Nashville's Hip & Knee Replacement Specialist

🦶Why Your Ankle Keeps Rolling and How Surgeons Tighten It Back Up

Your ankle rolls on flat ground, on stairs, stepping off a curb. That is not bad luck. After repeated sprains, the ligaments on the outside of the ankle can heal stretched and loose, and the joint loses its restraint against tipping inward.

The usual culprit is the anterior talofibular ligament, or ATFL, which resists the pointed-toe, rolled position where most sprains happen. When it stays lax, the result is chronic ankle instability: repeated giving way, hesitation on uneven ground, and lingering pain.

Treatment starts without surgery. Balance training, peroneal strengthening, and bracing help many patients regain control. When the ankle still gives way after a full course of rehabilitation, the Brostrom repair is the gold standard surgical option.

Through an incision on the outer ankle, the surgeon detaches the stretched ATFL from the fibula, shortens it, and reattaches it to bone with strong sutures through small drill holes or suture anchors. The calcaneofibular ligament can be tightened the same way when needed. In the modified technique, the inferior extensor retinaculum is drawn over the repair as a second layer of support.

Recovery is staged: protection in a splint or boot, no inversion while the repair heals, then progressive motion, strength, and balance work before a gradual return to sport.

If your ankle keeps giving out, a specialist evaluation can determine whether rehabilitation or repair is the right next step.

⬇️ SHARE your #ankleinjury experience

🛁 Inside the OR: How Your Leg Is Prepped for Knee Replacement

Three things about OR skin prep that might surprise you:

1. Clean skin is not sterile skin. Even after a good shower, bacteria live on the surface. Before a hip or knee replacement, our goal is to drop that number as low as possible right where the incision will be.

2. The patient changes the math. In a study of 99 #kneereplacement patients, those with diabetes were 3.6X more likely to still carry bacteria after prep, and higher BMI raised the odds too. That’s why blood sugar and weight conversations start weeks before surgery, not on surgery day.

3. The debate isn’t fully settled. Chlorhexidine-alcohol clears more skin bacteria than povidone-iodine in randomized trials. Yet a 2025 Tennessee study of 607 hip and knee patients, all prepped with chlorhexidine-alcohol, reported infection rates of 0 to 1.4%, and a head-to-head trial in revision surgery is still underway. A good solution matters, but technique matters just as much. (doi:10.3390/antibiotics14020155)

In the OR, that technique looks like this: clip instead of shave, prep the entire limb working outward from the incision, and let the solution dry fully before draping, since alcohol-based preps are flammable. Patients play a part too: chlorhexidine washes at home, no shaving near the surgical site, and a call to our office about any cut or rash before surgery.

Full discussion at ccmd.pro/skinprep

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😱 Scared of Pain After Joint Replacement?

Pain is the fear patients carry quietly before a hip or knee replacement. Many never ask about it, because they assume they already know the answer: yes, it is going to hurt. The honest answer is it is uncomfortable, and we are not passive about it. For a knee replacement, pain control is built in layers:
- Numbing medicine placed around the joint during the operation
- Two different nerve blocks
- Spinal anesthesia rather than general anesthesia in most of our cases

Each layer targets pain differently, and they work at the same time. That is not the experience your neighbor had 15 yrs ago. The unasked questions deserve an answer at the pre-op visit. A patient who expects severe, uncontrolled pain brings that expectation into recovery, and a clear explanation of the plan changes the conversation before surgery day. If you are facing #jointreplacement - ask your surgeon how your pain will be managed. You deserve a specific answer.

Full discussion at ccmd.pro/fears

👇 SHARE your #kneereplacement journey & experience

Follow @corycalendinemd for #orthopedicsurgery highlights

Before the first incision of every hip and knee replacement, there is a step most patients never see: the skin prep.

In our OR, we prep the leg with 2% chlorhexidine and 70% isopropyl alcohol. The alcohol kills bacteria on contact. The chlorhexidine binds to the skin and keeps working after it dries. Speed plus staying power.

The evidence is worth knowing. In one study of 99 knee replacement patients, skin cultures grew bacteria in 20% before prep and 5% after. A 2021 meta-analysis of 8 randomized trials in orthopaedic surgery found chlorhexidine-alcohol left about half as many positive cultures as povidone-iodine. In one hip study, it took about 3.5 minutes versus 13.5 for an iodine scrub-and-paint protocol.

The solution is only half of it. Technique matters just as much:
- Clip, never shave.
- Prep the entire limb, working outward from the incision.
- Let it dry completely before draping. Alcohol is flammable.

Infection after primary hip or knee replacement is uncommon, roughly 0.3 to 1.9%, but the stakes are high. Every layer of prevention counts, and skin prep is one of the simplest layers we control.

⬇️ How did your #skinprep go before surgery?

#kneereplacement

Radiocarpal Wrist Joint Injection Technique

Your wrist is a crowded intersection of bones, ligaments, tendons, and cartilage. When the source of pain is unclear, or inflammation persists despite rest, splinting, and oral medication, a radiocarpal joint injection can answer two questions at once.

The #radiocarpal joint connects the distal radius to the first row of carpal bones. Diagnostically, a targeted injection of local anesthetic helps confirm whether this joint is truly the pain generator. Meaningful relief shortly afterward points to the joint itself rather than nearby tendons or nerves. When an effusion is present, aspirating first allows synovial fluid analysis for infection, gout, or pseudogout. Therapeutically, corticosteroid with local anesthetic can calm synovitis from rheumatoid arthritis, psoriatic arthritis, and degenerative or post-traumatic arthritis.

Technique rewards respect for anatomy: With your forearm pronated and wrist in slight flexion over a towel roll, your surgeon palpates Lister’s tubercle and slides distally into the soft spot of the joint line, staying ulnar to the extensor pollicis longus tendon. Entering radial to that tendon can put the anatomic snuffbox and its neurovascular structures at risk. Sterile, no touch technique is essential and the injectate should flow freely - the joint holds little volume. Ultrasound guidance can be used when landmarks are difficult or no clear effusion is present. Relief may be temporary, brief rest is usually advised, and increasing redness, pain, or swelling afterward warrants prompt evaluation. #wristinjection

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🎥 @osgenicmedical - #wristinjection technique, Actium Function Anatomy Group - Radiocarpal joint anatomy

The #1 Fear Before Joint Replacement (And How to Fix It)

Most people assume the biggest fear before a hip or knee replacement is pain. In pre-op conversations, the most common fear is often something else: the unknown.

You don’t know what the room looks like. You don’t know what you’ll feel. You have no idea what day three or day seven will look like. That uncertainty is the most common fear I hear, and it is also the most fixable.

The cure is not reassurance. It’s information, and the more specific, the better. Questions worth asking before surgery:
- What time do I arrive?
- What does the spinal anesthesia look like?
- Who will be in the room, and where?
- When will I walk?
- What number do I call, and when?

We to build preop visits around these questions. Handouts to take home, time to talk, and a team of schedulers, nurses, hospital and anesthesia staff who expect to answer them. A question is not a doubt. It’s patients doing their job, and expectations shape satisfaction. Full discussion at ccmd.pro/fears

👇 What question would you add?