ANTERIOR APPROACH · MUSCLE-SPARING · FRANKLIN, TN

Anterior Hip Replacement Surgery
in Franklin, TN

Q: Is the anterior approach to hip replacement better than the posterior approach?

The anterior approach consistently demonstrates faster early recovery compared to the posterior approach in comparative studies — with patients discontinuing walkers, gait aids, and narcotic medications earlier, and returning to normal activities more quickly. The elimination of posterior hip precautions is a meaningful quality-of-life difference in the first weeks after surgery. That said, 'better' depends on patient anatomy and surgical context. The anterior approach is Dr. Calendine's primary technique and is appropriate for the majority of hip replacement patients. In some cases, anatomy or surgical complexity makes the posterior approach the technically correct choice — and both approaches are performed with Mako robotic guidance and OrthoGrid intraoperative verification for precise implant placement.

Q: How is the HANA table used in anterior hip replacement?

The HANA table (Hana Orthopedic Table) is a specialized surgical positioning device designed specifically for anterior approach hip replacement. It supports the leg during surgery and allows controlled, precise movement of the hip joint — enabling the surgeon to work through the anterior corridor without excessive manipulation. The BJIT facility is equipped with the HANA table for anterior approach cases. Not all surgical facilities in the Nashville region have this table, which is one reason the anterior approach is not uniformly available from every orthopedic practice in the metro area.

Dr. Cory Calendine, MD · Same-Day Surgery · Bone and Joint Institute of Tennessee

Dr. Cory Calendine, MD is a board-certified, fellowship-trained orthopaedic surgeon at the Bone and Joint Institute of Tennessee in Franklin, Tennessee, serving the greater Nashville area. His practice specializes in direct anterior approach hip replacement, performed with Mako® robotic-arm assistance and OrthoGrid® intraoperative guidance on a HANA® table, with more than 700 hip and knee procedures performed per year. Anterior approach hip replacement is a muscle-sparing technique in which the surgeon accesses the hip joint from the front, through a natural interval between the muscles, moving them aside rather than cutting through them. No major muscle group is divided. Patients travel from across Middle Tennessee — including Nashville, Brentwood, Murfreesboro, and Spring Hill — for anterior hip replacement at his practice.

ANTERIOR APPROACH

HIP REPLACEMENT TECHNIQUE

700+

JOINT REPLACEMENTS/YEAR

FELLOWSHIP TRAINED

JOINT REPLACEMENT SURGEON

THE MUSCLE-SPARING ALTERNATIVE TO TRADITIONAL HIP REPLACEMENT

Anterior vs. Posterior Hip Replacement
Muscle Preservation & Recovery

The Three Surgical Approaches — and Why Muscle Preservation Is the Deciding Factor

Total hip replacement can be performed through several surgical approaches — each named for the direction from which the surgeon accesses the joint. The posterior approach enters from the back, requiring incisions through the gluteal muscles and short external rotators. The lateral approach enters from the side. The anterior approach — Dr. Calendine’s primary technique — accesses the hip from the front, working through a natural muscle interval rather than cutting through any major muscle group.

The distinction matters because not all muscles contribute equally to recovery. The gluteus medius and surrounding stabilizers disrupted in a posterior or lateral approach are the same muscles that power walking, stair climbing, and hip stability. Preserving them completely is the mechanism behind faster recovery, fewer activity restrictions in the early weeks after surgery, and a more natural return to function — not a minor technical detail.

The Anterior Approach: Dr. Calendine's Technique for Primary Hip Replacement

The anterior approach is the technique Dr. Calendine uses for the majority of hip replacement cases. Performing it well requires fellowship-level subspecialty training, specific surgical positioning equipment and the high-volume experience that builds genuine fluency with the technique’s demands. Dr. Calendine trained at the Anderson Orthopaedic Research Institute, one of the country’s leading hip and knee fellowship programs, and performs more than 700 joint replacements annually at BJIT in Franklin.

The anterior approach is not available from every orthopedic surgeon. When patients from Nashville, Brentwood, Murfreesboro, and surrounding Tennessee communities research anterior hip replacement and find Dr. Calendine’s practice, what they find is the full convergence: subspecialty training, surgical volume, the anterior technique, and a purpose-built orthopedic facility equipped to support it at every stage of care.

WHAT THE DATA SHOWS ABOUT ANTERIOR HIP RECOVERY

Anterior vs. Posterior Hip Replacement
The Clinical Difference

Muscle Preservation: The Core Advantage

The primary difference between anterior and posterior hip replacement is where the surgical incision is placed and which muscles must be addressed to reach the joint. The posterior approach enters from behind the hip, requiring division of the short external rotator muscles and portions of the gluteus maximus. The anterior approach enters from the front through a natural anatomical interval — the tensor fasciae latae and rectus femoris create a corridor that provides direct access to the hip socket without cutting through any major muscle groups.

