HIP REPLACEMENT · SECTION 2
Surgeon's Complete Hip Replacement Guide
A NOTE FROM DR. CALENDINE — HIP REPLACEMENT
If you are reading this section, you are probably already considering hip replacement.
This section explains exactly how hip replacement works, how to choose a surgeon, how to prepare, and what recovery and long-term results actually look like. My goal is not just to explain the operation, but to help you understand how to do this the right way — at the right time, with the right plan, and with the right expectations.
Cory Calendine, MD, Orthopaedic Surgeon, Bone & Joint Institute of Tennessee
CHAPTER 1
Understanding Hip Arthritis
Hip replacement has been called the “Operation of the Century” — and not as marketing. The Lancet ranked it among the procedures that most dramatically restore quality of life, rivaled only by cataract surgery. Chapter 1 begins where every good decision begins: with a clear, plain-language explanation of what is actually happening inside your hip. Dr. Calendine walks through the ball-and-socket anatomy, the role of articular cartilage, and why — once cartilage is gone — the breakdown is permanent and bone begins to contact bone.
You’ll learn why hip arthritis isn’t a single disease but an endpoint reached by four distinct paths: osteoarthritis, inflammatory arthritis, post-traumatic arthritis, and avascular necrosis. Each has a different cause, a different timeline, and a different patient story — but all arrive at the same place: a joint that no longer works. This chapter also explains what hip replacement actually does, and why it’s the only true cure for hip arthritis. Understanding the problem is the foundation every later decision in this guide is built on.
CHAPTER 2
Where Is Your Pain Really Coming From?
Before we talk about hip replacement, we need to talk about something more fundamental — making sure your pain is actually coming from your hip. Chapter 2 introduces the simple framework Dr. Calendine uses with every patient: front pocket versus back pocket. Deep, aching pain in the front crease where your thigh meets your torso is the classic signature of hip joint arthritis. Pain in the buttock is far more often coming from the spine. And pain on the outer side of the hip is almost always bursitis — usually referred from back tightness, not from the joint itself.
This chapter also walks through the hip-spine overlap that Dr. Calendine sees daily in his Franklin clinic — why hip and spine arthritis frequently coexist, what hip replacement will and will not fix, and why a bad hip can actually increase irritation in the lower back. You’ll learn what an exam reveals, why internal rotation is one of the most telling physical findings, and how weight-bearing imaging fits in. Getting the diagnosis right is as important as anything that happens in the operating room — and it is the fastest way to avoid an unhappy outcome.
CHAPTER 3
Your Surgical Options for Hip Replacement
Not all hip replacements are the same. The components used, the surgical approach taken, and the technology employed in the operating room all vary. Chapter 3 walks through the decisions that go into planning your surgery sothat when you sit down with your surgeon, you can ask the right questions and evaluate the answers. You’ll learn the difference between total hip replacement and partial hip replacement, why total replacement is the standard for virtually all arthritis patients, and where partial replacement genuinely fits — primarily in specific hip fracture situations.
Dr. Calendine explains both the posterior approach, the decades-long workhorse of hip replacement, and the anterior approach, which works between natural muscle intervals without cutting or detaching any muscle. You’ll learn what each approach means for stability, recovery, and post-operative precautions, why movement restrictions vary from surgeon to surgeon, and why Dr. Calendine uses the anterior approach for the large majority of his primary total hip replacement patients in Franklin.
CHAPTER 4
Understanding Risks | Before You Decide
Hip replacement is one of the most successful elective surgical procedures in medicine — but every surgery carries risk, and you deserve a complete picture before you decide. Chapter 4 is Dr. Calendine’s honest account of what the real risks actually are, how common they are, and what we do to minimize them. The goal is not to scare you away from surgery. It is to make sure nothing surprises you — and to give you the confidence that comes from understanding the full landscape before you sign a consent form.
