May 23, 2025 • 29 mins
Revolutionizing Patient Recovery: Dr. Andrew Wickline's Mission for Opioid-Free Healing
In this episode of the AHF Podcast, host Joe Schwab interviews Dr. Andrew Wickline, an orthopedic surgeon, educator, and author committed to improving patient recovery and education. Dr. Wickline discusses his books 'Less Swelling, Less Pain' for total hip and knee replacements, the importance of patient engagement, and his groundbreaking '1 Million Patient Mission' to eliminate opioid addiction risks. The conversation covers the current landscape of patient recovery education, the benefits of the anterior approach, and future innovations in surgery and recovery.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Joseph M Schwab (00:24):
Hello, and welcome to the AHF Podcast.
I'm your host, Joe Schwab.
Dr.
Andrew Wickline is an orthopedicsurgeon, educator, and author of
two books, less Swelling, lessPain, total Hip.
And less swelling, less pain,total knee.
Both books are now available inSpanish reflecting his deep
commitment to accessible patientcare and education.
(00:47):
Dr.
Wickline, thank you for joiningus.
Andrew Wickline (00:51):
Good morning from upstate New York.
Glad to be here.
Joseph M Schwab (00:54):
Um, let's start with your book.
Uh, less pain, less, uh, excuseme, less Swelling, less Pain.
What inspired you to write theseand what's really your goal in
making them available to a wideraudience, including Spanish
speaking patients?
I.
Andrew Wickline (01:09):
Well, uh, back in 2015, I heard, uh.
Dr.
Craig McAllister and Dr.
Ira Kirschenbaum, they, theytalked about how, um, patient
engagement was the key towardsallowing patients to go home the
same day.
And, uh, so they convinced me tokind of write my, my version of
the book and took me six months.
I mean, most surgeons were busy.
(01:29):
They've got a bunch of flyersthey hand out at at different
time points postoperatively.
But I sat down, I said, what ifI was a patient?
What.
What would that book look like?
You know, when your daughter,uh, or wife gets pregnant for
the first time, she gets thisbook called What to Expect When
You're Expecting.
Right.
Everybody in the United Stateshas seen that.
Um, and then, you know, if youhave a family member, uh, like
with my wife, when she hadcancer, we had this amazing book
(01:51):
to Breast Cancer handbook, youknow, how to, how to Succeed and
get through this really terribletime.
And I recognized that Total Kneeand Total Hip, it's not a lot of
fun and it's a, it's a big blackbox for patients so.
I, I wrote the, the first book,I've, I've revised it 31 times
and since that time of the veryfirst book, we've published
lowest opioid use in the UnitedStates.
(02:12):
We, uh, just published lowestswelling worldwide after knee
replacement.
And so I thought it was time to,to bring the, uh, that, that
data, those publications all inone book to patients, uh, direct
to patients.
Joseph M Schwab (02:25):
So what have you seen or, or in your
research, what is the landscapefor current, you know, patient
recovery education look like?
Andrew Wickline (02:35):
So it's kinda all over, uh, the, the, uh,
field.
It's, you know, I, I've, I'veoperated with many, many
different surgeons, uh, over 60surgeons.
Uh, and, uh, and it's, you know,when you're busy, when you're
not busy, you, you have time todo all these things, but once
you get busy, it's reallychallenging the way, um, uh,
(02:56):
most surgeons do it.
They've got their handoutsagain, just like what I was
doing, but it, it's.
It's very hit or miss and it'svery sporadic.
I really think we could do abetter job at tightening up the
protocol.
Um, you know, otherwise patientsgo to Dr.
Google and that's, that's aterrifying experience.
You know, I, I've got 8,200hours of my life, you know,
that's four full-time years ofworking, uh, nights and weekends
(03:20):
away from my, my wife and kids,you know, and I, and I tell
patients, listen, this is mylove letter to you.
I took time away from my familyto help you succeed.
And so.
They would take the book, theywould journal in it.
I've got 7,000 patients thathave given me the book back, and
I, I, I'm able to see reallyamazing detailed descriptions
about what happens every daypost-op, what to expect.
(03:42):
It's not just black and white, apain score, a three or a four.
It's, you know, actualsentences.
Hey Doc, I really have troublerolling over at night.
You know, what, what, what isthat?
Normal?
And, and patients are worried.
They wanna know what's normal,what's not.
And it answers every questionthe last 23 years of practice.
You know, can I have a flu shot?
Uh, what are the parts made of,uh, what's the best diet?
(04:02):
Uh, am I ready for surgery?
I got two whole pages to helppatients determine, am I ready
for surgery?
Joseph M Schwab (04:08):
Is it, so you mentioned Dr.
Google.
Is that how you find mostpatients are currently learning
about recovery?
Apart from, of course, the.
The patients that you're givenyour book to.
Andrew Wickline (04:18):
It seems like it, you know, uh, when you look
online, look at the blogs,there's lots of, you know, um,
uh, patient organized blogs to,uh, to kind of help people
because, because their doctorisn't doing it, you know, isn't
providing the information, andso they feel the need to do it
themselves.
So I.
Um, this is one way that, thatyou can have qualified
information if you, if patientslook in my book, I, I've got,
(04:41):
uh, references to each of thearticles that are published that
help, uh, show them where theycan find, actually find the
science behind therecommendation I'm giving them.
Joseph M Schwab (04:50):
Yeah.
And do you find, does your bookalso sort of create or recreate
that sense of maybe communitythat some folks feel online with
an online blog?
Andrew Wickline (05:01):
I think so because there's actual patient
quotes every single day post-op.
So the book is kind of dividedin two, two parts, you know?
Um.
What to expect before surgery.
How to optimize each of thedifferent body systems, you
know, if you're a man, if youhave prostate issues, did you
know that, you know, certaintypes of anesthesia can put you
at more risk for having, uh, youknow, prostate, you know,
(05:21):
problems post-op and wearing acatheter.
Nobody wants that and nobody'sgonna be happy with that, with
that outcome.
So at least if you can discussit with patients, that helps,
you know, post-op, uh, uh, youknow, I generally have a, a, a
good comment and a and a.
And a patient who's got having arough day comment to kinda show
that range, uh, so that, um,patients can say to themselves,
(05:43):
well, I guess this is normal.
I, you know, I thought I wasworried when I woke up this
morning with this new problem.
Uh, and um, but geez, there'sfour quotes in the book that
said this is normal.
Joseph M Schwab (05:54):
Of course, patients have access.
All, All patients everywherewould have access to your book,
right?
It's available, you know, forthem to purchase.
But for a, a number of patientswho are seeing their doctor are
getting their, uh, informationdirectly from their doctor.
Um, what concerns you most aboutkind of the current approach
that surgeons are taking towardseducating their patients about
(06:17):
their recovery?
Andrew Wickline (06:20):
Well, you know what's been really helpful is
I've had several surgeons, hipsand, you know, surgeons who've
had hips and knees who'veactually got, purchased my books
and, uh, reached out to me andsaid, wow, I did not realize
this or that, or this or that.
And that's the surgeonthemselves, right?
Who's, who's been doing this for5,000, 10,000, 20,000 cases.
(06:41):
And, um, it's, it's really hardto put yourself in those shoes
until you've.
Until you've walked it.
Right.
I, I've had patients stay at myhouse, uh, because of covid and
a few, uh, challenging, uh,situations.
And, um, you really start tolearn a lot more about what
recovery's like when youactually go and visit the
therapist and watch thepatients, uh, being tortured
(07:03):
after surgery.
