Issue link: https://viewer.e-digitaledition.com/i/1305937
T O TA L K N E E R E P L A C E M E N T is one of the more pa in- ful surgeries. "My patients used to say, 'I'd rather have another child than do this again,'" says Andrew Wickline, MD, FAOSS, FA AHKS, a n or thopedic joint reconstruction specia list at Genesee Orthopedics & Plastic Surgery Associates. The level of pain associated with a total knee replacement typically results in a large prescription for narcotic pain medica- tion post-surgery. With opioid use and addiction up across the state, however, Dr. Wickline created a different approach for his patients. He now uses multiple non-opioid choices and a game-changing home therapy plan he created. "There's somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn't use opioids before," Dr. Wickline says. "That's at least eight out of 100 people or at least 50,000 people a year nationally. That's a frightening number." THE PROBLEM WITH OPIOIDS In 2018, opioids were involved in almost 47,000 overdose deaths — 69.5% of all drug overdose deaths. Although New York has not been hit as hard as some other states, the problem continues to grow. "Once you become an opioid user, you end up costing the medical system double the average amount of cost for a year," Dr. Wickline says. "For commercial payers, for example, the average cost is around $11,000. But if you're an opioid user, it goes up to almost $20,000." Even just a 24-hour prescription of narcotics has a 6% risk of chronic opioid addiction. So, after studying the issue and working with patients, Dr. Wickline published a study — 23-hour TKA in 10 Opioid Pills or Less Through 90 Days: A Non-Selected Prospective Consecutive One Year Cohort — earlier this year outlining his approach. " There's somewhere between an 8% to 14% risk of permanent opioid addiction after a total knee replacement for a patient who didn't use opioids before." — ANDREW WICKLINE, MD, FAOSS, FAAHKS, ORTHOPEDIC JOINT RECONSTRUCTION SPECIALIST AT GENESEE ORTHOPEDICS & PLASTIC SURGERY ASSOCIATES Dr. Wickline Andrew Wickline, MD, with a robotic surgical system. He is now also using a different type of technique called kinematics alignment for personalized fit. The negative to the robot is that it shoe horns people into the same size fit no matter what their pre-existing pre-arthritic alignment was. Kinematic alignment allows for that. Genessee Orthopedics will be performing a trial of an augmented reality system in the near future. BY CARI WADE GERVIN ANDRE W WICKlINE, MD, FAOSS, FA AHKS, USES A JOINT REPl ACEMENT PROGR AM THAT MINIMIZES OPIOID USE TO PROMOTE HOlISTIC HE AlING AND BE T TER OUTCOMES. Minimal Medication, Maximum Care at Genesee Orthopedics & Plastic Surgery Associates 1 0