Kate Killebrew, M.D., and John Karon

Kate Killebrew and John Karon of Albuquerque, New Mexico, both traveled to
Missouri Hip & Knee Center for hip replacement surgery.

It's unusual for a patient to travel halfway across the country for surgery. It’s even more unusual for a husband and wife to both make the journey for separate surgeries. But when radiologist Kate Killebrew, M.D., and John Karon of Albuquerque, New Mexico, decided the time for hip replacement surgery had come, they turned to the Missouri Hip & Knee Center. They agreed to share some of their experiences with us.

Kate: I was severely limited when I had my right total hip replacement. I was using a cane and had given up all exercise and unnecessary walking. Several times during the POET pre-op orientation at the hospital, I was asked if I wanted a wheelchair. John was less restricted, but had had to drop much of his customary active exercise -- running, jogging, hiking, backpacking, skiing.

I ran into Dr. Bal because of his experience and his great Web site. I have a large old third-degree burn covering my right hip and leg, which was the hip that needed replacing.  He was willing to operate on the hip and used the anterior incision, which I wanted because of the fast recovery. Because of what he encountered when he entered, he had to use a different prosthesis, which lengthened my leg somewhat, about 4-5 mm, which doesn't sound like much, but which necessitates my using a lift in the other shoe. I also needed three transfusions, because of the constant oozing from the site. Nevertheless, I made a very speedy, uncomplicated recovery. I accepted this as the price you pay for  having a very difficult problem. Dr. Bal used the anterior incision through the scar despite potential complications, because overall it's the best approach for the replacement.

John: I had been running for 45 years (since high school), finishing 15 marathons in quite respectable times starting when I was in my mid-50s (including Boston), annual roughly one-week backpack trips in the high Sierra in California for many years, approximately 10-mile-a-day hikes in New Mexico, among other activities. I developed groin pain while training for the Boston Marathon during the winter of 2003, and was eventually diagnosed with hip arthritis. I continued hiking and backpacking until I developed substantially greater discomfort during the winter of 2007, forcing me to give up hiking and backpacking for the rest of the year. These kinds of activities have been a major part of my life, and I wanted to be able to continue doing them!  I might have delayed surgery, but I walked with a distinct limp, and things weren't going to get any better.

Kate: My surgical experience and especially the anesthesia were a breeze. As a radiologist, I was “hoping” to see the Matta table and Dr. Bal in his hazmat suit, but I received the anesthetic while in my bed in the corridor and woke up the next second in recovery!  I was immensely relieved. The anesthesiologist had also used Duramorph  in the epidural, so that I had no post-op pain.  This was in startling contrast to hand orthopedic surgery I had in the early 1990s, when I had a morphine pump, which didn't work, but did disorient me, and  I became extremely constipated. In contrast, the night of my surgery with Dr. Bal, I watched two “Cosby” reruns on TV! I could not believe that I would not be in agony afterwards and wouldn't require IV morphine. I was told that I needed a long-acting pain pill for the first physical therapy and really didn't. Being on a dedicated orthopaedic ward is great.

John: My surgical experience was very routine. I received a total replacement of my left hip on a Tuesday during late October 2007 (Kate went first, in early June, so I knew what to expect). Not much pain afterward (nothing I remember). I had hoped to have resurfacing, but Dr. Bal was forced to do a standard prosthesis as a result of a cyst on the head of the femur, a good conservative approach.

Kate: I never had “pain” in the usual sense. When I stood up or sat down, I felt stiff and sore for a few seconds. I also felt stiff and sore when I did the bed exercises, especially the slide, but again, not enough to justify taking the prescription painkiller. When I left I was given a bottle of 90 of these. I used three of them. I had a smooth and uneventful recovery. I did see a physical therapist once in my home city, but she said that I didn't need any therapy. But she -- not being used to such a fast recovery -- told me to lie down TWO HOURS a day and proceed with my walking VERY SLOWLY, which I did, fearing something calamitous would happen if I didn't.

