The moment came when Dr. Mark Hartman — an almost compulsively active man and the father of an NFL quarterback — could no longer deny what was happening to his knees.

It was October 2025. Hartman had adopted a new routine in his nonworking days of semi-retirement: Wake up at 4:30 a.m. Ride his bike, then lift weights. Play pickleball, a game he’d grown addicted to, from 6 to 8 a.m. Then hit golf balls until about 9 a.m., fish until noon, then work as a volunteer football coach at Oceanside Collegiate Academy high school near his home in Mount Pleasant, South Carolina, just across the Cooper River from Charleston. (He moved to Mount Pleasant from Charlotte at the end of 2022.) Only then, at about 4 p.m., would he even think about winding down.

That fall, Hartman’s knees began to hurt. The pain was excruciating, like a bad toothache. “I got to the point where I was having to sit down at football. I was having to bow out of my pickleball games,” he said. “I could not do my routine, which was very important to me.”

A warning from a colleague

Hartman had received a warning from a colleague some months before. In late 2023, Novant Health purchased three South Carolina hospitals and other operations from Tenet Healthcare to expand Novant’s footprint in the Carolinas.

At a dinner meeting later to discuss the acquisition’s effects, Dr. H. Del Schutte, Jr., of the Joint Institute at Novant Health Orthopedics & Sports Medicine spotted Hartman as he made his way around the room. The two had met but didn’t know each other well.

It was months before Hartman’s pain set in. But Schutte, an orthopedic surgeon who specializes in knee replacements, took one look at Hartman’s gait and asked: “When are you going to get them fixed?”

Relating the story recently, Hartman recalled with a chuckle: “He saw me and just shook his head.”

By fall 2025, Hartman understood what his colleague had meant. He had his knees X-rayed at The Southeastern Spine Institute in Mount Pleasant. By then, the institute was a Novant Health property where Hartman worked on a part-time basis, assessing whether patients needed surgery.

This time, he assessed himself: Yes. The cartilage in both knees had worn away. “Complete bone-on-bone,” he said. “There was no doubt I needed my knees replaced.”

Chatting about a famous son

Hartman, 65, played defensive back at Davidson College from 1979-83. His younger son, Sam, took to football, too. Sam Hartman was a four-year starter at quarterback for Wake Forest from 2018-22, then spent his final year of eligibility at Notre Dame, where he led the Fighting Irish to a 9-3 record. He’s currently on the Washington Commanders’ roster.

Mark Hartman and Schutte had talked briefly about Sam before the knee pain hit, but Hartman didn’t know that much about Schutte. After the X-rays, Hartman did some checking, and he learned that his colleague was one of the best knee replacement surgeons around.

Besides, Hartman knew what artificial knees he wanted — implants from the Michigan manufacturer Stryker. From there, it was simply a matter of scheduling the surgery and getting it done. You might think, given Hartman’s aggressiveness — he concedes, too, that “I’ve got a pretty damn big ego” — that he might be a handful as a patient.

The opposite happened. The only specific question Hartman had was: When can I play pickleball again? Gradually, a friendship developed between the two surgeons. A frequent conversation topic is Hartman’s older son, Joe, an aspiring orthopedic surgeon who’ll soon begin a residency program at Vanderbilt University School of Medicine. And the December replacement of both knees, from pre-op to post-op, went off without a hitch.

Why a double knee replacement?

As a general rule, knee replacement surgeons recommend treating one knee at a time so patients have one “good” leg to help steady themselves during recovery. Also, there’s a slightly higher chance of complications with a double knee replacement.

But Hartman, ever up for a challenge, literally trained for the surgery, building up even more muscle and losing some weight. Schutte was confident his 6-foot-1 patient could handle it.

Knee replacement surgery has come a long way in recent years, Schutte said. He champions what surgeons refer to as the “muscle-sparing subvastus approach.” Surgeons reach the joint by going under the vastus medialis muscle in the thigh rather than cutting through the muscle and quadriceps tendon. That means far less pain and quicker recovery time.

Schutte also favors kinematic rather than anatomical alignment, which means the surgery is tailored to restore each individual’s pre-arthritic state rather than adhere to a more uniform standard. Hartman agreed with him on both approaches.

“He knew enough to know that controlling the environment from a patient standpoint is not ideal,” Schutte said. “He trusted us. He trusted our program. He had access to patients we had taken care of before, so he knew our results.

“He was really an ideal first patient. He was willing to come, follow the regimen, and didn’t try to cut corners. He was prepared before surgery. He was fit and healthy and optimized his care before, and that’s part of the reason we ended up with a good result.”

Most of the way back

Nonetheless, after surgery, Schutte made sure Hartman didn’t push it. That’s the main contradiction of joint replacement surgery: You want to resume your active lifestyle. So you have surgery. After surgery, the way to be active again is to take it slow.

“We saw him frequently, at almost weekly or every other week intervals, knowing that he would tend to push the envelope a little bit,” Schutte said. “We just wanted to check and make sure that he wasn’t doing too much too fast, and he really followed the program as well as you could have ever hoped for.”

Hartman’s rehab is going well this spring under Schutte’s supervision. Both doctors said Hartman has regained about 80% of the strength and range of movement he had before — although it’ll likely be another six to eight months before that number hits 100%. Everything considered, it’s OK.

Hartman and I spoke by phone in early April. I started the conversation by asking him how he was doing. “I just got through playing pickleball and hitting golf balls,” he said, “so I’m doing pretty good.”

“I’m doing everything that I want to do,” he added later. “I’m not doing it at the same pace or intensity. If I sit for a while, when I get up to go, that first step is still a little bit of a doozy. But I’ve heard that goes away somewhere between nine months and a year.”

The surgery had another unexpected benefit, Hartman said with another chuckle: “I got an inch back in height, which was nice.”

Bottom line: Don’t wait until you’re suffering to have an orthopedist examine your knees and hips. If you undergo surgery, carefully follow your doctor’s recovery and rehab guidelines. And remember that not every patient will be a candidate for the two-knees-at-once approach.

Finally, keep in mind that “One of the challenges in hip and knee replacement,” Schutte said, “is people who do too much too soon.”