Some patients also had to travel long
distances for physica l therapy, which
presented a sig nif ica nt obstacle to a
successful recovery. After developing an
at-home therapy plan for these patients,
Dr. Wickline found that they experienced
less pain, better range of motion, and a
faster overall recovery than those who
followed a traditional, intensive inpatient
physical therapy program. This success
has been seen with patients from Pakistan,
southeast Asia, Canada, the Caribbean,
Texas, North Carolina, New Jersey, Maine
and Pennsylvania.
EXCEEDING EXPECTATIONS
Dr. Wickline began using a home-therapy
method for all of his patients combined
with a comprehensive education and
optimization plan. The results showed
not only an easier recovery, but patients
needed drastically fewer narcotics for
pain relief following surgery. In 2020, he
published the results of his new study, in
the Journal of Orthopaedic Experience &
Innovation. It involved 386 patients who
had tota l knee replacement. During a
12-week period, 86.3% of patients needed
10 or fewer opioid pills, while 18.9% used
zero opioids.
Dr. Wickline's results are 16 times less
than the national average and five times
less than the next best published opioid
reduction paper from Mayo Clinic.
"I saw a new study that said the average
across the country is 1,200 morphine
milligram equivalents for the three-month
period after tota l joint replacement,"
Dr. Wickline says. "That's around 160
oxycodone 5mg pills for 90 days — com-
pared to 10 pills or less with my protocol.
There is still a disconnect, and we need
better opioid stewardship in New York
and across the country."
In 2021, more than 107,000 people in
the United States died from opioid-related
overdoses. According to some studies,
between 8% and 12% of people who are
prescribed opioids for pain after joint
replacement may develop an addiction.
Dr. Wickline's approach replaces the
t y pica l 90 -minute physica l t herapy
sessions three times a week with four
simple 8-minute exercises once an hour.
Using elevation and ice after the exercises
also keeps swelling down, which further
decreases pain.
"If you sprain your ankle badly, you're
not going to do a 90-minute workout three
times a week," he says. "It turns out that
you don't need to do aggressive, tortuous
therapy if you control swelling. Formal
therapy is best used to fine tune recovery
at five to six weeks after surgery."
More t ha n 85% of pat ient s i n Dr
Wickline's study did not need forma l
physical therapy, leading to an average
persona l sav ings of $720 in therapy
copays and more than $3,000 savings to
insurers. In addition, 64% of patients in
the study went home the day of surgery
and 91% were discharged within 23 hours.
Currently, 95% of patients go home the
same day their joint was replaced.
Pat ient s who fol low t he prog ra m
a l s o e x p e r i e n c e s i g n i f i c a n t l y
fewer complications.
"Our readmission rate is 1.2%. That is
markedly lower than results published by
some big institutions," Dr. Wickline says.
"That's also where cost is kept down. If
you get readmitted for a fracture, sud-
denly the cost for that patient has gone
up dramatically. According to Medicare
cost data, I have the lowest 90-day cost in
the state, even though my patients have a
higher number of medical issues."
CONTRIBUTING SUCCESS FACTORS
Dr. Wickline is among a small percentage
of surgeons in the country performing
tourniquet-free knee replacements. This
practice lowers the risk of blood clots by
19%. It also reduces pain and infection
risk and improves incision healing.
In addition, Dr. Wickline is the only site
in New York offering personalized kine-
matic alignment and medial pivot knee
replacement. It restores each patient's
normal anatomy of the knee and provides
knee motion that most closely resembles
that of the native join — without painful
ligament releases that increase swelling.
Improving nutrition with branched-
chain amino acid protein supplementation
a nd specif ic a nti-inf la mmator y diet
Siobhan Fitzgerald, RN,
BSN, Nurse Administrator
Apex Surgical Center
M D N E W S . C O M /// M D N E W S C E N T R A l N E W Y O R K
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