Uh, because our industry hastold patients to go, go, go.
And, uh, and I think that's amistake.
We, we certainly don't do that.
If you sprain your ankle, youwouldn't.
Walk, you know, 10,000 steps thenight after Spraining your
ankle.
We've all learned that lesson asa teenager.
So I think part of it is justwe, we really, um, we all go to
(07:23):
these meetings.
We focus on the one hour ofsurgery at the meetings, but,
but there's six weeks pre-op, 12weeks post-op, that's 3000, 24
hours that we could be focusingon, and yet we only focus on
one.
Joseph M Schwab (07:35):
Yeah, and it's interesting'cause a lot of the
publications about outcomes fortotal hip, total knee, you know,
they'll want two year outcomesand a lot happens in that first
two years.
What's the incentive for thesurgeon to focus on that
recovery in the first threemonths if really, you know, most
of the literature is on two yearoutcomes.
Andrew Wickline (07:56):
So you are right, and it's just easy to
tell patients.
Well, it'll all be better in,you know, uh, at a year or two
years and, you know, hang inthere.
But I.
But again, if you have somethingthat's actually documented,
that's published that, that hasdata behind it, that, that with
publications, at least thepatient, if that's the, the
case, which again, there ishealing out to two years, nine,
(08:16):
it takes 92 years to get 98%healing of the wound.
Um, you know, at least thepatient can see it.
And, and it.
It, it feels more like it's thetruth, right?
When we tell, if a patient says,doc, I'm still sore at three
months, and the doc says, well,that's normal, and, and it'll
all get better by a year.
It kind of feels like we'rebrushing them off.
(08:36):
But yeah, they can see in thebook that it says, you know,
here's.
You know, you only have 50%healing at week six.
You know, at three months you'regonna have 15% more water in
your leg than normal still.
Um, okay, well that is, that's areason why I'm still sore and
it's okay.
This, it, it's not an infection.
I'm not rejecting the implant.
People think they rejectimplants, so, you know, again,
(08:57):
the mind goes to the darkestplace.
Um, that's, that's what happenswhen we encounter something
that, that no one gave us anexplanation for before.
Joseph M Schwab (09:06):
Is there anything we should be doing in
the literature to change theincentive structure for
patients?
Or excuse me, for, for surgeonsto be making, uh, patient
recovery education a higherpriority?
Andrew Wickline (09:22):
Um, well, I can say that, that, so to
incentivize, I don't think theliterature is going to push
unless, unless you can, youknow, I.
Do this large multicenter studywith a specific protocol and
follow these patients for twoyears.
I mean, I guess that's one wayto do it in the literature, but.
Boy, that's gonna be a challengeto get done.
(09:43):
And who's gonna pay for that?
You know, uh, I think reallywhat needs to happen is, uh,
the, the government needs toincentivize surgeons to do this,
right?
Um, you know, we've publishedlowest opioid, lowest swelling,
uh, uh, and with that comes, uh,you know, over a 50% reduction
in 90 day recidivism rate, youknow, coming back to the
(10:04):
hospital.
So lower complications usingthis protocol.
And so.
You know, I think if we canincentivize, if the government
says, you know, let'sincentivize surgeons to, to
reduce opioid prescribing andreduce complications, that's the
way to do it.
I, I, I, I guarantee if thegovernment came out tomorrow and
said, we're gonna pay surgeonsan extra thousand dollars, uh,
(10:24):
for lower opioids, lowercomplications, and, and there's
no, um.
Uh, and there's no downside toit.
Like they did that forB-P-C-I-A, right?
The, the, the government plan.
But, but boy, that was Russianroulette.
Like many people got burnedbecause, you know, got a
readmission, um, because theydidn't have the right protocol.
How about we just incentivizepeople to, to uh, do the right
(10:47):
thing And, uh, and, and if, ifyou win, you get to share in the
savings.
And if not, you're trying hardto win.
I think we just need to refocuson this.
Joseph M Schwab (10:56):
So, shifting gears a little bit, one thing
that really stands out aboutyour career, um, uh, just
looking over it, is yourdedication to learning from
others.
And you've, um, I I read thatyou've either visited or hosted
over 60 surgeons over the last20 years, which is a truly
remarkable number.
Uh, and I'm curious to know fromyour perspective, what inspired
(11:19):
this, uh, interest in anexchange of ideas.
Andrew Wickline (11:24):
Well, I think it's a couple things.
Um.
First, you know, as a resident,we don't, we don't learn by just
going to a, you know, a, a twohour lecture or, or a two two
day weekend le series oflectures.
We, we operate with multipledifferent surgeons and we we're,
we're watching differentartisans and learning from their
craft, right?
And so that's how to do theprocedure.
(11:45):
But then, you know, um.
The real key is going to theoffice and actually seeing those
patient outcomes more than a, abinary, you know, a, you know,
zero one or a, or a pain scoreor a, um, a prom score that,
that's not as really helpful asactually seeing the patients
that, that are in each of thesesurgeon's office.
(12:06):
So I think, I think that's.
I mean, that's how we learn and,you know, as residents.
So why aren't we doing that whenwe, when we leave fellowship?
And the number two reason is I'mfrom West Virginia.
Uh, I didn't have a lot of moneygrowing up.
I was always told I was secondbest.
And, um, you know, some peoplethey knuckle under that
pressure.
They, you know, I was told Iwasn't ever gonna be able to be
a surgeon.
(12:26):
Um, let, let alone, um, youknow, uh, successful.
And so some people will knuckleunder and I, I just made me mad
so.
I, um, I said, no, I'm gonnaprove to people.
So that was very helpful in someways, but it's, it's a monkey on
your back, right?
I, and, and so I.
At Aus, unfortunately, that wesee this still.
(12:47):
I, I stood up in 2013 and Isaid, you know, I think we're
hurting patients with therapy.
I live in a small town.
I'm seeing patients reallysuffering.
I think we should stop therapy.
And the whole, the whole roomlaughed and you know, you know,
because when I said we shouldstop there, and I, I persisted.
I said, no, I, I'm in a smalltown.
I'm, I'm, I was one of thebusiest striker users in New
(13:08):
England at the time.
And, uh, I, I do a lot of workand, and a guy in the lectern
actually said, no, we'reserious.
Shut up.
Sit down if you believe thatnonsense.
Come back when you havesomething published.
And that was mortifying to me.
And you know, again, kinda mywhole life, I've been told I'm
second best now here I am withall my computers.
You're second best.
So, so I, I, in hindsight, Iwant to thank that gentleman,
(13:32):
uh, because he spurred me tostart looking at my outcomes and
start looking at more than justthe surgery.
I.
But also all the other stepsthat six weeks before 12 weeks,
that other 3000 plus hours thatwe could be optimizing, that's
low hanging fruit, man.
That that's really the, that'swhen the patient's awake, by the
way, when you know those other3000 hours.
So you better be payingattention to that.
Joseph M Schwab (13:54):
Uh, my goodness.
So that, that sounds like it wasa really, um, a challenging
experience at that, at, at the,the meeting.
Were, were there otherexperiences that come to your
mind that really challenged theway you, uh, were thinking or
the way that you, you know, thattransformed your approach to
your patients?
Andrew Wickline (14:13):
You know, um, there's a lot of surgeons that
have, you know, been, beenhelpful.
Uh, you know, at that meeting,the only person who stood up for
me at that meeting was AdolfLombardi.
