POSTERIOR APPROACH · ROBOTIC-ASSISTED · FRANKLIN, TN

Posterior Hip Replacement Surgery
in Franklin, TN

Q: Does the posterior approach use robotic guidance?

Yes. Dr. Calendine uses the Stryker Mako robotic system and OrthoGrid AI-assisted fluoroscopy for both anterior and posterior hip replacement cases. Both procedures begin with the same pre-operative CT scan and patient-specific digital planning process. The robotic system provides real-time intraoperative guidance for implant cup positioning regardless of which approach is used. Patients undergoing posterior hip replacement with Dr. Calendine receive the same precision guidance technology as anterior approach patients.

Dr. Cory Calendine, MD · Mako® Robotic Guidance · Bone and Joint Institute of Tennessee

The posterior approach to hip replacement is one of the most widely performed hip replacement techniques in orthopedic surgery. Dr. Cory Calendine uses the anterior approach as his primary technique for most hip replacement cases — but performs the posterior approach when patient anatomy, surgical complexity, or revision circumstances make it the technically superior choice. When Dr. Calendine recommends the posterior approach for a specific patient, it is because it is the right technique for that patient’s hip. Both approaches are performed at the BJIT in Franklin, TN with Mako® robotics and OrthoGrid AI-assisted fluoroscopy.

OPTIMAL APPROACH

MATCHED TO YOUR ANATOMY

700+

HIP & KNEE REPLACEMENTS EACH YEAR

ANDERSON ORTHOPAEDIC

FELLOWSHIP TRAINED | JOINT REPLACEMENT

TECHNIQUE SELECTION IS A CLINICAL DECISION, NOT A PREFERENCE

The Posterior Approach — The Right
Technique for the Right Case

Why Approach Selection Matters

Total hip replacement can be performed through several surgical approaches — the anterior (from the front), the lateral (from the side), and the posterior (from the back). Each approach has clinical trade-offs that make it more or less appropriate for a given patient’s anatomy, surgical history, and the complexity of the case. There is no single approach that is universally correct for every hip. The right technique is the one that produces the best outcome for that specific patient’s anatomy.

Dr. Calendine’s default technique is the anterior approach, which preserves the gluteal muscles completely and eliminates post-operative hip precautions. For the majority of primary hip replacement cases, the anterior approach delivers faster early recovery and greater patient freedom. But surgical medicine does not operate on defaults — it operates on anatomy. When anatomy or surgical history calls for the posterior approach, that is the recommendation a patient will receive.

When Posterior Approach Is a Better Option

The posterior approach is Dr. Calendine’s technique of choice in specific clinical circumstances where it provides superior surgical access, visualization, or safety. These include revision hip replacement — where prior implant geometry or bone loss requires broader joint exposure; complex primary cases where anatomy limits safe anterior access; and patients with prior hip surgery that has altered the anterior tissue planes. In these situations, the posterior approach is not a concession — it is the technically correct choice.

Certain anatomical configurations of the acetabulum or femur also favor posterior access for more precise implant positioning. When the posterior approach is the right recommendation for a patient, Dr. Calendine explains the specific clinical reason directly at the consultation — what it means for the procedure, what recovery looks like including the hip precautions period, and why it is the right choice for that specific hip. The decision is the result of a detailed review of imaging and a thorough physical examination.

INCISION PLACEMENT, MUSCLE MANAGEMENT, AND JOINT ACCESS

How the Posterior Approach Works —
Anatomy and Access

Skin Incision | Approach Direction

Posterior hip replacement uses a curved incision positioned at the side and back of the hip, curving strategically behind the greater trochanter — the bony prominence at the top of the femur. The incision is placed to preserve the abductor muscles, the gluteus medius and minimus, which are the primary muscles powering walking and hip stability. These muscles are not cut in the posterior approach — they are protected throughout the procedure while access is gained through the posterior soft tissue structures.

Achieving that access requires cutting through several structures at the back of the hip: the external rotator muscles, a group of small muscles connecting the top of the femur to the pelvis that help prevent the femur from rotating out of the socket, and portions of the posterior hip capsule. These structures are carefully managed during the procedure and meticulously repaired at closure. Their healing during the post-operative period is the clinical reason hip precautions are required after posterior hip replacement surgery.

Posterior Approach | Key Advantages

The clinical trade-off of the posterior approach is that some soft tissue structures are cut vs. preserved, requiring repair at closure and imposing hip precautions during the post-operative period. But this trade-off comes with a meaningful clinical return: the posterior approach provides the surgeon with a broader direct sightline to the joint. This superior visualization is particularly valuable in revision surgery — where existing implants must be removed and replaced in a compromised anatomical environment.

That visualization advantage also applies in complex primary cases where hip socket requires precise visual confirmation during implant seating. The posterior approach requires less specialized positioning equipment than the anterior approach and carries the longest published outcome record of any hip replacement technique — decades of data demonstrating high success rates and patient satisfaction across a broad patient population. For the cases where it is the right clinical choice, its track record is strong.

