HIP & KNEE REPLACEMENT GUIDE · SECTION 1
Before You Decide — The Essentials
A MESSAGE FROM DR. CALENDINE
You deserve real answers. That's what this is for.
“In my practice I’ve had some version of this conversation thousands of times — with patients who are in pain, frustrated, uncertain, and tired of being without a clear picture of what their options actually are. That’s what this guide is for. Read it straight through, or jump to the section that applies to your joint. Either way, my goal is simple: to give you the honest information you need to make confident decisions about your hip and knee.”
Cory Calendine, MD
Orthopaedic Surgeon, Bone & Joint Institute of Tennessee
CHAPTER 1
How Healthy Joints Work — and Why They Fail
Think of your hip or knee joint as a precision-engineered ball and socket, or a complex hinge. In a healthy state, these surfaces are coated with cartilage — a slick, resilient tissue that allows for frictionless movement. When this “cushion” remains intact, you move through life without a second thought. Understanding what a healthy joint actually does is the first step toward understanding what happens when it stops working.
The Anatomy of Stability
Joint failure rarely happens overnight. It’s often a gradual thinning of that protective layer, eventually leading to bone-on-bone contact. This isn’t just a mechanical issue; it’s a quality-of-life issue that affects your sleep, your mood, and your ability to engage with your family. Chapter 1 explains the critical difference between your hip (a deep ball-and-socket built for stability) and your knee (a hinge joint that depends on surrounding muscles and ligaments) — and why both depend entirely on the same irreplaceable layer of cartilage.
"Joint replacement is not just about replacing bone and metal. It's about restoring the mechanical rhythm of your daily life."
Understanding the transition from “discomfort” to “disability” is the first step in deciding when intervention is necessary. This chapter walks you through the four main causes of cartilage failure — osteoarthritis, inflammatory arthritis, post-traumatic arthritis, and avascular necrosis — and explains why cartilage, once damaged, cannot heal on its own. That single fact shapes every treatment decision that follows.
A NOTE ON JOINT REPLACEMENT: Modern surgical techniques allow us to preserve more muscle and tissue than ever before, leading to significantly faster recovery times and more natural-feeling joint movement. Joint replacement is not a last resort — it is a proven solution to a structural problem, and one of the most effective elective procedures in all of medicine.
CHAPTER 2
Signs You May Need Hip or Knee Replacement
There is no single test that tells you it’s time for joint replacement — no blood value, no imaging finding, no pain score that crosses a line and makes the decision for you. The decision is always made in context. Chapter 2 walks through the specific symptom patterns Dr. Calendine sees most consistently in patients who are genuinely ready for this conversation — from groin pain that patients mistake for a pulled muscle (the hallmark of hip arthritis) to morning stiffness, nighttime pain, and the gradual loss of range of motion that signals a knee has progressed beyond what rest alone can manage.
This chapter also explains the role of weight-bearing X-rays, why imaging and pain don’t always match, and the six quality-of-life questions we ask in nearly every consultation. If you’ve started giving up activities that matter to you, calculating distances before you walk, or relying on daily medication just to get through a normal day — those answers matter more than any X-ray. You’ll also learn why timing matters, and why the most common mistake isn’t moving too fast toward surgery — it’s waiting longer than you needed to.
CHAPTER 3
Non-Surgical Options: What to Try First
Joint replacement is not the first step — and it shouldn’t be. Chapter 3 walks through every major conservative treatment option available for hip and knee arthritis: activity modification, physical therapy, weight management, NSAIDs and topical alternatives, bracing, corticosteroid injections, hyaluronic acid (gel shots), and PRP. Dr. Calendine explains what each one actually does, who benefits most, and where the real limitations are — including a direct, evidence-based warning about stem cell injections.
Nothing in this chapter reverses cartilage loss. What these treatments can do is manage your symptoms, preserve your function, and in many cases buy meaningful time before surgery becomes the right conversation. You’ll learn how and why the strength you build now isn’t wasted if surgery becomes necessary later, why every five pounds of weight loss removes roughly twenty pounds of force from your knee, and how to recognize the moment when conservative care has done everything it can. That moment isn’t failure, it’s information — and we’ll guide you safely through the next steps.
