Patient’s faith in doctor rewarded

When Tom Thomason took the fifth, he was in a Sunrise Hospital operating room, not a courtroom.

Still, there was a question he couldn't answer as he went under the knife.

Not because he was afraid of incriminating himself.

He simply didn't know the answer to this question: Could Dr. Troy Watson pull off a successful ankle replacement surgery on his fifth try?

Few people know better than the 69-year-old Thomason - he's long worked as an executive in the health insurance industry - that taking a surgeon's fifth attempt at a complex operation can have far more immediate dire consequences than refusing to answer a prosecutor's questions by invoking the Fifth Amendment to the U.S. Constitution.

Watson told Thomason, whose ankle pain was so bad from arthritis and injuries suffered in football that he couldn't walk on the beach without a limp, that an amputation was possible if the procedure went wrong.

Just as Realtors argue the importance of location, health care professionals, including Thomason, preach that the most important factor in choosing a surgeon is experience.

The more often a surgeon does a procedure, the more instinctive and consistent he becomes.

So why was Thomason cut on last year by a surgeon who had done most of his ankle replacements on cadavers?

"I researched doctors everywhere and decided Dr. Watson was my best choice," Thomason said as he walked, without a limp or pain, in his Henderson neighborhood. "Aftercare's important, and I couldn't live somewhere else for months."

Unlike knee and hip replacement surgeries - more than 800,000 are performed each year - ankle replacements aren't common. Though the procedure has been around for three decades, problems with early devices left surgeons and patients wary. Less than 5,000 are done each year, with only a few done in Las Vegas.

Most of the 50,000 people a year who experience end-stage ankle arthritis, with painful bone-on-bone contact, use ankle fusion as their surgical option. That procedure, where the worn-out part of the joint is removed and bones are locked together with screws and plates, relieves pain but decreases mobility.

"I didn't think fusion would leave my ankle flexible enough for golf," Thomason said.

So he ended up in Watson's office at Desert Orthopaedic Clinic. The surgeon, long experienced in fusions, described a new ankle replacement technique, one with minimal bone removal.

During surgery, the surfaces of the ankle joint are replaced with metal and a plastic spacer acts as a cushion between the surfaces. If all goes well, there is a smooth, stable motion through the ankle joint.

Thomason was impressed by how candid Watson was about his experience - and by how confident he was that his training in the new procedure would result in a successful surgery.

"I'm confident this new surgery is here to stay," Watson, 46, told me as we viewed Thomason's X-rays. "But not everyone can have it done. Some ankles are too deformed."

Thomason's surgery, which Watson performed with Dr. Roger Fontes' assistance - took two hours. He stayed off his feet for two months, seeing Watson weekly and often getting new casts.

At four months he walked well and by nine months he felt great.

Watson realizes Thomason had to take a leap of faith to undergo surgery from someone inexperienced in a procedure.

It is, he noted, how medicine advances: "Someone must be one of the first. I'm glad Mr. Thomason had confidence in me."

So is Thomason.

"Next to marrying my wife and having my children, this surgery is the best thing that ever happed to me."

Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at pharasim@reviewjournal.com or 702-387-2908.