I mean, that, that, that man's areal gentleman.
Uh, you know, he said, you know,Andy's been to my place twice
and, uh, I think, I think he, hemight be onto something.
And then over the years, youknow, Frederick Load, uh, from
(14:35):
Paris, I mean, just an amazinganterior hip surgeon.
Uh, and he's been doing a lotof, uh, videos recently on
LinkedIn, you know, showing andhighlighting.
Some of the things he's learned.
Um, uh, of course Joel Mata.
Um, he and I have shared love ofairplanes, so, uh, I, I get to
speak to Joel every so often.
Nick Mast, uh, um, Charlie tocook.
(14:57):
There's a whole bunch ofsurgeons that have, have showed
me their little tricks andpearls and, uh.
I've been very fortunate and I,I, I would encourage all
surgeons to spend time.
I just had a surgeon, uh, JimMitchell out from, uh, Oklahoma
the last two days.
It's super helpful to havesomeone come to your place and,
you know, help poke holes inyour thinking to say, Hey, why
(15:17):
are you doing it that way?
Is, is there, would this work,uh, a little bit better?
It's very, very, um, thecollaborative nature of this is,
has been really exciting.
Joseph M Schwab (15:28):
So you kind of touched on a, a number of folks
who are in our sphere, in theanterior approach sphere with
Dr.
Matta and Dr.
De Cook and, and Nick Mast andthings like that.
When did you start doinganterior approach?
And I know one of.
Your concerns is about painmanagement and opioid use.
Did you see any differences inopioid needs between patients
(15:48):
that you were doing anteriorapproach on and patients having
other approaches?
Andrew Wickline (15:52):
Yeah.
So, um, you know, I, I, I havea, a, a.
My residency was almostentirely, um, uh, posterior.
I did a little direct lateral,um, at the time, and, uh, um, I.
We had a surgeon, uh, that wasthere, he was working on the two
incision hip stuff.
(16:13):
So then I went and did myfellowship and, uh, that was all
direct lateral with LeicesterBorden and, uh, Cleveland
Clinic.
And so I've got five years ofpractice, uh, uh, using direct
lateral with good results.
But, you know, the, the limping,the, you know, the, the early
recovery was a challenge, youknow, no, it didn't have that
dislocation risk with theposterior.
(16:34):
And so then we did some twoincision stuff, uh, and then,
um.
You know, the literature wascoming out kind of against it in
some ways, in some centers, soit was challenging to continue.
So that's when I fell into, uh,direct interior.
We did a bunch of courses.
I started in 2007.
I started without a table.
Like I, I, uh, moved over tousing a table.
(16:54):
I found that much morereproducible, uh, and.
When, when we really starteddoing it, uh, for real, I
didn't, you know, none of myoffice staff knew the
difference.
My x-ray tech came to me andsaid, uh, Andrew, um.
You know, this is the time wehad non-digital x-ray.
Right.
Andrew, what are you doingdifferent?
Um, the patients can get on andoff this supine, you know, x-ray
(17:15):
table so much easier.
So is is there somethingdifferent you're doing?
And then, uh, that's when I knewthat I really had a game
changer.
Um, and so yeah, it was, thatwas kind of the telling point
for me in my office that thiswas definitely something
different.
Joseph M Schwab (17:30):
Um, as far as pain control is concerned, did
you notice any differences inpatients or was it mostly
functional recovery?
Andrew Wickline (17:38):
Uh, no, it was definitely both.
Uh, it's just the, the need for,for opioids, uh, was definitely
lower.
Um, and, you know, we, we.
Ultimately, I had a physicaltherapist.
She, she thought she was gonnaprove me wrong.
You know, the patients don'tneed therapy.
And so she wrote a paper with meand we actually saw about 90% of
patients use 10 pills or less.
(17:59):
Uh, mostly tramadol.
And now with a few more tweakswith my protocol, I we're, we're
gonna have to do another study.
'cause I think we're at 80 to90% using zero opioids now.
Joseph M Schwab (18:10):
Wow.
Wow.
Um, le let's talk a little bitabout, you have, uh, something
called the 1 million PatientMission, um, which is, I would
say inspiring and pretty bold.
Um, the goal seems to be to help1 million patients have zero
opioid addiction risk aftertotal hip and total knee
(18:31):
replacements.
What I'm curious is, from yourperspective.
How'd you come up with thismission, and specifically, how'd
you come up with the number?
A million is bold.
Andrew Wickline (18:41):
So.
The Baron Brothers again, I'm solucky that many surgeons are
willing to put up with me intheir, or.
The Baron Brothers invited meout to their, their meeting, uh,
a couple years ago, and that's,uh, happens, uh, that they
brought in, uh, or, uh, MorMalu.
I know, or I'm sorry if I'msaying your name wrong, he's the
(19:01):
PhD, uh, that's works at HarrisHip Labs.
He's responsible for, um,cross-link polyethylene and, uh,
when, when they started lookingat numbers.
That guy has helped over 20million people have a longer hip
and knee replacements.
And I, I, for, for the lastcouple years, I'm like, man, I,
I wish I had that kind ofinfluence.
(19:23):
I have a very small sphere ofinfluence, right?
My little town, you know, maybea few people that you see our
podcast and so forth, and useour books, but, you know, it's,
it's not 20 million.
So I've been looking at my, Igot 10 years left, uh, before I
retire.
I think, uh, depending on howthis stock market goes.
my kids decide to continuedoing.
(19:44):
But, um, so I said, okay,there's about 1.6, uh, 1.7
million total joints a year.
If I could affect a hundredthousand a year, that'd be like
7% of the market.
Um, I.
You know, in 10 years when Iretire, I, I could help a
million people.
So I said, you know, that, Ithink I like this.
This let's march to a million.
Uh, and that's March the numbertwo a million.com.
(20:08):
We have a website where, wherepatients can go on and, and
surgeons can get my free DPDF.
And if your patient doesn't 10pills or less, I want them to go
to that.
Website, log in with their firstname tag their surgeon claim
their, their own personal numberon the internet wall of fame,
that they did it in 10 pills orless.
And we have a leaderboard where,where we're gonna find out which
(20:30):
surgeons and which, uh, youknow, cities and states are
winning, uh, in this, thisproblem.
I mean.
In 2018, I published andpresented 10 pills or less for
total knee, like unheard of.
In 2020, we actually publishedthose papers and then Covid hit
and the whole nationalconversation left this opioid
epidemic problem and we've gottafix this.
(20:51):
I, one in four of my patientstalked to me about personal
family members.
Or, or a friends that, thatthey've lost because of opioids.
And I, I'm mad, you know, I thithis is fixable and so I've got
a bunch of surgeons alreadysigned onto this.
We're going to, we're gonnachange, uh, the national
conversation.
We're gonna get it back to whereit belongs, and we're going to
(21:12):
encourage all of other surgeonswho aren't doing these things
to, to improve painperioperatively to get on board.
Yeah.
I think this should, thisoperation should be 10 pills or
less.
Joseph M Schwab (21:22):
So we'll put a link to the March to a million
in our description, certainlywith the podcast.
But I wanna know, uh, maybe youcan give us a sneak peek.
What progress have you made sofar?
Andrew Wickline (21:33):
So again, I've, I've got 30 plus surgeons who,
you know, they, they bought in,it's easy to buy in, right?
It's, it's essentially, youknow, advertising their practice
that, that they care enough, uh,to, to uh, uh, provide
education, provide, uh, um.
techniques and.
