On March 7, I consulted Dr. Robert Trousdale regarding my knee. Dr. Trousdale is a physician in the Mayo Clinic Department of Orthopedics Surgery. He read my x-rays, examined my knee, and offered a straightforward evaluation of my options. I was, in his perspective, a candidate for total knee replacement. Imaging of my knee coupled with the history of the accident that initiated the deterioration of the joint cartilage and bone around my knee placed me in that category of dubious distinction, surgical candidate. He advised that the decision to go forward with surgery remained my own. He advised me that only I could know whether I had crossed the threshold of pain and disability that would lead me to deciding to undergo major surgery. And it was my decision alone to bear the risk and live with the pain of surgery and recovery.
It was an easy decision. I already had crossed the threshold.
I could no longer walk two blocks from my parked car or from the bus stop to my office without pain. I was more than uncomfortable sitting through hour long meetings with my knee folded under tables at ninety degrees. I grunted, or sometimes cried out, in pain just getting up from my desk. I woke up with pain in the morning, and the first few steps out of bed were difficult.
When I thought about it, I had really been limited for a couple years. An avid outdoorsman, I found that I could no longer hike up steep inclines such as the valleys and coolies that drain from the plains into the Mississippi River without sidestepping up the hillside, my right leg doing the bulk of the work to compensate for my weakened left knee. Even bicycling had become a challenge; I was too sore after a twenty mile bike ride to enjoy the post exercise endorphin high.
My knee imposed severe restrictions on my lifestyle. While some of that reduced quality of life had snuck up on my gradually, the painful result after remodeling our basement office took me beyond denial. It was time.
My commitment to surgery depended on gaining confidence that several parameters of reasonable expectation of success would be met. These included:
- I subject myself to surgery in an environment that promoted success. Mayo Clinic offered that opportunity. Currently number two on the U.S. News hospital ratings for orthopedics as a specialty (and number 3 overall among all hospitals), Mayo Clinic strives to meet the patient’s needs. Since I was to be the patient, that was important to me.
- I would settle for no less than an expert surgeon. In Dr. Trousdale, I found not only an elite expert, but an artist as well. Performing six surgeries a day with a well-orchestrated surgical team of orthopedic specialists, he has the experience to handle the normal case, as well as address beyond normal challenges for those patients who demand greater measures of care. He also taught his art to residents – a feature that some patients express concern about. I felt comfortable with the notion of Dr. Trousdale share his knowledge and experience with residents while I was the patient.
- The success ratio was maximized. As a research institution, orthopedic surgeons at Mayo had determined that the greatest opportunity of success for total knee replacements demanded a minimum of time during which the patient was being operated on. I expected a procedure to last an hour. Mayo’s team approach to knee surgery allowed shorter operations, which led to minimized risk for infection. Infection is a major concern and risk.
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I’m ready, I told Dr. Trousdale. We set a date for surgery on May 7.