THE SAME PRECISION TECHNOLOGY FOR EVERY HIP REPLACEMENT

Mako® Robotic System and OrthoGrid — Precision
for Every Approach

Robotic Guidance Is Not Limited to the Anterior Approach

A common patient misconception is that robotic-assisted hip replacement is only used with the anterior approach. This is not the case in Dr. Calendine’s practice. The Stryker Mako® robotic system and OrthoGrid AI-assisted fluoroscopy are used for both anterior and posterior hip replacement cases.

Every hip replacement performed by Dr. Calendine — regardless of approach — benefits from the same pre-operative CT-based digital planning, the same patient-specific three-dimensional anatomical model, and the same intraoperative robotic guidance for implant placement.

How Robotic Guidance Applies to
the Posterior Approach

Cup positioning is the single most consequential variable in total hip replacement outcomes, regardless of which surgical approach is used. In the posterior approach, the superior direct visualization of the acetabular socket is one of the technique’s recognized advantages.

Mako robotic guidance and OrthoGrid AI-assisted fluoroscopy add a data-verified layer on top of that direct visualization — confirming that the cup is positioned to the pre-planned alignment rather than relying on surgeon judgment alone. The result is a posterior hip replacement that combines the posterior approach’s visualization advantage with the precision guarantee of robotic guidance.

POSTERIOR APPROACH | RECOVERY CONSIDERATIONS

Recovery Timeline — Posterior Hip Replacement

Posterior Hip Precautions — What They Are and Why They Apply

Early mobilization is the standard after anterior approach hip replacement. Most patients are walking with a walker on the day of surgery — a practice that accelerates recovery and significantly reduces blood clot risk. The anterior approach eliminates the posterior hip precautions (restrictions on bending, crossing legs, and certain hip positions) that are standard after posterior approach surgery. This means patients can move more naturally from day one.

Posterior hip precautions typically include: do not bend the hip beyond 90 degrees (no deep squatting, no picking items off the floor by bending at the hip); do not cross the legs or feet; do not turn the foot of the operated leg inward (no internal rotation). These restrictions apply while seated, standing, lying down, and during all daily activities. They are in place for a defined period following surgery — typically 6 to 12 weeks, though the exact duration is individualized based on healing progress and Dr. Calendine’s assessment at follow-up visits.

Physical Therapy and Follow-Up

PT begins the day of surgery. Outpatient physical therapy and occupational therapy — which assists in adapting daily activities to the hip precautions — is particularly important after the posterior approach to ensure patients understand and consistently follow their precautions during the healing phase. Dr. Calendine and the BJIT care team provide written discharge instructions covering all precautions, wound care, and activity guidelines before you leave the facility. Follow-up is typically at 2 weeks (suture removal) and 6 weeks (precaution reassessment).

WHEN THE POSTERIOR APPROACH IS THE RIGHT CHOICE

When Does Dr. Calendine Recommend
the Posterior Approach?

Specific Clinical Situations That Favor the Posterior Approach

When Posterior Approach Is Recommended

Approach selection in hip replacement is a clinical decision, not a marketing one. Dr. Calendine evaluates each patient’s anatomy, surgical history, bone quality, and functional goals, then selects the approach — anterior or posterior — that will produce the safest exposure and the most accurate implant placement for that specific hip. While the anterior approach is his default for most primary hip replacements, the situations below are the ones that most commonly lead him to recommend the posterior approach instead:

Revision hip replacement. Replacing a previously implanted hip that has loosened, worn, dislocated, or become infected. The broader surgical exposure of the posterior approach is often essential for safely removing existing components, assessing bone loss, managing scar tissue, and seating new implants in a compromised anatomical environment.
Complex primary hip anatomy. Patients whose acetabular orientation, femoral geometry, or bone stock limits safe access through the anterior corridor, or creates visualization challenges that make posterior access the more accurate technical choice for component positioning.
Prior anterior hip surgery or tissue disruption. Patients who have had previous surgery through the front of the hip that has altered the tissue planes, making safe re-entry from the anterior approach technically inadvisable.
Patient-specific risk factors. Hip dysplasia, prior pelvic trauma, retained hardware, or other anatomical variants that the posterior exposure is better suited to address safely.

If You've Been Told You Need the Posterior Approach

If another orthopaedic surgeon has recommended the posterior approach for your hip replacement — or if Dr. Calendine’s evaluation of your anatomy leads to the same recommendation — your consultation at the Bone and Joint Institute of Tennessee will walk you through exactly why, in plain language, using your own imaging.

You will leave the visit understanding what the posterior approach involves for your hip specifically, how the muscles and tissues are accessed and protected, which implant Dr. Calendine plans to use and why, and what your recovery timeline realistically looks like — including the temporary hip precautions period that follows posterior surgery and when those restrictions are typically lifted.