You’ll learn about infection and why prevention protocols — antibiotic regimens, skin preparation, and quitting smoking — can push rates well below national averages. You’ll learn why dislocation is far less common than patients fear, and how soft tissue tension (the “rubber bands” around the hip) keeps the joint stable. Dr. Calendine also walks through blood clots, nerve and vascular injury, leg-length differences, periprosthetic fracture, and the realistic longevity of modern implants — giving you the unvarnished, evidence-based answers every patient deserves.
READY TO MOVE FORWARD WITH CONFIDENCE?
You know more. Now decide what's next.
You’ve just walked through everything that goes into a modern hip replacement — the diagnosis, the approach, the technology, the implants, the recovery, and the life that comes after. If you’re ready for a conversation about your specific hip, Dr. Calendine’s office is here to help. Schedule a consultation to discuss your situation directly — or download the complete hip replacement guide to keep every chapter at your fingertips. No referral required.
CHAPTER 5
OR Technology | OrthoGrid AI and Mako
There was a time when a hip replacement surgeon relied primarily on feel, experience, and a static X-ray taken before the patient entered the operating room. The technique was sound, and the results were often excellent. Chapter 5 explains how the technology now available in the modern hip replacement operating room has changed what is possible in terms of precision — and why component position, implant alignment, leg length accuracy, and soft tissue balance are the difference between a hip that feels natural and one that does not.
Dr. Calendine uses two systems in tandem: OrthoGrid AI, an artificial intelligence-assisted imaging platform that analyzes live intraoperative X-rays in real time to verify component position, leg length, and alignment — and the Mako robotic system, which builds a detailed three-dimensional model of your hip from a preoperative CT scan, allowing the entire surgery to be planned in advance and executed with haptic-guided precision. This chapter explains exactly how each tool works, why Dr. Calendine uses both, and why the robotic arm never operates independently — the surgeon is always in complete control.
CHAPTER 6
The Implants | What Goes In and Why
Every hip replacement involves the same fundamental task: removing the damaged joint surfaces and replacing them with implant components that recreate the mechanics of a healthy hip. The materials used, the fixation method, and the design of the bearing surfaces all influence how the hip performs and how long it lasts. Chapter 6 explains the four components that work together as a system — the acetabular cup, the liner, the femoral head, and the femoral stem — and why the better question is not “which implant is best” but “which implant does your surgeon know well.”
You’ll learn how modern cementless fixation actually works — why a precisely press-fit implant allows your own bone to grow directly into the porous surface, creating a bond that is designed to last. Dr. Calendine explains when cemented fixation is the right choice, and how the bearing surface decision drives implant longevity: why ceramic heads on highly cross-linked polyethylene liners are a top choice, what earlier bearing combinations taught us, and why the materials used today produce minimal wear over decades of normal use.
CHAPTER 7
Preparing for Hip Replacement Surgery
The outcome of your hip replacement is not determined entirely in the operating room. It begins weeks before surgery — in the decisions you make and the preparation you invest. Chapter 7 walks through what real preparation looks like: cardiovascular clearance, blood sugar control for patients with diabetes, smoking cessation, medication review, dental health, and bone health. Patients who arrive at surgery in the best possible shape consistently do better than those who don’t — and much of that optimization is directly within your control.
Just as important is prehabilitation — strengthening the muscles around the hip before surgery. Dr. Calendine explains one of the most common misconceptions patients have: that activity will damage the joint or make things worse. It won’t. Pain is information — not damage. This chapter explains why walking, swimming, cycling, and gentle strengthening build the reserve you will draw from in recovery, how to prepare your home before surgery day, what to expect at your pre-operative appointment, and the practical checklist Dr. Calendine gives every patient in the weeks leading up to the procedure.
CHAPTER 8
Surgery Day: What Actually Happens
Surgery day can be an anxiety-producing part of the entire hip replacement experience — and the anticipation is almost always worse than the reality. Chapter 8 walks you through the day from beginning to end so you know what to expect. You’ll learn what happens from the moment you arrive — check-in, the pre-operative area, the IV line, surgical site marking, the anesthesia consultation, and the final visit from Dr. Calendine before you are taken to the operating room. This is the chapter that replaces anxiety with understanding.
