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PRECISION GUIDANCE TECHNOLOGY · MAKO® ROBOTIC · FRANKLIN, TN

Robotic Joint Replacement Surgery
in Franklin, TN — Mako® System

Stryker® Mako® Robotic-Arm Assisted Surgery · OrthoGrid AI Fluoroscopy · Cory Calendine, MD

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Dr. Cory Calendine performs Mako® robotic-assisted hip and knee replacement at the Bone and Joint Institute of Tennessee in Franklin, TN. The Stryker Mako® robotic-arm assisted system uses a pre-operative CT scan to create a three-dimensional patient-specific model of the joint, enabling precise digital surgical planning before the patient enters the operating room — and providing real-time robotic guidance during the procedure itself. Dr. Calendine serves as an international trainer for Mako, having taught robotic joint replacement technique to surgeons in the United States, China, South Korea, India, and Bali. He performs robotic-assisted surgery for total hip replacement (using the anterior approach), total knee replacement, and partial knee replacement.

STRYKER®

MAKO® ROBOTICS SPECIALIST

700+

HIP & KNEE REPLACEMENTS/YEAR

ANDERSON ORI

ARTHROPLASTY FELLOWSHIP TRAINED

CT-PLANNED · PATIENT-SPECIFIC · REAL-TIME INTRAOPERATIVE GUIDANCE

The Stryker Mako® Robotic System — How It Works

Step 1: Pre-Operative CT Scan and 3D Planning

Before surgery, a specialized CT scan creates a detailed three-dimensional digital model of the patient’s specific joint anatomy — the actual shape and geometry of their individual hip or knee, not a generic template. Using this model, Dr. Calendine plans the surgery digitally before the patient enters the operating room: implant size, placement angle, alignment, and the specific bone resection boundaries are determined with precision that X-ray imaging cannot provide. By the time the patient is on the surgical table, the procedure has already been planned to their exact anatomy.

Mako® robotic arm system used for robotic-assisted joint replacement in an orthopedic surgical environment — Dr. Cory Calendine, MD, Bone and Joint Institute of Tennessee, Franklin, TN

Step 2: Real-Time Robotic Guidance During Surgery

In the operating room, Dr. Calendine maintains complete surgical control while the Mako® robotic arm provides real-time guidance and haptic feedback. The system’s AccuStop™ technology establishes virtual boundaries around the pre-planned surgical zone — providing tactile resistance if the surgical instrument approaches the boundary of the pre-planned resection area. This means bone removal stays within the precisely planned zone, preserving healthy tissue that would otherwise be at risk of inadvertent damage. The Stryker® robotic arm assists Dr. Calendine in achieving the exact implant position determined in the pre-surgical plan, with accuracy that manual technique alone cannot consistently replicate. Throughout the procedure, the system provides continuous real-time data on joint kinematics — movement, tension, and balance as the components are trialed before final fixation. This intraoperative feedback allows Dr. Calendine to make real-time adjustments to optimize balance and function before the implant is permanently fixed. The result is a procedure that combines surgical expertise with data-verified precision.

Mako® SmartRobotics™ pre-operative CT-based 3D surgical planning interface for robotic-assisted joint replacement — Dr. Cory Calendine, MD, Bone and Joint Institute of Tennessee, Franklin, TN

Mako® for Knee Replacement — How It Applies

The Mako® system is used for both hip and knee replacement in Dr. Calendine’s practice. For knee replacement, the CT-based pre-operative model captures the three-dimensional geometry of the patient’s knee — including the alignment of the femur, tibia, and the degree of deformity that arthritis has created. The digital plan determines tibial and femoral component positioning, rotation alignment, and the amount of bone to be resected. During surgery, the robotic arm guides these resections with precision. For partial knee replacement (unicompartmental), where the accuracy of tibial slope and implant position is especially critical to long-term outcomes, robotic guidance provides a particular advantage over manual technique.

Robotic-assisted joint replacement surgery using the Stryker Mako system — Dr. Cory Calendine, MD performing precision-guided implant positioning at the Bone and Joint Institute of Tennessee, Franklin, TN

AI-ASSISTED LIVE INTRAOPERATIVE X-RAY ANALYSIS

OrthoGrid® AI-Assisted Fluoroscopy —
Real-Time Intraoperative Verification

A Second Layer of Precision: Live AI Fluoroscopy

In addition to the Mako® robotic system, Dr. Calendine uses OrthoGrid® AI-assisted live fluoroscopy for intraoperative precision verification. OrthoGrid® is not a robotic arm — it is an AI-powered analytical overlay applied to real-time intraoperative X-ray (fluoroscopy) that provides immediate, data-driven feedback on implant positioning and leg length during the procedure itself. Where the Mako system’s precision is derived from the pre-operative CT-based 3D plan executed with robotic guidance, OrthoGrid’s precision is derived from live intraoperative X-ray analysis at the moment of implant seating. The two systems are complementary — the pre-operative plan is executed with robotic guidance, and live fluoroscopic verification with AI analysis confirms the result in real time before the surgical site is closed.