The result of this muscle preservation is direct and measurable: patients recover faster, experience less post-operative pain, and face fewer activity restrictions in the early weeks after surgery. The anterior approach also eliminates the posterior hip precautions — the restrictions on hip flexion, crossing legs, and certain movements — that are standard after posterior approach surgery and which patients understandably find limiting.

Recovery Comparison: Anterior vs. Posterior Approach

Comparative data published in peer-reviewed literature consistently demonstrates faster early recovery milestones for patients who undergo anterior approach hip replacement. The table below reflects recovery metrics from a comparative study of anterior versus posterior hip replacement patients:

Recovery Milestone

Anterior Approach

Posterior Approach

What 'Minimally Invasive' Actually Means for Anterior Hip Replacement

The anterior approach to hip replacement is minimally invasive in the way that matters most: it minimizes muscle disruption, not just incision length. Patients sometimes expect a very small incision, and the anterior approach does use a standard-length incision comparable to other hip techniques — but the defining characteristic of minimally invasive surgery in this context is not how long the cut is. Orthopedic research consistently identifies the extent of muscle damage during interval without cutting any major muscle groups, the anterior approach minimizes the tissue trauma that drives post-
operative pain and slows recovery — regardless of incision length.

ANTERIOR APPROACH TOTAL HIP REPLACEMENT

The Surgical Procedure — Incision, Positioning, and
Muscle Preservation

HANA Table and Patient Positioning

Anterior hip replacement requires specialized patient positioning on a HANA orthopedic table (Hana Surgical Table) — a purpose-built device that supports the leg and allows controlled, precise movement of the hip joint throughout the procedure. This eliminates the need for repeated manual rotation of the joint and gives Dr. Calendine direct access to the anterior corridor. The HANA table is not standard equipment at every Nashville-area surgical facility, and the Bone and Joint Institute of Tennessee has made the deliberate infrastructure investment to support anterior hip replacement at volume. That equipment, combined with fellowship-trained surgical experience, is what makes the technique consistently available to patients in Franklin and the surrounding region.

Incision and Surgical Technique

The anterior approach hip replacement incision is placed at the front of the hip — typically a short vertical or bikini-style horizontal incision near the top of the thigh, with exact placement guided by the patient’s unique anatomy. Dr. Calendine then works through a natural interval between the tensor fasciae latae and rectus femoris muscles, gently moving tissue aside rather than cutting through any major muscle group. This anterior approach muscle-sparing hip replacement technique preserves the gluteus medius muscle and posterior stabilizers that power walking and hip function. Once the hip joint is exposed, the hip is carefully dislocated to allow precision removal of the damaged surfaces of the femoral head and acetabulum (hip socket), in preparation for placement of implant components.

ROBOTIC PRECISION · ANTERIOR APPROACH · REAL-TIME GUIDANCE

Robotic Precision and the Anterior Approach
Mako® and OrthoGrid®

The Anterior Approach's One Trade-Off — and How Robotics Solves It

The anterior approach to hip replacement has one technical trade-off that is worth understanding: compared to the posterior approach, it provides a more limited direct visualization of the acetabular socket during implant placement. The posterior approach opens the hip from behind, giving the surgeon a wider direct sightline to the socket. The anterior approach, by accessing from the front through the natural muscle interval, requires the surgeon to work through a more constrained corridor.

In experienced hands, this is manageable — and the anterior approach’s advantages in muscle preservation overwhelmingly justify the technical demand. But the limited visualization is precisely where robotic guidance and real-time intraoperative imaging add their highest value. Rather than relying on direct visualization alone, the surgeon works from a verified digital plan executed with robotic precision and confirmed by live imaging throughout the procedure.

Two Intraoperative Systems: Mako® and OrthoGrid®

Dr. Calendine uses two advanced intraoperative guidance systems for anterior hip replacement. The Stryker Mako® robotic system begins with a pre-operative CT scan that creates a three-dimensional patient-specific model of the hip joint. Before surgery, cup position, stem alignment, and leg length are planned digitally to the patient’s exact anatomy. During surgery, the robotic arm provides real-time guidance, ensuring that the implant is placed to the pre-planned position with an accuracy that manual technique alone cannot consistently achieve.

OrthoGrid AI-assisted live fluoroscopy provides a second layer of intraoperative confirmation — real-time X-ray analysis with data-driven overlay that allows Dr. Calendine to verify leg length and cup positioning during the procedure itself, before the surgical site is closed. For the anterior approach specifically, where direct visualization of the socket is more limited than in the posterior approach, these two systems work together to ensure that the precision of cup placement matches the pre-surgical plan.