Uh, allow patients to recover,uh, with a, with way less if
(21:56):
zero, uh, risk of opioidaddiction.
And so, you know, like that's,that's super hard to, to get
surgeons together, right?
We, we all feel we're numberone, we're all great white
sharks in our little area of theocean.
And so we have to find ways thatwe can collaborate.
And I think this is a great way,it's, it's a competition.
Uh, we're also doing a videodocumentary of this, uh.
(22:19):
So, yes, the, the I I I, I'mflying my little plane.
I pull it outta the hangar andI, uh, uh, I just picked up, uh,
John Balk out of Cleveland tocome out and visit with us.
Uh, I flew down to see JohnMercury.
Uh, um, I'm flying down this,uh, coming week to see, uh, Del
Shoote, uh, to, to give alecture down there.
So, uh, pulling out my littlemarch to a million plane, uh,
(22:40):
with the big jets behind.
It's the story of my life, Davidversus Goliath.
I am gonna fix this problem.
Uh, I do not want these thingson the.
Joseph M Schwab (22:48):
So, I mean, this is a huge lift that you're
taking, and obviously it soundslike for a good cause the many
of the surgeons who are signingup, they're making a pledge to
do things differently.
But if there was one smallchange a surgeon or a care team
could make today that wouldcreate, um, from your
perspective, a huge impact inrecovery or outcomes for their
(23:11):
patients, what would that be?
Andrew Wickline (23:15):
Uh, so I agree, starting small is the key.
Uh, um, any of the surgeonslistening that can reach out to
me, I've got, you know, 40 plusways to help reduce swelling.
You know, again, part of it's inthe book, but, you know, you
don't have to use my book to dothis.
Um, the first thing I would sayis, uh, let's look at the step
count man Dome Karina OuttaFlorida.
Neither of us knew we were doingthis research, but both of us
(23:36):
came up with the same step countpost-op, uh, to help patients
recover, right?
Again, we talked about thisearlier.
If you sprain your ankle badly,you don't try to do 10,000 steps
the next day, but yet for kneesand hips, we tell patients to
go, go, go.
But, but that's not what we tellpatients for a rotator cuff or
having a hernia repair or anyother surgery.
So we have to understand thatthe, the, the wound is more than
(24:00):
just the bone that we poundedparts into.
Uh, we've got to help thatwound, uh, uh, heal better.
And that's by controlling thatswelling.
There's.
There's a lot of great stuffwe're gonna be working on the
near term.
Um, and, uh, but, but I thinknumber one key is start with the
step count.
Number two, recognize thatswelling is a real thing.
I mean, 34% more water on theleg on day seven, uh, not day
(24:24):
one or two, but day seven a weeklater, it's only 2% less, so 32%
more one on a leg.
We have to manage that, anduntil we recognize that those
are real parts, then you're notgonna see the success.
Joseph M Schwab (24:36):
Do you have a message for surgeons who
currently feel stuck in sort ofthe traditional models of care?
Andrew Wickline (24:44):
So.
Yeah, I guess, uh, I'm, I'mhappy to either come visit you
or you can come visit me.
Um, we, you know, the very firstperson that came to visit was a
surgeon out of, uh, uh, LA andum, uh, this was back in 2018
after he heard the talk and Iwe're driving to my clinic and
he says, I said, why, why didyou come all the way to, you
(25:04):
know, Utica, New York?
And he goes, because I call BSon your results.
There's no way you're doing thisin 10 pills or less.
And, um, and, uh, after fourhours in clinic, he goes, okay,
uh, I believe you now, and I'mgonna make these changes.
And it, there's just, it's justsome simple changes and you
don't have to do it all at once.
You know, start with some simplethings, you know, it's a six
(25:26):
month process.
I've, I've got a kind of roadmapfor patients, uh, and for
surgeons as well, um, to, tohelp succeed.
Again, if you try to do it allat once, it is overwhelming.
Agreed.
Joseph M Schwab (25:36):
When you have the opportunity to look back on
your legacy, um, through yourbooks, through your patient
care, through the, this, the themillion patient mission and your
global collaborations, um, whatdo you want it to look like?
Andrew Wickline (25:53):
I guess I just wanna know that, that I did
more, I mean, it's important tohelp our people in our local
town, but at some point I.
Those of us who've been doingthis a long time, it's time to
give back to the younger surgeonthat is still struggling on
trying to understand what, youknow, again, how does a 30
5-year-old surgeon understandwhat it's like to have a knee
(26:13):
replacement?
Really, you know, uh, unlessthey have one themselves or they
go and, and live with thatperson, uh, for the next six
weeks.
So, um, I think it's.
It's incumbent upon, uh, oldersurgeons to just, you know,
share the wisdom that we haveand, you know, the dos and the
don'ts and, uh, but again, tokeep trying to push forward.
(26:34):
Um, I'm excited for what thefuture holds.
I, I don't know.
I, I, my, my belief is that inthe next 15 to 20 years, we may
not be putting metal in, plasticin, I think we'll be replicating
cartilage 3D printing withnanobots.
Um, but the key will still beunderstanding the.
The, the cytokine milieu in thatknee and understanding the
(26:55):
basement membrane adhesion, uh,and uh, uh, trying to mitigate
those shear forces to allow thathealing to occur.
So I'm excited.
I hope I get to see that.
Um, but I think it's coming.
Joseph M Schwab (27:06):
What, so you, you talked briefly about what
you think, uh, the surgery willlook like in, in 20, 30, 50
years.
What do you think the recovery'sgonna look like in 50 years?
Andrew Wickline (27:19):
That's hard.
It's hard for me to know.
I, I.
Um, you know, we have our cellsare, you know, we're over 50.
Our cells are, they call'emsenescent, which is, is a
terrible word, but That's true,you know, and, um, and so these
cells act as, uh, pericrinecells.
So they, they control thesurrounding milieu in near, in
the regions of trauma.
So the next five years, I'd liketo see, um.
(27:42):
I'm trying to work with some ofour, uh, um, basic science, uh,
members, uh, inflammation, uh,specialists, as well as gate
specialists.
I'd love to sit down and workwith them on another kind of
landmark paper looking at how dothese senescent cells, instead
of going down that fibroticpathway, how do we get them to
go back to that?
That reparative pathway.
(28:03):
And I think by understandingthat that's gonna help us, uh,
as uh, the technology allows usto do things with cartilage
surfaces, I think we, we need tohave that together.
We can't, we can't have onewithout the other.
So, um, I'm excited that theshort term, I think we can help
recovery, uh, by looking at the,how the soft tissue reacts to
the trauma.
And in the long term, uh, Idon't know.
(28:25):
I'm, I'm, I still hit thingswith a hammer, so it may be.
Joseph M Schwab (28:31):
Uh, well, I can't think of a better place to
end than that, but Dr.
Wickline, I I really appreciatethe time that you've taken with
us today, and I look forward tohearing your full talk at the
AHF uh, 2025 annual meeting.
Andrew Wickline (28:44):
Thank you so much for having me and uh,
really, uh, I really appreciatethe opportunity.
Joseph M Schwab (28:49):
Absolutely.
you for joining me for thisepisode of the AHF podcast.
We think of the AHF as a family,so if you can remember to take a
moment to like and subscribe,you'd be helping us find more
people just like you to shareour thoughts with.
And as an AHF family member, youcan always drop an idea for a
topic or any feedback you like.
