Successful Surgeries Replace Only Kneecap Area of Woman's Knees

Jeanne Landreth had pain in her knees for close to 20 years. Finally, while spending the summer of 2014 in Sun Valley, Idaho, at her summer residence, she concluded that enough was enough.

“I’m a very active person, and I love to hike, so I decided to evaluate my options, including knee surgery,” she says. “I went to see a physical therapist, figuring he had no ‘skin in the game’ when it came to surgical treatments and would be likely to give me an unbiased opinion on knee surgeries. He said I needed knee replacement surgery.”

In September of that year, Ms. Landreth made an appointment with Dr. John Dearborn, who serves as co-medical director with Dr. Alexander Sah at the Institute for Joint Restoration and Research (IJRR) at Washington Hospital.

“Dr. Dearborn told me that my x-rays showed I only needed partial knee replacements, so he referred me to Dr. Sah for consultation because he is regarded as a leading specialist in the procedure,” Ms. Landreth recalls.

One of the most experienced total hip, total knee, and partial knee joint replacement surgeons in the Bay Area, Dr. Sah has performed more than 300 partial knee replacement surgeries. Few surgeons in the Bay Area perform partial knee replacements, and particularly patellofemoral (kneecap joint only) replacements.

“A friend of mine had hip replacement surgery performed by Dr. Sah, and she said she trusted him completely, so I decided to go ahead and see him,” says Ms. Landreth. “I was very impressed with Dr. Sah from the get-go. When I met with him, I still thought I wanted total knee replacements. But he showed me the x-rays and pointed out how the arthritic area at the top of the kneecaps was bone-on-bone, and that the rest of the knees were OK. It made sense to me, because 95 percent of my pain was on the top of the knees.”

Studies have shown that partial knee replacements can be durable up to 15 years and beyond in properly selected patients. In addition, if arthritis develops elsewhere in the knee, a partial knee replacement can be easily converted to a first-time total knee replacement.

“Partial knee replacement can be a great option for patients who have arthritis or damaged cartilage in only one part of the knee,” Dr. Sah explains.

“When you are deciding between total knee replacement and partial knee replacement, there are three areas that need to be evaluated – the inner and outer sides of the knee and under the kneecap,” he adds. “The advantages of partial knee replacement can be substantial. Partial knee replacement surgery is less invasive, bone preserving, and the ligaments in the center of the knee are left intact. Recovery is much faster than total knee replacement. Because all of the ligaments are preserved, the joint feels more like a natural knee – because it is. It is a good option especially for younger patients like Ms. Landreth, who is in her 60s, with damage to only one part of the knee.”

Ms. Landreth had surgery on her right knee in February 2015, and a second surgery on her opposite left knee just two months later.

“Dr. Sah and his staff were very thorough in preparing me for the surgeries, providing me with a large binder of information,” she says. “Also, since my muscles around the knees had atrophied because I had been avoiding movements that caused pain, they gave me several exercises to strengthen the muscles before surgery. Both surgeries were performed early in the morning, and I walked out of the hospital by 3 p.m. after each surgery.”

Since December 2014, Dr. Sah’s total knee replacement and partial knee replacement patients at the IJRR have been walking just hours after surgery. This change is due to his continued improvements in pain management, blood-preserving techniques, and accelerated rehab protocols. He speaks to surgeons throughout the state and at national meetings about optimizing pain control to maximize recovery. For example, Dr. Sah uses a novel local injectable, long-lasting pain medication in the knee at the time of surgery to minimize narcotic use. With this injectable pain medication, patients can experience two to three days of pain relief without the side effects of pain pills.

“Getting patients to walk the same day as surgery helps speed their recovery immediately after surgery, and patients also seem to recover faster overall,” Dr. Sah explains. As Director of the Outpatient Joint Replacement Program, Dr. Sah recently led a symposium on rapid-recovery joint replacement at the annual national hip and knee surgeon meeting in Dallas and also lectured at the California Orthopedic Association annual meeting this past May.

In 2015 and 2016, nearly every one of Dr. Sah’s partial knee replacement patients have been able to go home the same day as surgery, and about 85 percent of his total knee replacement patients go home the morning after surgery.

“Dr. Sah had told me I would be up and walking within hours of surgery, but I was still surprised,” Ms. Landreth says. “At no time did I feel the pain was unbearable. I don’t like pain medications, but I took the prescription ones at night for a few weeks, later switching to Tylenol. I know people who had total knee replacement surgeries, and I think my experience was much better.”

After each of her surgeries, Ms. Landreth carefully followed Dr. Sah’s instructions for elevating and icing the knee and for exercising in moderation, increasing the exercise gradually. A physical therapist visited her at home in Carmel for several sessions after each surgery, and then she went to outpatient physical therapy to work on exercises for strengthening and improving her range of motion.

“I was very surprised that Dr. Sah called me at home several times after my surgeries to personally check in with me,” Ms. Landreth remarks. “If I had any questions or concerns, I could call him or email his physician’s assistant, Abigail Goetz.”

By mid-June, Ms. Landreth was once again enjoying hiking and golfing, and she got back on a bicycle at the end of June.

“I did a lot of hiking at our summer home in Sun Valley this year,” she notes. “I noticed I had better balance and strength because of the surgeries and physical therapy. I also really noticed the difference in the level of pain between last summer and this summer. I still have a little bit of pain when climbing stairs, but it is so much better than before and keeps getting better.

“Dr. Sah and the entire staff at Washington Hospital were wonderful,” she adds. “There was not a single person who wasn’t courteous and helpful, which made it a really good experience. I would absolutely recommend them to anyone considering total or partial knee replacement surgery.”

Learn More

If you need help finding a physician, visit www.whhs.com and click on the link for “Find Your Physician.” For more information about the Institute for Joint Restoration and Research at Washington Hospital, including information about partial knee replacement surgery, visit www.whhs.com/joint-restoration/.