Not Your Parent's Knee Surgery | Torrance Memorial

Published on June 28, 2021

Not Your Parent's Knee Surgery

New techniques expand options for knee replacement surgery.

Dr Andrawis

Written by John Ferrari

I continued through the pain. – Hashem Ghafourian | I postponed it and postponed it. – Harold Jesse

How many times have you heard someone say that about knee pain and knee replacement surgery? How many times have you said that about knee pain – putting off surgery? The surgery will be painful, the recovery will be lengthy, it won’t fix the problem…

Not so fast. Knee surgery has come a long way, and the Torrance Memorial Lundquist Orthopedic Institute is at the forefront of innovations that can keep you on your feet, participating in the sports and exercises you enjoy – without pain. Nearly one million patients undergo total or partial knee replacement surgery each year, a number that is expected to rise through the decade as Baby Boomers – and, increasingly, Gen Xers – continue to remain active as they mature. That statistic reveals two major trends in knee replacement surgery: both older and younger individuals are electing to have knee replacement surgery, and total knee replacement surgery is not the only option anymore.

“We used to think in older patients, full was better, but that’s not actually the case,” says Lundquist Orthopedic Institute orthopedic surgeon Dr. John Andrawis. Besides total knee replacement, there are three types of partial knee replacement, he explains: medial which resurfaces the inside of the knee (closest to the other leg) and is the most common; lateral which resurfaces the outside of the knee; and patellar which resurfaces the inside of the kneecap (the surface facing the femur).

“There’s a big difference between partial and full knee replacement surgery,” Dr. Andrawis says. “There’s quicker recovery and much less pain.” Partial knee replacement surgeries are often performed as outpatient procedures, and patients typically experience better knee function and a more ‘normal’ feeling knee.

Of course, partial knee replacement surgery is not for everyone. It’s an option for individuals with arthritis in one of the three areas of the knee. “Younger patients are good candidates,” Dr. Andrawis says. “But now I have patients in their late 80s, even 90s, who have had successful partial surgeries.”

Orthopedic surgeons used to recommend full knee replacements over partial for two reasons. First, resurfacing just part of the knee does leave open the possibility a second, full replacement surgery (known as a revision surgery) may be necessary. “Traditionally, when we had a revision surgery later, it was a big surgery,” Dr. Andrawis says. “Now we can easily convert someone with a partial knee replacement to a full replacement.” Second, partial knee replacement surgeries require more skill, but Torrance Memorial’s adoption of robotic-assisted surgery has made them “easier than ever.”

The use of robotic-assisted surgery allows surgeons to perform both partial and full joint replacement surgeries with unmatched precision, ensuring a perfect fit between all parts of the joint. This advance, combined with minimally-invasive surgical techniques that require much smaller incisions – and much less dislocation of the muscles, tendons and other soft tissues surrounding the knee – have revolutionized knee replacement surgery. The term knee replacement is a bit of a misnomer, Dr. Andrawis explains. “It’s a resurfacing procedure of the bone, and the bone is OK. It’s the soft tissue that needs to heal, and we’re very delicate with that.”

Reading about Dr. Andrawis’ experience with joint replacement and sports medicine led Harold Jesse to finally stop postponing his knee replacement surgery. An avid athlete – running 40 miles and bicycling up to 200 miles a week – Jesse worried surgery would keep him from his favorite activities. He started noticing joint pain in his mid-60s, but it wasn’t until he neared his 70th birthday it began to really bother him.

“I chose Dr. Andrawis because of his specialty in sports. He really discussed all options, including different surgery types,” Jesse says. “He was very sensitive to my hesitancy to get knee surgery. I came to him a year earlier and tried cortisone which did nothing. He said, ‘Come back to me when you feel you really need something.’ It took 6 or 8 months until I could say I really do need to do something.”

Jesse had two partial knee replacements a year apart -- the first when he was 72 and the second last November at age 73. Both times “it was a very quick recovery,” he recalls. “I was doing a lot of exercises right away. I was cross-country skiing in January and February.”

The same advances that helped make Jesse’s partial knee replacements successful kept Hashem Ghafourian on his feet after a total replacement of his left knee. “I’m kind of an active person – exercising, doing many types of sports,” Ghafourian says. That’s putting it mildly! His first knee injury, a torn meniscus (cartilage), occurred while he was practicing kickboxing in his 60s. Surgery didn’t solve the issue and Ghafourian relied on painkillers until COVID-19 disrupted the supply. “My pain increased significantly,” he recalls. “I could barely walk, and it was very difficult to get in and out of my car.”

Dr. Andrawis remembers too. “He was a young guy, using crutches to walk.” (Ghafourian was 67 when he had a total knee replacement.) “Narcotic pain medication is not a long-term solution. It’s important for people to recognize if they need to take pain medication to get through the day, it’s a signal to consider surgery. We know over time, their bodies will get used to narcotics and just need more.” Knee replacement surgeries require pain management, but that’s most often accomplished with a pain block administered at the time of the surgery. “Pain blocks now last three to four days, which is when people feel the most pain,” Dr. Andrawis says. “People are able to get back to their normal routines faster and more easily than ever.”

For Ghafourian, it meant at-home physical therapy. “Every single day a physical therapist and a nurse came to my house and checked on me. I really appreciated that. I had two weeks of rest, and then I started using crutches – I could stand and I could walk,” he says. “Dr. Andrawis told me to use crutches for another two weeks, and after that I started PT two or three times a week. After another two or three weeks I was able to walk with no pain. Now I’m walking, jogging and kickboxing with no pain.”

“Dr. Andrawis and his Torrance Memorial team gave me a bit of light and happiness. I am a new person… I am so happy.” 

John Andrawis, MD, is an Orthopedic Surgeon at Torrance Memorial Physician Network’s two Orthopedic locations in Torrance: 23550 Hawthorne Blvd. Ste. 120; 310-517-1216: 23560 Crenshaw Blvd., Ste. 102; 310-784-2355. Dr. Andrawis is also part of the Lundquist Orthopedic Institute at Torrance Memorial.