Hip & Knee Replacement Blog — Dr.
Cory Calendine, MD

Follow @corycalendinemd for orthopedic surgery highlights
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Rethinking How We Fix Ankle Fractures
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For decades, plate-and-screw fixation has been the standard for unstable fibula fractures. But intramedullary fibular nailing is changing the conversation — and the evidence is compelling. Instead of an extensile 8 cm incision along the subcutaneous border of the fibula, nail fixation is placed through a small incision, often 2 to 3 cm. That smaller footprint means less periosteal stripping, less soft tissue disruption, and better preservation of blood supply at the fracture site.
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What the literature shows: Meta-analysis of randomized trials found significantly lower infection rates with nail fixation compared to plating. A separate systematic review of 1,710 patients reported wound complications in 1.7 percent of nailed fibulas versus 15.1 percent with plates. Large single-surgeon series report union rates approaching 100 percent with minimal hardware removal. Because the nail is a load-sharing construct, many patients begin protected weight-bearing earlier than traditional protocols allow. This matters most in higher-risk patients — older adults, diabetics, smokers, and anyone with a fragile soft tissue envelope, where a wound complication can become the real problem. Anatomic reduction still comes first. The implant is a tool, not a shortcut.
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⬇️ SHARE your #anklefracture experience & insights
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🎥 @tribemedical , @arthrexmeded - Fibular Nail

What Actually Protects Your New Hip (Not the Rulebook)

Someone may have handed you a list. Don’t cross your legs. Don’t sit in low chairs. Sleep with a wedge between your knees. Most of that list belongs to a different operation, and maybe a different decade. Many of those rules exist for one reason: dislocation. With the anterior approach, which I use for almost all of my hip replacements, the muscles that hold the hip in place are never cut. There is no six-week countdown to protect. Many posterior surgeons have relaxed the strict version too. The field has moved.

What actually protects a new hip is strong muscles and common sense in the first couple of weeks. Everyday life is not an extreme of motion. The real goal is a hip you forget you have. No restrictions long term is not a perk. It is the point. Full discussion at ccmd.pro/restrictions

👇 What #hipreplacementrecovery rule were you given?

High Ankle Sprain Explained: Why It Is Not a Normal Ankle Sprain

A high #anklesprain is not a worse version of the sprain most people have had - it’s a different injury in a different place. Your ankle depends on the two lower leg bones, the tibia and fibula, staying tightly joined just above the joint. That connection is the syndesmosis, and its ligaments act as a shock absorber every time an athlete lands, cuts, or pivots. A high ankle sprain tears those ligaments. The mechanism is usually a collision or a forced outward twist with the foot flexed upward. Athletes describe pain across the front of the ankle that travels up the leg rather than along the outside, difficulty bearing weight, and trouble pushing off the toes. Bruising may not appear for several days.

In the office we look for pain when the tibia and fibula are squeezed together, tenderness well above the joint line, and pain when the ankle is rotated outward. X-rays rule out fracture, MRI defines the ligament injury, and stress imaging tells us whether the joint is stable. Stability drives the decision. A stable injury is treated without surgery: protected weight bearing, immobilization, and progressive rehabilitation. Recovery is slower than a routine ankle sprain, and returning too soon is the most common reason athletes struggle. When the #syndesmosis is unstable, surgery restores the relationship between the two bones so the ligaments heal in the correct position. Fixation may be a screw across the syndesmosis or a flexible suture button construct, sometimes with arthroscopic assessment of the joint. Flexible fixation permits some natural motion and often avoids a second procedure to remove hardware. If you cannot bear weight after an ankle injury, have it evaluated. A missed high ankle sprain is much harder to treat later.
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⬇️ SHARE your #ankleinjury experience & insights
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🎥 @arthrexmeded - Tightrope™️ repair

Knee Dislocation: The Knee Injury That Can Threaten Your Leg

A knee dislocation is not a bad sprain, and it is not a dislocated kneecap. It is a limb-threatening emergency, and must be taken seriously. In a true knee dislocation, the thighbone (femur) and shinbone (tibia) separate - several major stabilizers usually tear at once: the ACL and PCL, often along with the MCL, LCL, and the posteromedial or posterolateral corner. Most occur with high-energy trauma such as car crashes, dashboard impacts, and falls from a height. Sports injuries can cause them too, and in some patients even a low-energy misstep is enough.
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The real danger sits directly behind the knee - your popliteal artery. This main blood supply to the lower leg, is tethered above and below the joint, so it can stretch, tear, or clot when the bones shift. The peroneal nerve, which lifts the foot and ankle, is also vulnerable, and injury can lead to foot drop. Many #kneedislocations pop-back into place before anyone reaches the hospital, so the knee may look almost normal. A palpable pulse in the foot doesn’t rule-out an artery injury either, because smaller vessels around the knee can mask it. That is why emergency teams check blood flow repeatedly, often with an ankle-brachial index, ultrasound, or CT angiography Treatment starts with prompt realignment and a vascular assessment, followed by stabilization, ligament reconstruction in most cases, and dedicated rehabilitation. If a knee injury comes with gross instability, a cold or pale foot, numbness, or trouble lifting the foot, call 911.

👇 SHARE your #kneeinjury experience & insights
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🎥 @anatomia.repost - knee dislocation injury

🦴 Donated Bone Becomes Your Bone: How Bone Grafts Really Work

Sometimes the best bone for your surgery isn’t your own. When we fuse a joint, fill a gap left by a fracture, or rebuild bone that has been damaged, we often need more bone than your body can spare. That’s where donated bone, called allograft, comes in. It comes from a living donor or, more often, from someone who has passed, and it’s processed into chips, strips, or a moldable putty known as bone matrix. It arrives packed with the natural proteins that signal your body to start building. Think of it less as a replacement and more as a set of instructions. Your own cells move in, follow the blueprint, and over the following months your bone grows straight through the graft until you can no longer tell where it ends and you begin.

#DemineralizedBoneMatrix is rarely rejected, it spares you a second incision to harvest bone from your own hip, and it has been used safely in #orthopedicsurgery for decades. Donors are carefully screened, and the tissue is processed to make disease transmission extremely rare. Every graft is also a gift from someone who chose to donate.

👇 Have you ever had a bone graft, or been told you might need one? Share your experience.