(29:11):
In the comments below, you canfind us on Apple Podcasts,
Spotify, or in any of yourfavorite podcast apps, as well
as in video form on YouTubeslash at anterior hip
Foundation, all one word.
New episodes of the ahf Podcastcome out on Fridays.
(29:31):
I'm your host, Joe Schwab,asking you to keep those hips
happy, healthy, and swellingfree.
Hello, and welcome to the AHF Podcast.
I'm your host, Joe Schwab.
Dr.
Andrew Wickline is an orthopedicsurgeon, educator, and author of
two books, less Swelling, lessPain, total Hip.
And less swelling, less pain,total knee.
Both books are now available inSpanish reflecting his deep
commitment to accessible patientcare and education.
(00:47):
Dr.
Wickline, thank you for joiningus.
Andrew Wickline (00:51):
Good morning from upstate New York.
Glad to be here.
Joseph M Schwab (00:54):
Um, let's start with your book.
Uh, less pain, less, uh, excuseme, less Swelling, less Pain.
What inspired you to write theseand what's really your goal in
making them available to a wideraudience, including Spanish
speaking patients?
I.
Andrew Wickline (01:09):
Well, uh, back in 2015, I heard, uh.
Dr.
Craig McAllister and Dr.
Ira Kirschenbaum, they, theytalked about how, um, patient
engagement was the key towardsallowing patients to go home the
same day.
And, uh, so they convinced me tokind of write my, my version of
the book and took me six months.
I mean, most surgeons were busy.
(01:29):
They've got a bunch of flyersthey hand out at at different
time points postoperatively.
But I sat down, I said, what ifI was a patient?
What.
What would that book look like?
You know, when your daughter,uh, or wife gets pregnant for
the first time, she gets thisbook called What to Expect When
You're Expecting.
Right.
Everybody in the United Stateshas seen that.
Um, and then, you know, if youhave a family member, uh, like
with my wife, when she hadcancer, we had this amazing book
(01:51):
to Breast Cancer handbook, youknow, how to, how to Succeed and
get through this really terribletime.
And I recognized that Total Kneeand Total Hip, it's not a lot of
fun and it's a, it's a big blackbox for patients so.
I, I wrote the, the first book,I've, I've revised it 31 times
and since that time of the veryfirst book, we've published
lowest opioid use in the UnitedStates.
(02:12):
We, uh, just published lowestswelling worldwide after knee
replacement.
And so I thought it was time to,to bring the, uh, that, that
data, those publications all inone book to patients, uh, direct
to patients.
Joseph M Schwab (02:25):
So what have you seen or, or in your
research, what is the landscapefor current, you know, patient
recovery education look like?
Andrew Wickline (02:35):
So it's kinda all over, uh, the, the, uh,
field.
It's, you know, I, I've, I'veoperated with many, many
different surgeons, uh, over 60surgeons.
Uh, and, uh, and it's, you know,when you're busy, when you're
not busy, you, you have time todo all these things, but once
you get busy, it's reallychallenging the way, um, uh,
(02:56):
most surgeons do it.
They've got their handoutsagain, just like what I was
doing, but it, it's.
It's very hit or miss and it'svery sporadic.
I really think we could do abetter job at tightening up the
protocol.
Um, you know, otherwise patientsgo to Dr.
Google and that's, that's aterrifying experience.
You know, I, I've got 8,200hours of my life, you know,
that's four full-time years ofworking, uh, nights and weekends
(03:20):
away from my, my wife and kids,you know, and I, and I tell
patients, listen, this is mylove letter to you.
I took time away from my familyto help you succeed.
And so.
They would take the book, theywould journal in it.
I've got 7,000 patients thathave given me the book back, and
I, I, I'm able to see reallyamazing detailed descriptions
about what happens every daypost-op, what to expect.
(03:42):
It's not just black and white, apain score, a three or a four.
It's, you know, actualsentences.
Hey Doc, I really have troublerolling over at night.
You know, what, what, what isthat?
Normal?
And, and patients are worried.
They wanna know what's normal,what's not.
And it answers every questionthe last 23 years of practice.
You know, can I have a flu shot?
Uh, what are the parts made of,uh, what's the best diet?
(04:02):
Uh, am I ready for surgery?
I got two whole pages to helppatients determine, am I ready
for surgery?
Joseph M Schwab (04:08):
Is it, so you mentioned Dr.
Google.
Is that how you find mostpatients are currently learning
about recovery?
Apart from, of course, the.
The patients that you're givenyour book to.
Andrew Wickline (04:18):
It seems like it, you know, uh, when you look
online, look at the blogs,there's lots of, you know, um,
uh, patient organized blogs to,uh, to kind of help people
because, because their doctorisn't doing it, you know, isn't
providing the information, andso they feel the need to do it
themselves.
So I.
Um, this is one way that, thatyou can have qualified
information if you, if patientslook in my book, I, I've got,
(04:41):
uh, references to each of thearticles that are published that
help, uh, show them where theycan find, actually find the
science behind therecommendation I'm giving them.
Joseph M Schwab (04:50):
Yeah.
And do you find, does your bookalso sort of create or recreate
that sense of maybe communitythat some folks feel online with
an online blog?
Andrew Wickline (05:01):
I think so because there's actual patient
quotes every single day post-op.
So the book is kind of dividedin two, two parts, you know?
Um.
What to expect before surgery.
How to optimize each of thedifferent body systems, you
know, if you're a man, if youhave prostate issues, did you
know that, you know, certaintypes of anesthesia can put you
at more risk for having, uh, youknow, prostate, you know,
(05:21):
problems post-op and wearing acatheter.
Nobody wants that and nobody'sgonna be happy with that, with
that outcome.
So at least if you can discussit with patients, that helps,
you know, post-op, uh, uh, youknow, I generally have a, a, a
good comment and a and a.
And a patient who's got having arough day comment to kinda show
that range, uh, so that, um,patients can say to themselves,
(05:43):
well, I guess this is normal.
I, you know, I thought I wasworried when I woke up this
morning with this new problem.
Uh, and um, but geez, there'sfour quotes in the book that
said this is normal.
Joseph M Schwab (05:54):
Of course, patients have access.
All, All patients everywherewould have access to your book,
right?
It's available, you know, forthem to purchase.
But for a, a number of patientswho are seeing their doctor are
getting their, uh, informationdirectly from their doctor.
Um, what concerns you most aboutkind of the current approach
that surgeons are taking towardseducating their patients about
(06:17):
their recovery?
Andrew Wickline (06:20):
Well, you know what's been really helpful is
I've had several surgeons, hipsand, you know, surgeons who've
had hips and knees who'veactually got, purchased my books
and, uh, reached out to me andsaid, wow, I did not realize
this or that, or this or that.
And that's the surgeonthemselves, right?
Who's, who's been doing this for5,000, 10,000, 20,000 cases.
(06:41):
And, um, it's, it's really hardto put yourself in those shoes
until you've.
Until you've walked it.
Right.
I, I've had patients stay at myhouse, uh, because of covid and
a few, uh, challenging, uh,situations.
And, um, you really start tolearn a lot more about what
recovery's like when youactually go and visit the
therapist and watch thepatients, uh, being tortured
(07:03):
after surgery.
Uh, because our industry hastold patients to go, go, go.
And, uh, and I think that's amistake.
We, we certainly don't do that.
If you sprain your ankle, youwouldn't.
Walk, you know, 10,000 steps thenight after Spraining your
ankle.
We've all learned that lesson asa teenager.
