Responding to Knee Pain
Blue Ridge HealthCare Focuses on Most Frequently Injured Joint

Click here to view this story as it appeared in the Morganton News Herald (Includes additional graphics and information) in pdf format. (about 850k)

By JERRY DAVIS - Blue Ridge HealthCare

SPECIAL TO THE NEWS HERALD

VALDESE - Jim Hatley enjoys walking the course when he plays golf. This may not seem special to most people, but for Hatley, it’s the next best thing to hitting a hole-in-one.

“Last year I had to get a handicapped certificate that allowed me to drive the golf cart right up to the green,” said the avid golfer, grandfather of two and Mayor of Valdese.

“The pain in my knees had been getting progressively worse for three or four years. It had gotten to the point where I was having trouble with day-to-day things like exercise, playing golf, even picking up our grandchildren,” he said. “If I worked in the yard one day, I couldn’t do other tasks the next.”

Hatley has plenty of company. The knee is injured more frequently than any other joint in the body.

“We abuse our knees a lot through activity and obesity,” said orthopedic surgeon Christopher T. Daley, MD. “As you start to bend your knee, you put about six times your body weight through the kneecap. Throw in any genetic weakness in the cartilage, arthritis or injury, and it’s no wonder that over the course of a lifetime you start to have problems with your knees.”

Although Dr. Daley performed a total knee replacement on Hatley at Valdese Hospital, most knee problems do not require surgery.

“Rarely do I initially recommend surgery. I recommend options,” said the Canadian-born physician, who began his career as an engineer and early on actually helped design a bionic arm. Out of curiosity, he watched an orthopedic surgeon implant the arm in a patient. “That’s all it took and I was hooked,” he said, going on to attain not only a medical degree but also a medical science degree, a psychology/biology degree and a fellowship in sports medicine and total joint surgery.

“Sometimes, it’s a simple matter of modifying routine activities so you lower the impact on your knees,” Dr. Daley said.

Other measures - often taken concurrently - might include exercise, therapy, weight loss programs, walking aids, braces, shoe wedges and medications or supplements. If symptoms are not relieved, then X-rays or MRI might follow to see inside the knee joint. Depending on the diagnosis, options then include steroid injections, cleaning debris from the joint arthroscopically, even visco-supplementation, “a ‘WD-40’ for the knee that offers relief for some people for up to a year,” he explained.

“If you still have pain and especially if the joint is improperly aligned, then we think about joint reconstruction and joint replacement,” Dr. Daley said, adding that some people come to him with pain and deformity so severe that the path to surgery is a lot quicker.

When surgery is the best option to relieving knee pain, there’s good news. Artificial knee joints are more durable than ever, and methods for implanting them can help ensure a motion that mimics the feel of a natural knee.

Great Expectations

“People today want the ability to be more active. Weekend warriors and aging athletes are a big part of my practice. They grew up working out and are now in their late 40s, 50s and 60s. Guess what? They’re just as about as athletic now as they were in their 30s,” he said. “They want to get back to or continue to do what they regularly do, whether it’s cycling, golfing, windsurfing or walking. Simply relieving pain is not enough for these active adults.”

While a pain-free lifestyle is not realistic for some people, Dr. Daley said his goal is to leave patients like Hatley with a pain-free gait and the ability to perform their activities of daily living. “By the time I went to Dr. Daley, I had developed a funny gait. I’d slide my feet along to make up for my bad knee joint, but four weeks after my surgery, I already had a much better gait,” Hatley said.

Durability, Design & Precision

The biggest advancement in artificial joints is how they’re constructed, Dr. Daley believes. The newest generation of implants, as orthopedists call them, is made from high-tech materials including titanium, surgical stainless steel, metal alloys and ultra high-grade polyethylene designed to last for 20 years or more. “There’s more science to them than in the past,” he said.

More than ever, the new joints also duplicate the body’s natural joints.

“Today’s artificial joints, like the one Jim received, are really designed to move like the body,” Dr. Daley said. “Jim’s new knee is a classic example. The rotating platform knee from Depuy more closely reproduces the twisting, sliding, bending of a natural joint. It’s really amazing.”

Besides durability and design, though, surgical precision is essential whenever an artificial joint is implanted, and Dr. Daley employs a special device during surgery to ensure just the right “fit” - the Knee Balancer.

“The device has been around now for a number of years and we were, according to Erik Weaver at Depuy, the first center outside of Charlotte to use it,” he said.

“During surgery, it helps us define to within a millimeter exactly where to place the artificial knee, so we can reproduce the natural mechanics of the knee. When you complete the surgery, you know the joint is well balanced,” he added.

Extraordinary precision is especially important with a rotating artificial knee joint like the one Hatley received.

“We were able to get it perfectly balanced for him and it works beautifully,” he said. “We are so much more precise than we were even several years ago and I think it’s going to improve that much more.”

Since he began using the knee balancer, Dr. Daley said results are more predictable, joints are more stable, motion much better and patients are back to routine activities quicker.

Rehabilitation Motivation

Within hours of his surgery, Hatley was taking his first tentative steps on his new knee, first to a chair in his room and the next day down a hallway at Valdese Hospital. For the next three weeks, the team at Blue Ridge Home HealthCare provided therapy in his home. Then began a month of rehabilitation designed to improve his balance, range of motion and strength.

“Patient motivation plays a big part, and Jim consistently showed excellent progress, great appearance and an impressive range of motion,” said Blue Ridge HealthCare Physical Therapist Keisha Paige.

Fellow PT Tracy Stillwell, manager of the rehabilitation program at Valdese Hospital, said her team is able to tailor a program to fit any patients’ functional goals.

“Mr. Hatley told us that one of his goals is to revive his golf swing and drive a golf ball 20 yards farther than before his surgery,” she said.

Hatley is confident that his new knee will exceed his expectations in every way, including his golf game.

“With a team like this behind me, I’ve put all my golfing buddies on notice that there’s a new game in town,” he said.

The second largest employer in Burke County, Blue Ridge HealthCare serves a four-county area and includes Grace and Valdese hospitals, Blue Ridge Home HealthCare, Grace Heights and College Pines Health & Rehabilitation Centers, Grace Ridge Retirement Community, Phifer Wellness Center and a number of physician practices.