The posterior approach is a mature, extensively studied technique with a long and successful clinical history in hip replacement. It remains one of the most widely performed approaches in the world precisely because it works, and works reliably. The fact that Dr. Calendine performs anterior hip replacement as his default approach does not mean the posterior approach is a lesser option. It means approach selection is taken seriously in his practice — and when the posterior approach is the right answer for a patient’s hip, it is recommended without hesitation and performed with the same precision, planning, and commitment to outcome that defines every joint replacement at his Franklin, Tennessee practice.

Patients seeking a second opinion on hip replacement in the Nashville and Franklin area are welcome to schedule a consultation to review their imaging and discuss which surgical approach is right for their hip.

Related Hip & Knee Replacement Procedures

FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions — Posterior Hip Replacement

Why would a surgeon recommend the posterior approach instead of anterior approach?

Several clinical situations make the posterior approach the technically superior choice for a specific patient: revision hip replacement (replacing a failed prior implant) is the most common — the posterior approach’s broader joint exposure is essential for safe implant removal and revision in a compromised anatomy. Complex primary anatomy that limits anterior access, prior anterior hip surgery that has altered tissue planes, and specific acetabular configurations that require wider visualization are other reasons Dr. Calendine may recommend the posterior approach.

When Dr. Calendine recommends the posterior approach for a patient, he explains the specific anatomical or clinical reason at the consultation. It is a deliberate clinical choice, not a default.

What are posterior hip replacement precautions, and how long do they last?

Posterior hip precautions are movement restrictions placed on the operated hip during the early recovery period to prevent dislocation while the posterior capsule and external rotator muscles heal. The standard precautions are: do not bend the hip beyond 90 degrees; do not cross the legs or feet; do not turn the foot of the operated leg inward. These apply during all daily activities — sitting, standing, lying down, and getting in and out of a car.

The duration of hip precautions is individualized. The standard range is 6 to 12 weeks. Dr. Calendine reviews precaution status at your 6-week follow-up appointment. Unlike the anterior approach, which eliminates hip precautions entirely due to muscle preservation, the posterior approach requires this restriction period as part of safe recovery.

Does the posterior approach use robotic guidance?

Yes. Dr. Calendine uses the Stryker Mako® robotic system and OrthoGrid AI-assisted fluoroscopy for both anterior and posterior hip replacement cases. Both procedures begin with the same pre-operative CT scan and patient-specific digital planning process. The robotic system provides real-time intraoperative guidance for implant cup positioning regardless of which approach is used. Patients undergoing posterior hip replacement with Dr. Calendine receive the same precision guidance technology as anterior approach patients.

How does recovery from the posterior approach compare to the anterior approach?

The anterior approach consistently shows faster early recovery milestones in comparative studies, primarily because it preserves the gluteal muscles and eliminates hip precautions. Patients undergoing the posterior approach typically have a walker-to-cane transition at 2–3 weeks, driving at 4–6 weeks, and return to most daily activities by 3 months — but with a 6-to-12-week hip precautions period that the anterior approach does not impose.

That said, when the posterior approach is the appropriate technique for a patient’s anatomy, the longer recovery timeline reflects the correct clinical decision — not a surgical shortcoming. A well-executed posterior hip replacement in the right candidate produces excellent long-term outcomes and patient satisfaction.

Is the posterior approach safe? Does it have a high dislocation risk?

The posterior approach carries a statistically higher dislocation risk than the anterior approach in primary hip replacement — this is well-documented in the orthopedic literature and is the primary reason the anterior approach is preferred when anatomy permits. The hip precautions prescribed after posterior hip replacement are specifically designed to protect against this risk during the healing period.

However, two factors meaningfully reduce this risk in Dr. Calendine’s posterior approach cases: meticulous posterior capsular and external rotator repair at closure (which restores the posterior restraint structures), and Mako® robotic precision guidance for cup positioning (since malpositioned cups are a primary driver of impingement and dislocation). Both approaches, anterior and posterior, can produce excellent and stable long-term outcomes when performed by an experienced, high-volume surgeon using modern technique and technology.

If Dr. Calendine recommends the posterior approach for me, should I get a second opinion?

Second opinions are always welcome and encouraged — for any major surgical decision. If Dr. Calendine recommends the posterior approach for your hip replacement, the consultation will include a detailed explanation of exactly why: the specific anatomical or clinical factors that make the posterior approach the right technical choice for your hip. You will leave with a clear understanding of the recommendation.

If you have been seen by another surgeon who has recommended the posterior approach and you would like Dr. Calendine’s assessment of your imaging and anatomy, a second opinion consultation can be scheduled. Bring any imaging, operative reports from prior surgeries, and prior surgical recommendations you have received.

FRANKLIN, TN · SERVING ALL OF MIDDLE TENNESSEE

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

Consultations for posterior 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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Posterior Hip Replacement Surgery
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