READY TO TAKE THE NEXT STEP?
Real answers. Clear options. A path forward.
Whether you’re still exploring your options or ready to have a conversation about your joint, Dr. Calendine’s office is here to help. Download the complete guide for the full picture — or schedule a consultation to discuss your specific situation. No referral required.
CHAPTER 4
Overview of Your Options: What Surgery Actually Is
Total versus partial. Anterior versus posterior. Robotic versus traditional. Patients hear these terms constantly but rarely get a clear explanation of what they actually mean. Chapter 4 cuts through the confusion and gives you a plain-English map of the surgical options available for both hip and knee replacement — what each procedure involves, how the approaches differ, and what those differences mean for your recovery. You’ll understand why Dr. Calendine uses the subvastus approach for most knee replacements and the anterior approach for hips, and why surgeon experience matters more than any single technique.
This chapter also explains how the Mako robotic system works — not as an autonomous device, but as a precision tool guided by a three-dimensional model of your specific anatomy. You’ll learn what modern implants are designed to last, why most patients now go home the same day or after one night, and how to evaluate your options with the right question in mind: not which approach is “best,” but which surgeon does it most, does it best, and has the outcomes to prove it.
CHAPTER 5
Are You a Candidate? The Decision Process
There is no age requirement for joint replacement. The decision comes down to three things: what your symptoms are doing to your life, what your imaging shows, and whether conservative treatment has had a fair chance. Chapter 5 explains the framework Dr. Calendine uses in every consultation to evaluate candidacy, including the health factors that affect surgical planning — cardiovascular health, diabetes, body weight, smoking, and even dental health — and why none of them are automatic disqualifiers.
This chapter also addresses the two things patients underestimate most: timing and mindset. Waiting beyond the right window doesn’t earn you anything — it costs you. And patients who go into surgery with realistic expectations and a genuine commitment to the work of recovery consistently report better outcomes than those who weren’t prepared. You’ll learn exactly what to bring to your consultation, why a second set of ears in the room makes a real difference, and why the most important thing to remember is this: the decision is yours, and it should be.
VIDEO INTRODUCTION FROM DR. CALENDINE
The Essentials — In Dr. Calendine's Own Words
Introduction: Hip Replacement
Introduction: Knee Replacement
A Surgeon's Complete Guide to Hip Replacement
If hip pain is what brought you here, Section Two goes the full distance. In ten detailed chapters, Dr. Calendine covers everything from understanding hip arthritis and pinpointing where your pain is actually coming from, to choosing between the anterior and posterior surgical approaches, evaluating Mako® robotic technology and OrthoGrid AI guidance, selecting the right implant, preparing for surgery, and knowing what to expect week by week through recovery. This is the complete clinical picture — written for patients who want real answers, not reassurance. Whether you’re considering hip replacement in Nashville, Franklin, or anywhere in Middle Tennessee, this is the guide to read before your consultation.
GO TO COMPLETE HIP REPLACEMENT GUIDE
A Surgeon's Complete Guide to Knee Replacement
Knee replacement is more demanding than hip replacement — and the decisions leading up to it are equally complex. Section Three walks you through all of it across ten chapters: diagnosing arthritis accurately, understanding total versus partial knee replacement, comparing Dr. Calendine’s muscle-sparing subvastus approach to the standard technique, the role of Mako® robotic guidance in soft tissue balancing, implant selection, preparing your body, what happens the day of surgery — including the nerve block protocols — and a week-by-week recovery timeline that sets honest expectations. For patients considering knee replacement near Nashville, TN, this section gives you the clinical foundation to make a confident, informed decision.
GO TO COMPLETE KNEE REPLACEMENT GUIDE
COMMON QUESTIONS ABOUT THIS GUIDE
Frequently Asked Questions
What is this guide, and who is it for?
