The Joint Replacement Podcast – Episode #30 featuring Andrew Wickline, MD
One of the biggest concerns patients have before hip or knee replacement surgery is pain. For decades, opioid medications were considered the cornerstone of postoperative pain management. While opioids remain appropriate in certain circumstances, growing awareness of opioid dependence and advances in multimodal pain management have led many orthopedic surgeons to rethink traditional recovery pathways.
In Episode #30 of The Joint Replacement Podcast, Dr. Matthew Sloan sits down with fellowship-trained adult reconstruction surgeon Dr. Andrew Wickline to discuss how modern recovery protocols are helping many patients recover from joint replacement with little—or even no—opioid medication. Throughout the conversation, Dr. Wickline shares the philosophy, data, and practical changes that have shaped his approach to postoperative recovery.
Why Pain After Joint Replacement Is More Than Just the Incision
One of the central themes of the discussion is that postoperative pain is influenced by far more than the surgical incision itself.
Dr. Wickline believes postoperative swelling plays a major role in patient discomfort. His recovery protocol is designed to minimize swelling during the critical first week after surgery through careful activity modification, compression, cryotherapy, and patient education. By reducing swelling, patients often experience less pain and improved early range of motion.
The Importance of Patient Education
Successful recovery begins long before surgery.
Dr. Wickline emphasizes preparing patients by educating them about what to expect each day during recovery. Setting realistic expectations helps patients recognize normal healing milestones and reduces unnecessary anxiety when temporary increases in pain or swelling occur.
Rather than reacting to unexpected symptoms, patients understand that swelling often peaks approximately one week after surgery and can plan accordingly. This proactive approach may reduce unnecessary emergency room visits while improving confidence throughout recovery.
Rethinking Early Recovery
Traditional recovery pathways often encouraged aggressive early physical therapy following total knee replacement.
After carefully tracking his own patient outcomes, Dr. Wickline questioned whether excessive early activity might actually increase swelling and delay recovery.
His current protocol includes:
- Limiting walking during the first several weeks after surgery
- Focusing on gentle range-of-motion exercises
- Delaying strengthening exercises
- Progressively increasing activity as swelling improves
According to his experience, reducing unnecessary inflammation may allow patients to regain motion more comfortably while requiring fewer opioid medications.
Building an Opioid-Free Recovery Protocol
Pain management is not based on a single medication.
Instead, Dr. Wickline describes a comprehensive multimodal strategy that includes:
- Preoperative patient education
- Scheduled acetaminophen
- Anti-inflammatory medications
- Extended tranexamic acid (TXA)
- Regional anesthesia
- Periarticular injections
- Compression therapy
- Cryotherapy
- Activity modification
- Selective use of newer non-opioid analgesics such as suzetrigine (Journavx®)
He emphasizes that these interventions work together rather than relying on any single component.
Can Patients Really Recover Without Opioids?
One of the most striking parts of the conversation involves Dr. Wickline’s reported outcomes.
He explains that:
- 88% of his total knee replacement patients never receive an opioid prescription
- 98% of his hip replacement patients never receive an opioid prescription
Importantly, he stresses that patients are not expected to simply tolerate severe pain. Instead, optimizing swelling control, education, anesthesia, and rehabilitation appears to substantially reduce pain before opioids become necessary. Patients who require additional pain control still receive appropriate medication when indicated.
Measuring Outcomes Instead of Following Tradition
Another major topic is continuous improvement.
Early in his career, Dr. Wickline challenged several long-held assumptions regarding rehabilitation after knee replacement. Rather than relying on anecdotal experience alone, he began systematically collecting patient-reported outcomes to determine whether protocol changes actually improved recovery.
He encourages surgeons to measure pain scores, range of motion, complications, emergency department visits, and opioid consumption rather than assuming traditional approaches remain optimal.
The Future of Joint Replacement Recovery
As technology continues to evolve, improvements in joint replacement recovery will likely come from multiple areas working together:
- Better perioperative education
- Data-driven recovery pathways
- Advanced anesthesia techniques
- Improved blood management
- Enhanced rehabilitation protocols
- New non-opioid pain medications
- Continuous outcomes monitoring
Dr. Wickline believes future progress will depend on surgeons openly sharing data and learning from one another to continually improve patient outcomes.
Listen to the Full Conversation
Episode #30 of The Joint Replacement Podcast provides an in-depth discussion of one surgeon’s evidence-informed approach to reducing opioid use while improving patient recovery after hip and knee replacement.
Whether you’re a patient considering joint replacement, a medical student, resident, or practicing orthopedic surgeon, this episode offers valuable insights into one of the fastest-evolving areas of modern arthroplasty.
Watch on YouTube: https://youtu.be/nPqFPJBJpaY
Or search “The Joint Replacement Podcast” on Spotify, Apple Podcasts, or wherever you listen to podcasts.
References
- Wickline A, Sloan M. The Joint Replacement Podcast, Episode #30: Opioid-Free Joint Replacement Recovery. 2026.
- American Academy of Orthopaedic Surgeons. Clinical Practice Guideline: Management of Osteoarthritis of the Knee (Non-Arthroplasty).
- American Association of Hip and Knee Surgeons. Clinical guidance on multimodal pain management and enhanced recovery after total joint arthroplasty.
- Centers for Disease Control and Prevention. Clinical Practice Guideline for Prescribing Opioids for Pain (2022).