WHAT RECOVERY FROM TOTAL HIP REPLACEMENT LOOKS LIKE

Recovery Timeline | Anterior Approach Hip Replacement

No Hip Precautions — What This Means for Your Recovery

One of the most practically meaningful differences between anterior and posterior hip replacement is the elimination of hip precautions. After a
posterior approach hip replacement, patients are given restrictions on hip flexion beyond 90 degrees, crossing the legs, and certain sitting and
bending positions — restrictions that remain in place for weeks to protect the repaired soft tissues from dislocation. Because the anterior
approach does not cut through those posterior muscles and capsule structures, there are no equivalent precautions. Patients can sit in a normal
chair, bend as needed, and sleep in a natural position from the day of surgery.

Physical Therapy and Follow-Up

Physical Therapy begins the day of surgery. Outpatient PT at BJIT Rehabilitation Services or a provider of your choice follows for patients who benefit from structured supervision. Much of the recovery work — progressive walking, hip strengthening exercises, range-of-motion work — can be completed independently at home. Discharge instructions covering wound care, activity guidelines, and any precautions are provided in writing before you leave the facility. Follow-up appointments are typically at 2 weeks and 6 weeks post-operatively.

UNDERSTANDING HIP PRECAUTIONS

Anterior Hip Precautions — What My Patients Actually Follow

Where traditional hip precautions came from

The rules most people know like do not bend the hip past 90 degrees, do not cross your legs, or do not twist the leg inward, were designed to protect a posterior hip replacement, where the surgeon works through the muscles and capsule at the back of the hip. Until those tissues heal, certain positions can stress the repair, so those patients follow strict precautions for weeks.

Do you need hip precautions after anterior hip replacement?

For most of my anterior hip replacement patients, the answer is: far fewer, and sometimes none. The anterior approach works between muscles at the front of the hip rather than cutting through them, and it leaves the posterior capsule undisturbed. That is why I can usually allow my anterior patients to bend, sit, and sleep in the positions that are comfortable, without the classic restriction list. Every patient is different and your specific precautions depend on your anatomy, your tissue quality, and what I see in the operating room, so the final word always comes from your own surgical team, not a website.

Positions to avoid after anterior hip replacement

In the early weeks, I do ask anterior patients to be sensible about two motions: forcing the leg into extreme extension behind the body, and aggressively rotating the leg outward — for example, a deep lunge with the surgical leg trailing, or pivoting hard away from the leg. These positions load the front of the hip where the approach was made. Normal walking, stairs, sitting in ordinary chairs, and sleeping on your side or back are generally fine as comfort allows.

The first six weeks — what I actually tell patients

Walk early and often; walking is the best therapy an anterior hip gets.
Let comfort be your guide for bending and sitting — pain is information, not a challenge.
Avoid forced hip extension and aggressive outward rotation until I clear you.
Keep your follow-up visits; I adjust each patient’s guidance based on how the hip is healing.
Call the office about fever, calf pain or swelling, drainage from the incision, or a sudden change in pain — those are never “wait and see” symptoms.

The bottom line on anterior hip precautions

The anterior approach was chosen, in part, so you would not have to live by a list of rules. A few weeks of common sense, an individualized plan, and early movement replace the old permanent restriction list for most patients. For the longer discussion of what you can and cannot do after hip replacement — including the old rules and why they have changed — read my full guide: What You Can Never Do After Hip Replacement

CANDIDACY FOR THE ANTERIOR APPROACH

Is the Anterior Approach Right for Me?

Who Is a Good Candidate for Anterior Hip Replacement?

The anterior approach is Dr. Calendine’s primary technique for total hip replacement, and the majority of his hip patients are evaluated for anterior approach candidacy as part of their consultation. Most patients who need total hip replacement are candidates for the anterior approach. The technique is appropriate for patients across a wide range of body types, ages, and
activity levels, and Dr. Calendine uses it for both straightforward primary hip replacements and more complex cases.

Candidacy is determined during your consultation through a combination of physical examination and imaging review. Factors that influence approach selection include hip anatomy, acetabular bone stock, prior hip surgeries, and any anatomical variations that affect access from the front. Dr. Calendine will explain his recommendation specifically for your anatomy — including whether an
anterior or alternative approach is the best technical choice for your case

When the Posterior Approach Is Selected Instead

In some cases — complex anatomy, revision surgery, or specific anatomical considerations — Dr. Calendine may recommen the posterior approach as the more appropriate technique. When this is the case, he explains why and what the posterior approach involves for your specific situation. The goal is always the best outcome for your hip, not a preference for a specific technique independent of your anatomy. Both approaches are performed with the Mako robotic system and OrthoGrid
intraoperative guidance.