Dr. Calendine explains exactly what spinal anesthesia is and why it is his standard for hip replacement — in plain terms that make the reality far less frightening than the phrase suggests. You’ll learn why you will not have a breathing tube, why most patients don’t remember the operating room at all, and what happens if general anesthesia becomes the better choice. The chapter then walks step-by-step through what actually occurs during an anterior approach hip replacement — from incision through implant placement and closure — so you arrive at surgery day knowing what is happening at every stage.
CHAPTER 9
Recovery: Week by Week
Hip replacement recovery is one of the most pleasant surprises in all of surgery. Patients arrive expecting something difficult — and discover they are more capable than they imagined. They walked the day of surgery, likely went home the same day, and slept in their own bed that night. Chapter 9 gives you a realistic, week-by-week picture of what recovery actually looks like, from surgery day through week one to the longer arc of three, six, and twelve months. It also explains the one principle that governs early recovery: do not do too much too early.
Dr. Calendine walks through the protocols that makes many patients feel surprisingly good on day two, why that feeling can be misleading, and how to avoid the day-five-through-ten setbacks. You’ll learn why the walker is about balance and confidence, why the surgical dressing is waterproof and you can shower from day one, how to stay ahead of pain rather than chase it, and when to transition from walker to cane to walking unaided. Most importantly, you’ll learn the framing that matters most: your recovery runs on your body’s schedule, not someone else’s — direction matters more than pace.
CHAPTER 10
Expectations, & Life After Hip Replacement
This is the chapter most patients wish they had read earlier — not because it contains information they couldn’t find elsewhere, but because it puts everything together in the way that actually matters. What does this surgery deliver? What should you expect going in? And what does life actually look like on the other side of it? Chapter 10 answers those questions directly. The honest answer, for the overwhelming majority of patients, is this: better than they imagined, more complete than they hoped, and faster than they feared. Only cataract surgery rivals it in quality-of-life restoration.
Dr. Calendine walks through what the evidence actually shows and the consistent patterns he sees in his patients — medically optimized, genuinely committed to recovery, and measuring progress against where they started rather than someone else’s timeline. The chapter also gives an honest comparison between hip and knee replacement recovery, practical guidance for patients facing both, and the long-term realities of implant longevity, activity after surgery, and how to think about the decision you are now ready to make.
HEAR IT FROM DR. CALENDINE
A Surgeon's Perspective on Hip Replacement
Section 3 | Knee Replacement Guide
Back To Section 1 | Joint Replacement Essentials
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
Before You Decide — The Essentials
Section Two took you deep into hip replacement — but some of the most important questions come earlier. How does arthritis actually develop? How do you know when it’s time? And what should you try before surgery becomes the conversation? Section One is the foundational pillar of this guide: three chapters on understanding hip and knee arthritis, recognizing the signs you may need replacement, and working through every major non-surgical option — activity modification, physical therapy, weight management, NSAIDs, bracing, injections, and an evidence-based look at stem cell treatments. If you’re earlier in your decision than this hip section assumes, start here. It’s the chapter every patient wishes they had read first.
GO TO THE ESSENTIAL | BEFORE YOU DECIDE
COMMON QUESTIONS ABOUT THIS GUIDE
Frequently Asked Questions
How do I know if I need a hip replacement?
There is no single test that tells you it’s time for hip replacement. The decision is made in context — by the location and pattern of your pain, how it’s affecting your daily life, and what weight-bearing X-rays show. The hallmark of hip arthritis is deep groin or front-of-hip pain that catches you standing up from a chair, climbing stairs, or rolling over in bed. When that pain starts dictating what you can do, it’s time for a conversation.
