Total Hip Replacement Can Be Safely Performed with Minimal Opioids for Pain Relief Interview with:
Andrew Wickline MD FAAOS
New Hartford, NY 13413  What is the background for this study?  What are the main findings?

Response: Joint replacement has long been synonymous with pain relief–but not until 6-12 weeks after surgery.  Many patients put off joint replacement due to fear and anxiety–particularly about the possible pain after surgery often seen in the first several months.  Opioids have long been the mainstay of controlling pain after surgery but are associated with significant side effects and risk for addiction and injury. 

Our study shows that with our comprehensive protocol, 97% of patients can have successful surgical recovery with little to no opioids being necessary to stay comfortable.  Additionally, it shows that 94% of patients can go home within 24 hours and 95% will likely need no post-operative therapy to recover. What should readers take away from your report?

Response: Research your surgeon.  Find a surgeon that performs 200 cases or more per year.  Find a surgeon that has a comprehensive optimization and education protocol with published results.  Do not underestimate the potential hazards of opioid medications and use them sparingly if needed.  Ask which approach your surgeon uses and ask to see verified results.  The top 200 orthopedic hospitals average a readmission rate of 3.2%.  You should try to find someone with approximately a 1% complication rate. What recommendations do you have for future research as a result of this work?

Response:  I would like to see a multi-center study looking at our same peri-operative protocol with the only variation being the surgical approach–anterior with a table, anterior without a table and posterior.  I believe a difference would be found which is why my protocol includes anterior approach using the Hana table as I believe the anterior approach allows for less soft tissue trauma and less inflammation as documented in previous publications. Is there anything else you would like to add?

Response: I personally operate with a new surgeon at least 3-4 times per year, both in the US and internationally.  It is my personal belief that every surgeon should feel that there is always room for improvement.

Do not settle for a surgeon that performs hip replacement exactly the same way he or she has done for the last 2 decades.  I suggest you be your own advocate.  Ask the surgeon what things have changed in the last 5 years and how many other surgeons they have visited since leaving formal residency and fellowship.  If they have not operated with someone else or had other surgeons visit them, then find a new surgeon.


J Orthopaedic Experience & Innovation

Wickline, Andrew, Kimberly Strong, and Jeffrey Murphy. 2020. “23-Hour Total Hip Replacement Requiring Only 3.5 Opioid Pills Through 6 Weeks:  A Non-Selected Prospective Consecutive One Year Cohort.” Journal of Orthopaedic Experience & Innovation, August.


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Last Updated on August 27, 2020 by