So I think part of it is justwe, we really, um, we all go to
(07:23):
these meetings.
We focus on the one hour ofsurgery at the meetings, but,
but there's six weeks pre-op, 12weeks post-op, that's 3000, 24
hours that we could be focusingon, and yet we only focus on
one.
Joseph M Schwab (07:35):
Yeah, and it's interesting'cause a lot of the
publications about outcomes fortotal hip, total knee, you know,
they'll want two year outcomesand a lot happens in that first
two years.
What's the incentive for thesurgeon to focus on that
recovery in the first threemonths if really, you know, most
of the literature is on two yearoutcomes.
Andrew Wickline (07:56):
So you are right, and it's just easy to
tell patients.
Well, it'll all be better in,you know, uh, at a year or two
years and, you know, hang inthere.
But I.
But again, if you have somethingthat's actually documented,
that's published that, that hasdata behind it, that, that with
publications, at least thepatient, if that's the, the
case, which again, there ishealing out to two years, nine,
(08:16):
it takes 92 years to get 98%healing of the wound.
Um, you know, at least thepatient can see it.
And, and it.
It, it feels more like it's thetruth, right?
When we tell, if a patient says,doc, I'm still sore at three
months, and the doc says, well,that's normal, and, and it'll
all get better by a year.
It kind of feels like we'rebrushing them off.
(08:36):
But yeah, they can see in thebook that it says, you know,
here's.
You know, you only have 50%healing at week six.
You know, at three months you'regonna have 15% more water in
your leg than normal still.
Um, okay, well that is, that's areason why I'm still sore and
it's okay.
This, it, it's not an infection.
I'm not rejecting the implant.
People think they rejectimplants, so, you know, again,
(08:57):
the mind goes to the darkestplace.
Um, that's, that's what happenswhen we encounter something
that, that no one gave us anexplanation for before.
Joseph M Schwab (09:06):
Is there anything we should be doing in
the literature to change theincentive structure for
patients?
Or excuse me, for, for surgeonsto be making, uh, patient
recovery education a higherpriority?
Andrew Wickline (09:22):
Um, well, I can say that, that, so to
incentivize, I don't think theliterature is going to push
unless, unless you can, youknow, I.
Do this large multicenter studywith a specific protocol and
follow these patients for twoyears.
I mean, I guess that's one wayto do it in the literature, but.
Boy, that's gonna be a challengeto get done.
(09:43):
And who's gonna pay for that?
You know, uh, I think reallywhat needs to happen is, uh,
the, the government needs toincentivize surgeons to do this,
right?
Um, you know, we've publishedlowest opioid, lowest swelling,
uh, uh, and with that comes, uh,you know, over a 50% reduction
in 90 day recidivism rate, youknow, coming back to the
(10:04):
hospital.
So lower complications usingthis protocol.
And so.
You know, I think if we canincentivize, if the government
says, you know, let'sincentivize surgeons to, to
reduce opioid prescribing andreduce complications, that's the
way to do it.
I, I, I, I guarantee if thegovernment came out tomorrow and
said, we're gonna pay surgeonsan extra thousand dollars, uh,
(10:24):
for lower opioids, lowercomplications, and, and there's
no, um.
Uh, and there's no downside toit.
Like they did that forB-P-C-I-A, right?
The, the, the government plan.
But, but boy, that was Russianroulette.
Like many people got burnedbecause, you know, got a
readmission, um, because theydidn't have the right protocol.
How about we just incentivizepeople to, to uh, do the right
(10:47):
thing And, uh, and, and if, ifyou win, you get to share in the
savings.
And if not, you're trying hardto win.
I think we just need to refocuson this.
Joseph M Schwab (10:56):
So, shifting gears a little bit, one thing
that really stands out aboutyour career, um, uh, just
looking over it, is yourdedication to learning from
others.
And you've, um, I I read thatyou've either visited or hosted
over 60 surgeons over the last20 years, which is a truly
remarkable number.
Uh, and I'm curious to know fromyour perspective, what inspired
(11:19):
this, uh, interest in anexchange of ideas.
Andrew Wickline (11:24):
Well, I think it's a couple things.
Um.
First, you know, as a resident,we don't, we don't learn by just
going to a, you know, a, a twohour lecture or, or a two two
day weekend le series oflectures.
We, we operate with multipledifferent surgeons and we we're,
we're watching differentartisans and learning from their
craft, right?
And so that's how to do theprocedure.
(11:45):
But then, you know, um.
The real key is going to theoffice and actually seeing those
patient outcomes more than a, abinary, you know, a, you know,
zero one or a, or a pain scoreor a, um, a prom score that,
that's not as really helpful asactually seeing the patients
that, that are in each of thesesurgeon's office.
(12:06):
So I think, I think that's.
I mean, that's how we learn and,you know, as residents.
So why aren't we doing that whenwe, when we leave fellowship?
And the number two reason is I'mfrom West Virginia.
Uh, I didn't have a lot of moneygrowing up.
I was always told I was secondbest.
And, um, you know, some peoplethey knuckle under that
pressure.
They, you know, I was told Iwasn't ever gonna be able to be
a surgeon.
(12:26):
Um, let, let alone, um, youknow, uh, successful.
And so some people will knuckleunder and I, I just made me mad
so.
I, um, I said, no, I'm gonnaprove to people.
So that was very helpful in someways, but it's, it's a monkey on
your back, right?
I, and, and so I.
At Aus, unfortunately, that wesee this still.
(12:47):
I, I stood up in 2013 and Isaid, you know, I think we're
hurting patients with therapy.
I live in a small town.
I'm seeing patients reallysuffering.
I think we should stop therapy.
And the whole, the whole roomlaughed and you know, you know,
because when I said we shouldstop there, and I, I persisted.
I said, no, I, I'm in a smalltown.
I'm, I'm, I was one of thebusiest striker users in New
(13:08):
England at the time.
And, uh, I, I do a lot of workand, and a guy in the lectern
actually said, no, we'reserious.
Shut up.
Sit down if you believe thatnonsense.
Come back when you havesomething published.
And that was mortifying to me.
And you know, again, kinda mywhole life, I've been told I'm
second best now here I am withall my computers.
You're second best.
So, so I, I, in hindsight, Iwant to thank that gentleman,
(13:32):
uh, because he spurred me tostart looking at my outcomes and
start looking at more than justthe surgery.
I.
But also all the other stepsthat six weeks before 12 weeks,
that other 3000 plus hours thatwe could be optimizing, that's
low hanging fruit, man.
That that's really the, that'swhen the patient's awake, by the
way, when you know those other3000 hours.
So you better be payingattention to that.
Joseph M Schwab (13:54):
Uh, my goodness.
So that, that sounds like it wasa really, um, a challenging
experience at that, at, at the,the meeting.
Were, were there otherexperiences that come to your
mind that really challenged theway you, uh, were thinking or
the way that you, you know, thattransformed your approach to
your patients?
Andrew Wickline (14:13):
You know, um, there's a lot of surgeons that
have, you know, been, beenhelpful.
Uh, you know, at that meeting,the only person who stood up for
me at that meeting was AdolfLombardi.
I mean, that, that, that man's areal gentleman.
Uh, you know, he said, you know,Andy's been to my place twice
and, uh, I think, I think he, hemight be onto something.
And then over the years, youknow, Frederick Load, uh, from
(14:35):
Paris, I mean, just an amazinganterior hip surgeon.