- Download Complete Hip & Knee Replacement Guide (PDF)
What is the difference between the anterior and posterior hip replacement approaches?
The anterior approach accesses the hip from the front, working between natural muscle intervals without cutting or detaching any muscle. The posterior approach accesses the hip from the back through the gluteus maximus and is the traditional technique. Both deliver excellent results in experienced hands. Dr. Calendine uses the anterior approach for the large majority of his primary total hip replacement patients because no muscle is divided and the posterior structures are left undisturbed.
Is robotic hip replacement better than traditional hip replacement?
Robotic-assisted hip replacement — such as with the Mako system — offers measurable precision advantages over traditional manual technique. Mako builds a 3D model of your specific anatomy from a preoperative CT scan, allowing Dr. Calendine to plan and execute the surgery with haptic-guided accuracy. The robotic arm never operates independently; the surgeon is in complete control. The benefit is improved component positioning, leg length accuracy, and implant longevity.
How long does a modern hip replacement last?
Modern hip replacements are designed and engineered to last decades. The combination of cementless implants with porous bone-ingrowth surfaces, ceramic femoral heads, and highly cross-linked polyethylene liners has dramatically extended implant longevity compared to earlier generations. Most patients today can reasonably expect their hip replacement to last 20 to 30 years or longer, depending on activity level, implant position, and individual factors.
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- Call: (615) 791-2630
How long is recovery after hip replacement surgery?
Most hip replacement patients walk the day of surgery and go home the same day. A walker is typically used in the first week primarily for balance and confidence, then transitioned to a cane, and often no device at all by weeks two to three. Most patients feel meaningfully well within four to six weeks, with full recovery continuing to progress through three, six, and twelve months. Recovery runs on your body’s schedule.
Will I be put to sleep for hip replacement?
Most hip replacements are performed under spinal anesthesia with IV sedation. A single injection numbs the lower half of your body, and sedation keeps you deeply comfortable throughout the procedure — no breathing tube required. Most patients do not remember the operating room at all. In specific medical situations where spinal anesthesia isn’t appropriate, general anesthesia is used safely. Your anesthesia plan is discussed in advance.
What are the risks of hip replacement surgery?
The main risks of hip replacement are infection (approximately 1–2% nationally, significantly lower in centers with rigorous prevention protocols), dislocation (less than 1% with modern technique), blood clots, nerve or vascular injury, leg-length differences, and periprosthetic fracture. Dr. Calendine walks through every risk honestly in Chapter 4 of the complete guide. Understanding these risks should increase your confidence — not your fear.
- Read the Hip Replacement Guide
- Read the Knee Replacement Guide
Can hip arthritis be reversed without surgery?
No. Cartilage does not heal, and once it’s lost, the loss is permanent. Non-surgical treatments — activity modification, physical therapy, weight management, NSAIDs, bracing, and injections — can meaningfully manage your symptoms, preserve function, and often buy you significant time before surgery becomes the right conversation. But they do not reverse cartilage loss. Hip replacement is the only true cure for end-stage hip arthritis.
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- Call: (615) 791-2630
How soon can I drive after hip replacement?
Most hip replacement patients return to driving within two to three weeks after surgery — sometimes sooner for a left hip in an automatic transmission vehicle. The key requirements are being off narcotic pain medication, having the strength and reflexes to operate the vehicle safely, and feeling confident in emergency response. Dr. Calendine discusses specific driving clearance with each patient at the post-operative visit based on individual recovery.
Where does Dr. Cory Calendine perform hip replacement surgery?
Dr. Cory Calendine performs hip replacement surgery at Williamson Health and at the Bone and Joint Institute of Tennessee Surgical Center, both located in Franklin, Tennessee. His practice is based at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. Dr. Calendine serves patients throughout Middle Tennessee, including Nashville, Franklin, Brentwood, and the surrounding communities. Call (615) 791-2630 to schedule a consultation.
- Schedule Consult Today
- Call: (615) 791-2630