr. Manilal, with damage to only one part of the knee.”

Mr. Manilal notes, “Dr. Sah said to me, ‘Why do surgery on parts that don’t need to be replaced?’ I realized Dr. Sah is not one of those guys who are ‘cut-happy,’ and I knew from what I had read in the paper that he was very experienced in partial knee replacement. I’d rather have someone who really knows what he is doing, so I decided to go along with his recommendation.”

The surgery was performed on February 26 of this year. Prior to the surgery, the staff at the IJRR provided Mr. Manilal with an instruction binder and video to prepare him for what to expect before, during and after surgery.

“The instructions were very precise,” he notes. “I knew exactly what to expect and how to prepare for surgery. They also scheduled a consultation with the anesthesiologist – who offered to use local anesthesia so I could watch the surgery, but I preferred to be under total anesthesia. I also got a handwritten letter from Dr. Sah before the surgery, thanking me for choosing him to be my surgeon and offering to answer any questions I had.”

The 45-minute surgery started around 9:30 a.m. After a couple of hours in the recovery room, Mr. Manilal was transferred to his private room, where his wife and his friend (who had recommended Dr. Sah and Dr. Dearborn) stayed with him. By 5 p.m., the IJRR staff had him up and walking.

“Dr. Sah had told me ahead of time he wanted me to walk the same day as the surgery,” says Mr. Manilal. “Even so, my wife was in shock that I was up and about so quickly.”

Since December 2014, total knee replacement and partial knee replacement patients at the IJRR are taken off epidural medication right after surgery and are given a new injectable, long-lasting local pain medication instead. With the injectable pain medication, patients can feel their legs, so they have better motor control and can safely be mobilized faster.

“Getting certain patients to walk the same day as surgery helps speed their recovery and provides equal – if not better – knee range of motion,” Dr. Sah explains.

In 2015, nearly all of Dr. Sah’s partial knee replacement patients have been able to go home the same day. Not every patient is a candidate for same-day discharge, however. Mr. Manilal, for example, did stay overnight because he required a catheter.

“Once I got home, I recovered very quickly,” Mr. Manilal remarks. “I took prescription pain medications for only about a week. One of the great things about the IJRR is that they set you up with physical therapists who work with you at home, three times a week for the first two weeks. After that, you go to outpatient physical therapy. Four weeks after my surgery, I was swinging a golf club, although not hitting any balls. After six weeks, I went to a golf shop and hit a few balls. I thought, ‘This is amazing!’ Now I have no pain, period. I could play golf every day if I had the time. I’m hoping to play tennis again by the end of the year, too.”

Mr. Manilal credits Dr. Sah’s skill and expertise for much of his quick recovery from surgery. He also appreciates the doctor’s “amazing bedside manner.”

“Dr. Sah called me at home the day after surgery to check on me and to give me his cell phone number,” he marvels. “That doesn’t happen very often these days. Then he called again two weeks later, and when he couldn’t reach me, he called my wife. I call him ‘Alexander the Great’ because he is so responsive to any question or concern I might have.”

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