The only reliable way to determine whether the anterior approach is right for your hip is a consultation with Dr. Calendine. The appointment is a direct conversation about your imaging, your anatomy, your goals, and his recommendation.

Hip Procedures At Bone & Joint Institute

FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions — Anterior Hip Replacement

Is the anterior approach to hip replacement better than the posterior approach?

Hip replacement has evolved significantly over the past decade, and not all hip replacements are the same. Dr. Calendine’s practice is built around two elements that distinguish his approach: the anterior surgical technique and robotic precision with the Stryker Mako system.

The Mako robotic system adds a layer of precision that goes beyond technique alone. A patient-specific three-dimensional model built from a pre-operative CT scan guides implant positioning with an accuracy that is difficult to achieve manually. Cup position in hip replacement is one of the strongest predictors of long-term stability and function — and getting it right, specifically for your anatomy, is what the robotic system is designed to ensure.

What restrictions do patients have after anterior hip replacement?

The anterior approach eliminates the posterior hip precautions that follow traditional posterior approach surgery. There are no restrictions on hip flexion beyond 90 degrees, no restrictions on crossing legs, and no restrictions on sitting in a normal chair. Patients can sleep in natural positions from the day of surgery.

General activity precautions that do apply: avoid high-impact activities (running, jumping, sports that involve significant impact) for the first 3–6 months and long-term to protect implant longevity. Driving resumes once you are off narcotic pain medication and walking steadily, typically at 4–6 weeks. Individual guidelines are reviewed with Dr. Calendine at discharge and at your follow-up appointments.

How long does anterior hip replacement recovery take?

Most patients with anterior hip replacement are walking with a walker on the day of surgery. The transition from a walker to a cane typically happens in weeks 2–3. Driving resumes at 4–6 weeks (once off narcotics and walking steadily). Return to sedentary work: 4–6 weeks. By 3 months, most patients are performing virtually all daily activities. Full recovery, including return to more demanding physical activity, continues through 6 months. The anterior approach consistently produces faster early recovery milestones than the posterior approach due to muscle preservation and the absence of hip precautions.

How is the HANA table used in anterior hip replacement?

The HANA table (Hana Orthopedic Table) is a specialized surgical positioning device designed specifically for anterior approach hip replacement. It supports the leg during surgery and allows controlled, precise movement of the hip joint — enabling the surgeon to work through the anterior corridor without excessive manipulation. The BJIT facility is equipped with the HANA table for anterior approach cases. Not all surgical facilities in the Nashville region have this table, which is one reason the anterior approach is not uniformly available from every orthopedic practice in the metro area.

Can Dr. Calendine perform anterior hip replacement for revision cases?

Revision hip replacement — surgery to replace a previously implanted hip that is failing, painful, or unstable — is a different clinical situation from primary hip replacement. In some revision cases the anterior approach can be used; in others, the anatomy and surgical complexity of the revision make a posterior approach the more appropriate technical choice. Dr. Calendine’s fellowship training at the Anderson Orthopaedic Research Institute included a focus on revision surgery, and he evaluates revision candidates individually to determine the best approach for their specific situation.

Is anterior hip replacement available for all hip replacement patients, or only certain cases?

The anterior approach is Dr. Calendine’s primary technique and is appropriate for the majority of patients requiring total hip replacement. It is not limited to a specific age group, body type, or activity level. Candidacy is determined at the consultation through physical examination and imaging review. In a small subset of cases — complex anatomy, prior hip surgery, or specific anatomical considerations — Dr. Calendine may recommend the posterior approach as the technically superior choice for that patient. In those cases, he explains exactly why. Both approaches are performed with Mako robotic and OrthoGrid precision guidance at BJIT.

Who specializes in direct anterior hip replacement near Nashville, TN?

Dr. Cory Calendine at the Bone and Joint Institute of Tennessee in Franklin specializes in the direct anterior approach, combining it with Mako robotic guidance. Fellowship-trained in hip and knee reconstruction, he treats patients from Nashville, Brentwood, Franklin, and across Middle Tennessee.

FRANKLIN, TN · SERVING ALL OF MIDDLE TENNESSEE

Ready to Schedule? Dr. Calendine Is
Accepting New Hip Replacement Patients.

Consultations for anterior approach hip replacement at the Bone and Joint Institute of Tennessee,
3000 Edward Curd Lane, Franklin, TN 37067. No referral required.

Dr. Cory Calendine, MD

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Anterior Hip Replacement Surgery
in Franklin, TN

Anterior vs. Posterior Hip Replacement
Muscle Preservation & Recovery

The Three Surgical Approaches — and Why Muscle Preservation Is the Deciding Factor

The Anterior Approach: Dr. Calendine's Technique for Primary Hip Replacement