The following is a review of the first 32 cases of partial knee replacement at Peace Arch Hospital (December 2000 to February 2002). It describes the process of implementing a new procedure into an existing surgical practice and into an existing surgical facility.

Partial knee replacement (also called unicompartmental knee replacement, uni-knee or sometimes the 'Oxford Knee') is not a new concept. This method of replacing a small part of the knee has been studied and performed since the 1970's. The early results in North America were not encouraging. Failure rates five or six years after surgery were unacceptably high. Furthermore, this procedure initially required as large an incision and was as traumatic as for a total knee replacement. However, in 1999, I reviewed the work of Murray, Goodfellow and O'Connor -- they showed 98 percent survival of the Oxford partial knee replacement at 10 years. Obviously, significant steps had been made in combating the early difficulties.

By giving particular care to patient selection, the type of artificial component used, and surgical technique, partial knee replacement was successfully introduced into orthopaedic practice at the Peace Arch Hospital.

When I started general orthopedic practice in September 1999, I quickly realized that the main focus of my workload would be treatment of osteoarthritis (wear and tear on the joints). I encountered a significant number of people with severe functional restrictions due to wear and tear on one side of the knee (unicompartmental osteoarthrosis). The standard surgical treatment for these people was total knee replacement or, much more controversial, high tibial osteotomy. In the spring of 2000 I started evaluating younger, potentially more active, patients (usually age 50 or less) for suitability for high tibial osteotomy and by the summer I had several patients on my waiting list.