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Partial knee replacement may be an option for some patients

March 16, 2001

Partial knee replacement may be an option for some patients



By KEVIN CLAPP

kevinc@herald-mail.com

Photo: RICHARD T. MEAGHER / staff photographer

Allen CoolHe could call it a tale of two weddings.

Viewed together, the nuptials of his youngest daughter last summer and his middle daughter in May will paint a picture of how Allen Cool's life was, and what he can look forward to.

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In the late '60s, Cool, 54, of Smithsburg, injured his right knee in an accident. By the late '70s, he was feeling discomfort, then a pain that became so unbearable at times that he could not move without the assistance of crutches. Simply standing for too long could be excruciating.

Diagnosed with osteoarthritis, he had three procedures in the next 20 years to clear out the knee and relieve discomfort.

Still, the problem never went away as the inside of his knee deteriorated.

"I could walk, a limited amount of walking and standing, and it was getting worse," Cool says. "Last summer it got real bad. ... The whole leg started to ache. I couldn't walk, I couldn't sleep, riding in the car was awful."

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Then his physician, Robert J. Cirincione, suggested that Cool might be eligible for a partial knee replacement. It is a procedure that has existed for years but has become more practical recently with the development of new instruments to do the surgery.

Cirincione's colleague, Thomas G. Amalfitano, is among the few physicians in Maryland trained to do the Minimally Invasive Solution Procedure for a Unicompartmental Knee. Where a total knee replacement replaces the anterior, lateral and medial areas of the knee, this new procedure allows doctors to replace only the problem area.

If the anterior section of the knee is beyond repair, but the lateral and medial are in good condition, then doctors can focus on that one section of the knee and not replace them all.

Amalfitano, who performed the first partial knee replacement in Maryland by about 10 minutes, raves about the procedure for many reasons: It creates an incision roughly one-third the size of one for a full replacement; it drastically cuts the time a patient spends in the hospital; and quicker rehabilitation allows patients to get back to work sooner.

With a total knee replacement, patients usually spend a minimum of three days in the hospital; the three times Amalfitano has done the new procedure, the patient went home in less than a day.

"It's very early for these people, but they felt a difference almost immediately," he says. "Based on the literature and early experience, it appears to be what we had hoped."

Measure of relief


The procedure allows doctors to provide a measure of relief to older patients, who might be too frail to withstand the rigors of a total knee replacement and the rehabilitation that goes with it.

Similarly, Amalfitano says physicians have preferred to not perform full replacements on younger patients because of the time it takes to rehabilitate from the injury - patients are seldom back at work within two or three months.

And, he points out, replacement joints don't last forever. The younger the recipient, the more likely the joint will wear out and require its own replacement.

The partial replacement allows doctors to treat the problem area and still have the option of replacing the entire knee in the future if necessary.

"Once you do a total knee there's no backing up," Cool says. "Whereas this gave me an opportunity to stretch this out even further."

Cool was skeptical at first about the procedure and read up about it on the Internet. Unsure in the beginning whether he would be a candidate for the surgery, he is thrilled that it has gone so well.

Making up for lost time


Since having the procedure on Feb. 19, he has had three, one-hour therapy sessions a week, plus exercises to do at home. His right leg doesn't look like a 'noodle' anymore, and he says he is using muscles he hasn't used in years.

He feels better each day, and is looking forward to making up for lost time.

Cool and his wife of 34-years, Rose, own a boat on the Chesapeake Bay. After not being able to enjoy it because of his condition, they are looking forward to spending a long summer on it.

And they have their middle daughter's wedding coming up in May. Last summer, it was their youngest daughter who got married. Watching a video of that ceremony last fall is what spurred Allen Cool into action.

"I just waddled through it," he says. "Then and there I said 'I don't care what I have to do, but I have to do something.' "

This time around, he adds, it will be a little different when his other daughter gets married on the beach.

"I'll probably be able to run down the beach with her," Cool says. "I'm looking forward to it."

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