New Knee Sets the Stage

Pat Halloran waited for the announcement of his name before walking up the steps to the Orpheum stage to begin their annual auction.  On the second step, his right knee locked up and excruciating pain surged through his body.  “I thought I was going to die,” he said.  But he pushed through and limped out to the stage, remaining on his feet for the entire auction.

For Halloran, president of the Orpheum Theatre, that was the turning point.  In December, he had a total knee replacement, and it has made a world of difference.  Halloran, like most people, had dealt with knee pain for years, which progressively got worse.  His employees became worried after seeing him hobble around the office everyday.  “It was really bothering me.  I had to give up golf,” he recalled.  “I limped and could barely get out of my chair.”  With his busy schedule at the office and going back and forth to New York each month, he didn’t have a choice; he had to be able to walk.

The typical candidate for knee replacement surgery is someone with severe osteoarthritis.  Osteoarthritis is a progressive condition of cartilage degeneration in the joints.  The cartilage between the bones breaks down until it rubs against each other, resulting in damage to the tissue and underlying bone.  Symptoms include joint pain, stiffness after inactivity and limited motion.

Usually knee replacement surgery is a last resort until other treatments are exhausted.  Halloran tried all the alternatives to no avail, from cortisone shots to hyaluronic acid injections, a synthetic form of human joint fluid.  “After having a few X-rays, you could see it was bone on bone,” he said.  Being a football player and golfer in high school, along with being heavy, contributed to the breakdown of his knee, Halloran conceded.

If modifying daily activities and different therapies fail to improve the joint, the options dwindle, explains Tim Krahn, M.D., orthopedic surgeon at OrthoMemphis, who performed Halloran’s surgery.  He does about 10 to 15 knee replacements per month.  “When it gets to the point that the medications and injections aren’t working, the quality of life is to where you’re not walking, there are two options: learn to live with it and give up aspects of your life like walking and exercising, or take time out of your busy life and do a knee replacement,” he explained.

Knee replacement surgery, also known as total knee arthroplasty, can help relieve pain and restore function in diseased knee joints.  As explained by, total knee replacement involves surgery to cover ends of the damaged thighbone, lower leg bone, and usually the kneecap, with artificial surfaces lined with metal and plastic.  Doctors usually use cement to secure knee joint components to the bones.  The procedure takes about two hours and a patient’s average hospital stay is three days.

“We encourage people to try everything short of surgery,” Krahn said.  “Patients feel more comfortable with their decision if they’ve exhausted all the non-surgical approaches.”

These days the surgery doesn’t keep people down very long.  Depending on their fitness level, and most importantly their attitude, patients can function rather quickly.  One day after surgery, most people start to walk with a walker or crutches.  They can begin to resume climbing stairs, sitting in and rising from chairs, and other daily activities within a few days.  Doctors may recommend patients ride a stationary bicycle to strengthen their leg muscles and improve the ability to bend their knee.

“Pat amazed me with his progress,” said Krahn.  “Pat was very motivated and worked.  He was out doing things quicker than the average person.”  Most studies show that total knees have a 90 percent survivorship at 15 years.  Overall, the benefits outweigh the challenges; however, a small percentile may still have limited range of motion.

A couple weeks after his surgery, Halloran took a trip to Florida and walked around with a cane; two weeks later he was in New York.  Currently he has about 85 percent range of motion back in his knee.  Krahn says it takes about nine months to get back to 100 percent.

To keep in shape, Halloran began with walking and using the elliptical machine and recumbent bike four times a week.  He admits he’s let it go a little since the surgery, but he has new inspiration.  “I can tell it’s been getting a little stiffer because I have been preoccupied, but I am getting back on it,” he said.

Krahn maintained that people shouldn’t make assumptions when it comes to replacement surgery, especially about whether they are too old or young for the surgery.  His 70- to 85-year-old patients think there’s no point, but he asks them, “Do you want to live the next 10 years of your life as an 80- or 90-year-old person not being able to walk, or do you want to take two to three months and consider a knee replacement?”

While the average age of people undergoing replacement surgery is between 60 and 70, there are some younger people getting replacements, such as age 50 and even younger.  “As our society has gotten more active in older age, patients expect more out of their lifestyle,” said Krahn.  “Surgical technique and instrumentation, pain management, accelerated rehab – all these things have combined to give people a better experience and outcome in a more predictable way.”

As for Halloran, who was off to New York at press time to watch a series of Broadway shows for the Tony voting season, he hasn’t looked back since the operation.  “My advice would be, and I’m not a doctor, wait as long as you can, but don’t be miserable,” he said.  “If your doctor says it’s fine to do it, just do it.”

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