This guide — Before You Decide: A Surgeon’s Complete Guide to Hip & Knee Replacement — is a free patient education resource written by Dr. Cory Calendine, a board-certified, fellowship-trained orthopaedic surgeon at the Bone and Joint Institute of Tennessee in Franklin, TN. It is designed for anyone experiencing hip or knee pain who wants to understand their condition, their options, and what the path forward actually looks like — whether surgery is the right answer or not. The guide is written in clear, plain language at a 6th–7th grade reading level and covers the same foundational information Dr. Calendine shares in his exam room every day.
Does joint cartilage heal on its own?
No. Cartilage has no direct blood supply, which means the body cannot deliver the cells needed to repair damage. Once articular cartilage — the smooth tissue that covers the ends of your bones — wears away, it does not regenerate. This is why osteoarthritis is a progressive condition and why joint replacement addresses the problem structurally rather than biologically. Understanding this single fact is central to making informed decisions about treatment — and it’s covered in detail in Chapter 1 of this guide.
What are the most common causes of joint pain and instability?
The guide covers four main causes of cartilage and joint failure: osteoarthritis (the most common, caused by gradual cartilage breakdown over time), inflammatory arthritis (conditions like rheumatoid arthritis where the immune system attacks the joint lining), post-traumatic arthritis (joint degeneration that develops after a significant prior injury), and avascular necrosis (loss of blood supply to a section of bone, most commonly affecting the hip). All four lead to the same endpoint — a joint that no longer functions properly.
How do I know if my joint pain is serious enough to see a surgeon?
If you are avoiding activities that matter to you because of hip or knee pain, if pain prevents you from sleeping through the night, if you are calculating distances before you walk or relying on daily medication to get through a normal day — those are the patterns Dr. Calendine sees most consistently in patients who are ready for this conversation. A consultation is not a commitment to surgery. It is an evaluation that gives you a clear picture of where you stand and what your realistic options are.
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- Call: (615) 791-2630
Does the guide cover non-surgical treatment options?
Yes. Chapter 3 walks through every major conservative treatment for hip and knee arthritis: activity modification, physical therapy, weight management, oral and topical anti-inflammatory medications, bracing, corticosteroid injections, hyaluronic acid (gel shots), and platelet-rich plasma (PRP). The guide explains what each option can realistically do, who benefits most, and how to recognize when conservative treatment has done everything it can. It also includes a direct, evidence-based discussion of stem cell injections and why Dr. Calendine does not recommend them.
What is the difference between total and partial joint replacement?
In a total joint replacement, the damaged surfaces on both sides of the joint are removed and replaced with precisely fitted artificial components. In a partial replacement, only the most damaged portion of the joint is replaced while the healthier areas are left intact. The guide explains when each option is appropriate, why most patients with knee arthritis need a total rather than partial replacement, and what questions to ask your surgeon about the recommendation for your specific joint.
What topics are covered in the Hip and Knee Replacement sections of the guide?
The Essentials section you’re reading now covers the foundational information that applies to both joints — how joints work, symptoms, non-surgical options, surgical overview, and candidacy. Section Two (Hip Replacement) goes deeper into hip-specific topics: the anterior and posterior approaches, OrthoGrid AI, Mako robotic technology, implant selection, preparing for hip surgery, surgery day, and week-by-week recovery. Section Three (Knee Replacement) covers knee-specific topics: compartment anatomy, the subvastus muscle-sparing approach, knee-specific robotic planning, nerve block protocols, and knee recovery milestones.
- Read the Hip Replacement Guide
- Read the Knee Replacement Guide
Is there an age requirement for joint replacement surgery?
There is no minimum or maximum age for hip or knee replacement. The decision is based on three factors: the severity of cartilage damage confirmed on imaging, the degree to which symptoms are affecting your quality of life, and whether non-surgical treatments have been given a fair opportunity. Dr. Calendine has performed joint replacement on patients in their thirties and on patients in their nineties. What determines candidacy is the condition of your joint and your overall health — not your age. Chapter 5 of this guide explains the full candidacy framework in detail.
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- Call: (615) 791-2630