Uh, and he's been doing a lotof, uh, videos recently on
LinkedIn, you know, showing andhighlighting.
Some of the things he's learned.
Um, uh, of course Joel Mata.
Um, he and I have shared love ofairplanes, so, uh, I, I get to
speak to Joel every so often.
Nick Mast, uh, um, Charlie tocook.
(14:57):
There's a whole bunch ofsurgeons that have, have showed
me their little tricks andpearls and, uh.
I've been very fortunate and I,I, I would encourage all
surgeons to spend time.
I just had a surgeon, uh, JimMitchell out from, uh, Oklahoma
the last two days.
It's super helpful to havesomeone come to your place and,
you know, help poke holes inyour thinking to say, Hey, why
(15:17):
are you doing it that way?
Is, is there, would this work,uh, a little bit better?
It's very, very, um, thecollaborative nature of this is,
has been really exciting.
Joseph M Schwab (15:28):
So you kind of touched on a, a number of folks
who are in our sphere, in theanterior approach sphere with
Dr.
Matta and Dr.
De Cook and, and Nick Mast andthings like that.
When did you start doinganterior approach?
And I know one of.
Your concerns is about painmanagement and opioid use.
Did you see any differences inopioid needs between patients
(15:48):
that you were doing anteriorapproach on and patients having
other approaches?
Andrew Wickline (15:52):
Yeah.
So, um, you know, I, I, I havea, a, a.
My residency was almostentirely, um, uh, posterior.
I did a little direct lateral,um, at the time, and, uh, um, I.
We had a surgeon, uh, that wasthere, he was working on the two
incision hip stuff.
(16:13):
So then I went and did myfellowship and, uh, that was all
direct lateral with LeicesterBorden and, uh, Cleveland
Clinic.
And so I've got five years ofpractice, uh, uh, using direct
lateral with good results.
But, you know, the, the limping,the, you know, the, the early
recovery was a challenge, youknow, no, it didn't have that
dislocation risk with theposterior.
(16:34):
And so then we did some twoincision stuff, uh, and then,
um.
You know, the literature wascoming out kind of against it in
some ways, in some centers, soit was challenging to continue.
So that's when I fell into, uh,direct interior.
We did a bunch of courses.
I started in 2007.
I started without a table.
Like I, I, uh, moved over tousing a table.
(16:54):
I found that much morereproducible, uh, and.
When, when we really starteddoing it, uh, for real, I
didn't, you know, none of myoffice staff knew the
difference.
My x-ray tech came to me andsaid, uh, Andrew, um.
You know, this is the time wehad non-digital x-ray.
Right.
Andrew, what are you doingdifferent?
Um, the patients can get on andoff this supine, you know, x-ray
(17:15):
table so much easier.
So is is there somethingdifferent you're doing?
And then, uh, that's when I knewthat I really had a game
changer.
Um, and so yeah, it was, thatwas kind of the telling point
for me in my office that thiswas definitely something
different.
Joseph M Schwab (17:30):
Um, as far as pain control is concerned, did
you notice any differences inpatients or was it mostly
functional recovery?
Andrew Wickline (17:38):
Uh, no, it was definitely both.
Uh, it's just the, the need for,for opioids, uh, was definitely
lower.
Um, and, you know, we, we.
Ultimately, I had a physicaltherapist.
She, she thought she was gonnaprove me wrong.
You know, the patients don'tneed therapy.
And so she wrote a paper with meand we actually saw about 90% of
patients use 10 pills or less.
(17:59):
Uh, mostly tramadol.
And now with a few more tweakswith my protocol, I we're, we're
gonna have to do another study.
'cause I think we're at 80 to90% using zero opioids now.
Joseph M Schwab (18:10):
Wow.
Wow.
Um, le let's talk a little bitabout, you have, uh, something
called the 1 million PatientMission, um, which is, I would
say inspiring and pretty bold.
Um, the goal seems to be to help1 million patients have zero
opioid addiction risk aftertotal hip and total knee
(18:31):
replacements.
What I'm curious is, from yourperspective.
How'd you come up with thismission, and specifically, how'd
you come up with the number?
A million is bold.
Andrew Wickline (18:41):
So.
The Baron Brothers again, I'm solucky that many surgeons are
willing to put up with me intheir, or.
The Baron Brothers invited meout to their, their meeting, uh,
a couple years ago, and that's,uh, happens, uh, that they
brought in, uh, or, uh, MorMalu.
I know, or I'm sorry if I'msaying your name wrong, he's the
(19:01):
PhD, uh, that's works at HarrisHip Labs.
He's responsible for, um,cross-link polyethylene and, uh,
when, when they started lookingat numbers.
That guy has helped over 20million people have a longer hip
and knee replacements.
And I, I, for, for the lastcouple years, I'm like, man, I,
I wish I had that kind ofinfluence.
(19:23):
I have a very small sphere ofinfluence, right?
My little town, you know, maybea few people that you see our
podcast and so forth, and useour books, but, you know, it's,
it's not 20 million.
So I've been looking at my, Igot 10 years left, uh, before I
retire.
I think, uh, depending on howthis stock market goes.
my kids decide to continuedoing.
(19:44):
But, um, so I said, okay,there's about 1.6, uh, 1.7
million total joints a year.
If I could affect a hundredthousand a year, that'd be like
7% of the market.
Um, I.
You know, in 10 years when Iretire, I, I could help a
million people.
So I said, you know, that, Ithink I like this.
This let's march to a million.
Uh, and that's March the numbertwo a million.com.
(20:08):
We have a website where, wherepatients can go on and, and
surgeons can get my free DPDF.
And if your patient doesn't 10pills or less, I want them to go
to that.
Website, log in with their firstname tag their surgeon claim
their, their own personal numberon the internet wall of fame,
that they did it in 10 pills orless.
And we have a leaderboard where,where we're gonna find out which
(20:30):
surgeons and which, uh, youknow, cities and states are
winning, uh, in this, thisproblem.
I mean.
In 2018, I published andpresented 10 pills or less for
total knee, like unheard of.
In 2020, we actually publishedthose papers and then Covid hit
and the whole nationalconversation left this opioid
epidemic problem and we've gottafix this.
(20:51):
I, one in four of my patientstalked to me about personal
family members.
Or, or a friends that, thatthey've lost because of opioids.
And I, I'm mad, you know, I thithis is fixable and so I've got
a bunch of surgeons alreadysigned onto this.
We're going to, we're gonnachange, uh, the national
conversation.
We're gonna get it back to whereit belongs, and we're going to
(21:12):
encourage all of other surgeonswho aren't doing these things
to, to improve painperioperatively to get on board.
Yeah.
I think this should, thisoperation should be 10 pills or
less.
Joseph M Schwab (21:22):
So we'll put a link to the March to a million
in our description, certainlywith the podcast.
But I wanna know, uh, maybe youcan give us a sneak peek.
What progress have you made sofar?
Andrew Wickline (21:33):
So again, I've, I've got 30 plus surgeons who,
you know, they, they bought in,it's easy to buy in, right?
It's, it's essentially, youknow, advertising their practice
that, that they care enough, uh,to, to uh, uh, provide
education, provide, uh, um.
techniques and.
Uh, allow patients to recover,uh, with a, with way less if
(21:56):
zero, uh, risk of opioidaddiction.
And so, you know, like that's,that's super hard to, to get
surgeons together, right?
We, we all feel we're numberone, we're all great white
sharks in our little area of theocean.
And so we have to find ways thatwe can collaborate.
