Frequently Asked Questions

Probably far less than you expect — and possibly none. About 40% of my total knee patients use zero narcotic pills. Another 45% use fewer than ten. The remaining 15% use more than ten.

Narcotics are available for breakthrough pain. They are the backup, not the structure. If you have a history of opioid dependence, or you are worried about it, say so — it changes the plan and it is not a conversation to avoid.

Yes, and it is the part patients most want to negotiate.

Patients who exceed the activity limits have more pain, more swelling, and more stiffness. This is not a soft recommendation — it is the most consistent pattern I see. The two weeks of restriction buy you a much easier six weeks after them.

You may feel good enough to do more. Feeling good is the protocol working. It is not permission.

These are two different things, and patients conflate them constantly.

Bed jail restricts walking around. It does not restrict working the knee. Starting the day after surgery you work on the knee ten minutes of every waking hour — five minutes straightening, five minutes bending — and rest in between.

It is the combination that works: frequent motion, genuine rest, and very little walking. Doing one without the others does not produce the same result.

Two weeks after surgery — not two days, which is the standard approach.

The knee needs time to quiet down first. A joint that is still acutely swollen and inflamed responds to hard work by swelling more, and then you are fighting the swelling you just created.

You are not idle during those two weeks. You are doing your own exercises ten minutes of every waking hour, and staying within your step limits. That is what makes therapy productive once it begins.

Because feeling fine is the plan working. It is not a signal to stop.

Pain is far easier to prevent than to treat. If you let it build before treating it, the nerves have already become more sensitive, and it takes considerably more medication to get comfortable again than it would have taken to stay comfortable.

The traditional method builds every knee to the same textbook geometry, which usually means releasing and rebalancing your ligaments to make them fit. Kinematic Alignment restores the alignment your knee had before arthritis wore it down, and leaves the collateral ligaments alone.

Less disruption on the way in means less to recover from.

The surgical approach is the same — the Subvastus Approach, which goes underneath the quadriceps muscle rather than cutting through the tendon.

But the Quiet Knee Protocol is three parts, not one. The approach is only part one. The medication plan and the activity restrictions are the other two, and the results depend on all three.

Because there is no single list to publish. Your plan is assembled from your history — kidney function, heart or stroke history, blood thinners, ulcers, diabetes, prior gastric bypass, seizure disorder, cancer treatment, age, and allergies all change it. A combination that is right for one patient can be unsafe for another.

You will get your own written plan before surgery. That document is the one that applies to you.

In most cases, yes — but this is one of the most important things for us to know, and it substantially shapes your plan.

Tell the office about every blood thinner you take, including aspirin you started on your own. Do not stop or change a blood thinner without being told to.

It is one of the few things you can do before surgery that measurably changes how the surgery goes. After a major operation your body breaks down its own muscle for fuel, and protein blunts that.

It matters most if you take a GLP-1 medication (Ozempic, Wegovy, Zepbound) or if you already have low muscle mass. Full details here.

If you have kidney or liver disease, talk to us before starting one.

Dr. Andrew Wickline, M.D., in upstate New York. He performs over 700 total knee replacements a year and has the lowest complication rate in the state of New York. He developed the protocol to reduce his patients' opioid use. His site is andrewwicklinemd.com.