John: I had routine physical therapy on Thursday afternoon and twice Friday. I was discharged Friday afternoon. Because we are from out of state, we moved to a hotel suite, planning to stay for an extra week (as we had after Kate’s surgery). I realized I had a substantial bleed in my thigh the next Monday morning (the reason was not clear; both Dr. Bal and Linda Landry said that nothing unusual happened during surgery). We got an immediate appointment with Dr. Bal. We spent an extra week at the hotel, so that I could bend the knee enough to sit in a car for two and a half hours to Kansas City and in a plane for two hours for the nonstop flight home. I had in-room physical therapy every day for about a week, and Dr. Bal and Linda Landry came to see how I was doing. My range of motion for my knee improved during the drive to Kansas City and the flight; we arrived home on a Friday night. I abandoned the walker the next day and used a walking stick. I needed no physical therapy at home and did exercises on my own. I used the stairs to the second floor of the house three weeks after surgery (I think I could have done it earlier).

Kate: My incision was longer than the usual one and took longer to heal. So neither of our cases was straightforward or uncomplicated. But we'd do it all again, and I may have to, not only for my hip but even for my knees eventually. We have recommended others to Dr. Bal, but not many are willing to go out of state. Being an M.D. myself, I understand the problems and challenges better than most, and so would be willing to go out of state for such fine care.

John: I resumed swimming five weeks after surgery, with some stiffness doing a flutter kick that disappeared quite soon, and resumed pool running with a flotation belt eight weeks after surgery. I resumed cross-country skiing exactly 14 weeks after surgery, skiing five miles with no pain, a little stiffness and soreness afterward.  I spent six and a half days cross-country skiing in Jackson Hole, Wyoming, less than four months after surgery, doing a total of over 60 miles, including one day of about 12 miles, with absolutely no pain, stiffness, or soreness.  I am now doing a combination of race walking at a good pace and some jogging for five miles two to three times per week. Within three months after surgery, I was back to helping walk our dogs about 20 miles per week.

In August 2008, I took a six-day backpack trip in the Sierra Nevada in California, covering about 60 miles (five full days with a full pack), starting with about 35 pounds (25% of my body weight), about 10 miles each of the first two days (3,500 feet of elevation gain the first day) -- again, absolutely no pain, no stiffness, no soreness, never took any medications to prevent these. So, I can now do essentially everything I could do before development of arthritis except run distances, and that may be a result of physiological and cardiac changes resulting from age.

Kate: The only advice I have tried to give people is to go to Dr. Bal. Also I try to explain the table and the approach and not cutting muscles, etc. This approach is not used here in Albuquerque by our large orthopaedic group, the largest in the state. People can't fathom the importance of the hospital, the cleanliness of the operating rooms and the surgery, the approach, the (expensive) table, the technique. They can't imagine going out of town, which they would probably do if they had cancer.

Dr. Bal has an excellent Web site. I researched the approach because of the scar. I actually feared that I would need extensive plastic surgical revision of the scar before the surgery! At his request I sent pictures, and he decided to go ahead. I read about the many advantages of the anterior approach and decided it was for me.

John: Don't postpone surgery until disability becomes too great! It is hard to recover strength and function at older ages (as a former endurance athlete, I know this from personal experience). Don't hesitate to ask questions. Dr. Bal responds very quickly to e-mail, as does Linda Landry. Know that recovery could be delayed (as mine was by my bleed); our cases show that post-operative experience can differ; have confidence that you will recover. Do your physical therapy exercises! My own incision is only about 3" long! Care at Columbia Regional is very good. Don't hesitate to come from a distance; Columbia is a nice town. If your surgery is during football season and you need to stay at a hotel for a while, schedule so that there is no home football game at least the next weekend!

John Karon on his backpacking trip in California's Sierra Nevada, August 2008.

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