Andrew Wickline, MD, an orthopedic surgeon with Genesee Orthopedics in New Hartford, N.Y., and Apex Surgical Center in Westmoreland, N.Y., is leading a national push to remove opioids from recovery after hip and knee replacements, The Rome Sentinel reported Sept. 9.
Dr. Wickline’s practice now discharges 98% of hip replacement patients and 89% of knee replacement patients without an opioid prescription, relying instead on nerve blocks, anti-inflammatory drugs, steroids and other multimodal pain management techniques, according to the report. He began cutting back opioid use in 2013, reducing prescriptions from more than 250 pills to 30 per patient before eliminating them almost entirely. His research also identified hesperidin and diosmin, two supplements that reduce post-operative swelling and inflammation, as key elements of the protocol.
About 1.6 million hip and knee replacements are performed in the U.S. each year, and research cited in the report estimates 144,000 new opioid addictions annually stem from post-surgical prescriptions, with 1 in 11 opioid patients still addicted a year later. Unmanaged pain also drives complications — an estimated 15% of post-op patients return to the emergency room with pain or swelling, at roughly $5,000 per visit.
Dr. Wickline’s approach has spread through March 2 a Million, an initiative that has drawn more than 50 surgeons across the U.S. and Europe to protocols limiting total joint cases to fewer than 10 opioid pills per episode. Dr. Kurtis Biggs, another orthopedic surgeon in the group, has credited Dr. Wickline’s research with driving his own shift to a nearly opioid-free practice. Dr. Wickline has also detailed his data-driven, patient-education-focused protocols in his book “Less Swelling, Less Pain.”
“This is achievable,” Dr. Wickline said. “You look at patients’ comments [and] they’re happy.”
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