And I think this is a great way,it's, it's a competition.
Uh, we're also doing a videodocumentary of this, uh.
(22:19):
So, yes, the, the I I I, I'mflying my little plane.
I pull it outta the hangar andI, uh, uh, I just picked up, uh,
John Balk out of Cleveland tocome out and visit with us.
Uh, I flew down to see JohnMercury.
Uh, um, I'm flying down this,uh, coming week to see, uh, Del
Shoote, uh, to, to give alecture down there.
So, uh, pulling out my littlemarch to a million plane, uh,
(22:40):
with the big jets behind.
It's the story of my life, Davidversus Goliath.
I am gonna fix this problem.
Uh, I do not want these thingson the.
Joseph M Schwab (22:48):
So, I mean, this is a huge lift that you're
taking, and obviously it soundslike for a good cause the many
of the surgeons who are signingup, they're making a pledge to
do things differently.
But if there was one smallchange a surgeon or a care team
could make today that wouldcreate, um, from your
perspective, a huge impact inrecovery or outcomes for their
(23:11):
patients, what would that be?
Andrew Wickline (23:15):
Uh, so I agree, starting small is the key.
Uh, um, any of the surgeonslistening that can reach out to
me, I've got, you know, 40 plusways to help reduce swelling.
You know, again, part of it's inthe book, but, you know, you
don't have to use my book to dothis.
Um, the first thing I would sayis, uh, let's look at the step
count man Dome Karina OuttaFlorida.
Neither of us knew we were doingthis research, but both of us
(23:36):
came up with the same step countpost-op, uh, to help patients
recover, right?
Again, we talked about thisearlier.
If you sprain your ankle badly,you don't try to do 10,000 steps
the next day, but yet for kneesand hips, we tell patients to
go, go, go.
But, but that's not what we tellpatients for a rotator cuff or
having a hernia repair or anyother surgery.
So we have to understand thatthe, the, the wound is more than
(24:00):
just the bone that we poundedparts into.
Uh, we've got to help thatwound, uh, uh, heal better.
And that's by controlling thatswelling.
There's.
There's a lot of great stuffwe're gonna be working on the
near term.
Um, and, uh, but, but I thinknumber one key is start with the
step count.
Number two, recognize thatswelling is a real thing.
I mean, 34% more water on theleg on day seven, uh, not day
(24:24):
one or two, but day seven a weeklater, it's only 2% less, so 32%
more one on a leg.
We have to manage that, anduntil we recognize that those
are real parts, then you're notgonna see the success.
Joseph M Schwab (24:36):
Do you have a message for surgeons who
currently feel stuck in sort ofthe traditional models of care?
Andrew Wickline (24:44):
So.
Yeah, I guess, uh, I'm, I'mhappy to either come visit you
or you can come visit me.
Um, we, you know, the very firstperson that came to visit was a
surgeon out of, uh, uh, LA andum, uh, this was back in 2018
after he heard the talk and Iwe're driving to my clinic and
he says, I said, why, why didyou come all the way to, you
(25:04):
know, Utica, New York?
And he goes, because I call BSon your results.
There's no way you're doing thisin 10 pills or less.
And, um, and, uh, after fourhours in clinic, he goes, okay,
uh, I believe you now, and I'mgonna make these changes.
And it, there's just, it's justsome simple changes and you
don't have to do it all at once.
You know, start with some simplethings, you know, it's a six
(25:26):
month process.
I've, I've got a kind of roadmapfor patients, uh, and for
surgeons as well, um, to, tohelp succeed.
Again, if you try to do it allat once, it is overwhelming.
Agreed.
Joseph M Schwab (25:36):
When you have the opportunity to look back on
your legacy, um, through yourbooks, through your patient
care, through the, this, the themillion patient mission and your
global collaborations, um, whatdo you want it to look like?
Andrew Wickline (25:53):
I guess I just wanna know that, that I did
more, I mean, it's important tohelp our people in our local
town, but at some point I.
Those of us who've been doingthis a long time, it's time to
give back to the younger surgeonthat is still struggling on
trying to understand what, youknow, again, how does a 30
5-year-old surgeon understandwhat it's like to have a knee
(26:13):
replacement?
Really, you know, uh, unlessthey have one themselves or they
go and, and live with thatperson, uh, for the next six
weeks.
So, um, I think it's.
It's incumbent upon, uh, oldersurgeons to just, you know,
share the wisdom that we haveand, you know, the dos and the
don'ts and, uh, but again, tokeep trying to push forward.
(26:34):
Um, I'm excited for what thefuture holds.
I, I don't know.
I, I, my, my belief is that inthe next 15 to 20 years, we may
not be putting metal in, plasticin, I think we'll be replicating
cartilage 3D printing withnanobots.
Um, but the key will still beunderstanding the.
The, the cytokine milieu in thatknee and understanding the
(26:55):
basement membrane adhesion, uh,and uh, uh, trying to mitigate
those shear forces to allow thathealing to occur.
So I'm excited.
I hope I get to see that.
Um, but I think it's coming.
Joseph M Schwab (27:06):
What, so you, you talked briefly about what
you think, uh, the surgery willlook like in, in 20, 30, 50
years.
What do you think the recovery'sgonna look like in 50 years?
Andrew Wickline (27:19):
That's hard.
It's hard for me to know.
I, I.
Um, you know, we have our cellsare, you know, we're over 50.
Our cells are, they call'emsenescent, which is, is a
terrible word, but That's true,you know, and, um, and so these
cells act as, uh, pericrinecells.
So they, they control thesurrounding milieu in near, in
the regions of trauma.
So the next five years, I'd liketo see, um.
(27:42):
I'm trying to work with some ofour, uh, um, basic science, uh,
members, uh, inflammation, uh,specialists, as well as gate
specialists.
I'd love to sit down and workwith them on another kind of
landmark paper looking at how dothese senescent cells, instead
of going down that fibroticpathway, how do we get them to
go back to that?
That reparative pathway.
(28:03):
And I think by understandingthat that's gonna help us, uh,
as uh, the technology allows usto do things with cartilage
surfaces, I think we, we need tohave that together.
We can't, we can't have onewithout the other.
So, um, I'm excited that theshort term, I think we can help
recovery, uh, by looking at the,how the soft tissue reacts to
the trauma.
And in the long term, uh, Idon't know.
(28:25):
I'm, I'm, I still hit thingswith a hammer, so it may be.
Joseph M Schwab (28:31):
Uh, well, I can't think of a better place to
end than that, but Dr.
Wickline, I I really appreciatethe time that you've taken with
us today, and I look forward tohearing your full talk at the
AHF uh, 2025 annual meeting.
Andrew Wickline (28:44):
Thank you so much for having me and uh,
really, uh, I really appreciatethe opportunity.
Joseph M Schwab (28:49):
Absolutely.
you for joining me for thisepisode of the AHF podcast.
We think of the AHF as a family,so if you can remember to take a
moment to like and subscribe,you'd be helping us find more
people just like you to shareour thoughts with.
And as an AHF family member, youcan always drop an idea for a
topic or any feedback you like.
(29:11):
In the comments below, you canfind us on Apple Podcasts,
Spotify, or in any of yourfavorite podcast apps, as well
as in video form on YouTubeslash at anterior hip
Foundation, all one word.
New episodes of the ahf Podcastcome out on Fridays.
(29:31):
I'm your host, Joe Schwab,asking you to keep those hips
happy, healthy, and swellingfree.
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