Dr. Lindsey Rolston has found a nice niche for knees in the small east-central Indiana city of New Castle.

The orthopedic surgeon for Henry County Hospital is the inventor of a partial artificial knee device known as the Journey Deuce, which is manufactured by orthopedics implant maker Smith & Nephew.

In addition to that, Rolston and his surgical partner, Dr. Thomas Mathews, specialize in working simultaneously on the same patient in cases where people have two bum knees. Rolston said doing two knee replacements at once reduces a patient''s time under anesthesia.

All of this has resulted in the Henry County Center for Orthopedic Surgery & Sports Medicine drawing many of its patients -- Rolston said at least 60 percent -- from outside Henry Country.

One orthopedics industry insider was intrigued by Rolston and Mathews'' team approach.

"That''s pretty unusual and kind of cool, actually," said Robin Young, publisher of Pennsylvania-based trade newsletter Orthopedics This Week.

Young said the success of two surgeons simultaneously working on two knees is a balancing act: "A lot depends on chemistry of the two surgeons, how they get along in the O.R. together. It requires a really close working relationship that''s hard to find."

The two New Castle surgeons have strong ties. Rolston said he and Mathews were born the same week and were Michigan State medical residents together in Kalamazoo, and both started working in New Castle in 1994. Last week, Mathews implanted a Journey Deuce knee in Rolston''s mother.

Smith & Nephew launched the Deuce three years ago as an alternative to total knee replacement for some patients.

Rolston came up with the idea for the Deuce after noticing that in many of his knee-replacement patients, arthritis had badly damaged the inside part of the knee and kneecap area, while the outside portion of the knee and the supporting ligaments appeared normal. The Deuce replaces the kneecap and inner portion of the thigh and shin bones -- meaning less bone is removed than in total knee replacements.

The Deuce, unlike total knee replacement, also preserves the patient''s anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). Rolston said leaving those ligaments in place helps increase a patient''s stability for activities such as walking and climbing stairs.

According to Smith & Nephew, the Deuce''s benefits include a potentially smaller surgical incision, decreased blood loss and a possibly quicker recovery time.

Rolston estimates his team has performed about 800 Deuce operations, including on patients traveling to New Castle from locations such as Colorado, Florida, Minnesota and New Jersey.

Blake Dye, chief executive of Henry County Hospital, said Rolston and Mathews'' orthopedic center is one of the hospital''s top money makers. "They built this from scratch," he said.

It''s a nice reminder that medical innovation doesn''t always come from big-city medical centers.