OrthoGrid® AI-assisted live fluoroscopy interface showing real-time intraoperative implant positioning verification during robotic hip replacement — Dr. Cory Calendine, MD, Bone and Joint Institute of Tennessee, Franklin, TN

Why Two Systems Together

Cup positioning in total hip replacement is the most consequential variable in long-term outcome. Even small deviations from optimal cup angle affect stability, dislocation risk, range of motion, and how naturally the joint functions for the life of the implant. The combination of Mako® robotic precision and OrthoGrid AI fluoroscopic verification represents a dual-system approach to accuracy that addresses both the planning phase and the real-time confirmation phase of surgery. This level of intraoperative investment reflects the standard Dr. Calendine holds for every case.

OrthoGrid Hip AI — Zimmer Biomet

STRYKER® CONSULTANT · INTERNATIONAL MAKO® TRAINER · FELLOWSHIP-TRAINED SUBSPECIALIST

Dr. Calendine's Expertise with the Mako® System

Not Just a User — A Contributor to the Technology's Development

Dr. Calendine’s relationship with the Mako® system goes beyond clinical use. He serves as a consultant to Stryker® — the manufacturer of the Mako platform — contributing to the ongoing development and refinement of robotic joint replacement technology. This means the precision system used in his OR is one he has had a direct hand in improving. That depth of engagement with the technology is qualitatively different from a surgeon who uses the Mako system as a purchased tool.

He is also a national and international trainer on the Mako® robotic system, teaching proper technique to surgeons in the United States, China, South Korea, India, and Bali. When a surgeon is selected to teach other surgeons how to use a technology safely and precisely, it reflects a level of mastery and reproducibility in outcomes that the community of Mako users recognizes. For patients evaluating where to have robotic joint replacement, the distinction between a user and a trainer is meaningful.

Volume, Fellowship, and the Subspecialty Focus

More than 700 hip and knee replacements annually at the Bone and Joint Institute of Tennessee in Franklin, TN. Fellowship training at the Anderson Orthopaedic Research Institute in Alexandria, Virginia — one of the country’s most respected programs focused exclusively on hip and knee replacement and revision surgery. A practice scope limited entirely to hip and knee replacement — not divided across multiple orthopedic subspecialties.

For a procedure where the surgeon’s fluency with the robotic system directly affects the precision of the result, volume and focus compound over time. The more frequently a surgeon performs Mako-assisted joint replacement, the more refined the execution. The narrower the practice scope, the deeper the expertise becomes. This is the environment in which Dr. Calendine’s Mako® outcomes are produced.

WHAT ROBOTIC-ASSISTED PRECISION DELIVERS FOR PATIENTS

Advantages of Robotic Joint Replacement

AdvantageWhat It Means for the Patient
Patient-Specific Pre-Operative PlanningYour implant size, placement, and alignment are planned from your specific anatomy, not a population average or standard template.
Accurate Implant PositioningRobotic guidance achieves the precise cup angle, tibial slope, and component alignment determined in the pre-surgical plan. Consistent accuracy reduces risk of instability, impingement, and premature wear.
Healthy Bone and Tissue PreservationVirtual boundary (AccuStop™) technology limits bone removal to the pre-planned zone. Surrounding healthy tissue is protected from inadvertent damage.
Real-Time Intraoperative DataJoint movement, tension, and balance are assessed in real time during the procedure, allowing adjustments before final implant fixation.
Dual Verification (Mako® + OrthoGrid)Pre-operative plan executed with robotic precision; real-time AI fluoroscopy confirms positioning before closure. Two systems, one outcome standard.
Faster Recovery PotentialPrecise implant positioning and reduced surgical trauma to surrounding tissue are associated with faster early recovery milestones in multiple clinical studies.
Long-Term Joint FunctionAccurate positioning reduces wear rates and mechanical stress on implant components: factors that influence how naturally the joint functions and how long the implant lasts.
Stryker Mako® Patient Information

WHO IS A CANDIDATE FOR MAKO® ROBOTIC JOINT REPLACEMENT?

Is Robotic-Assisted Joint Replacement Right for You?

Mako® robotic joint replacement is not a procedure in itself — it is the precision guidance system used during hip or knee replacement. If you are a candidate for joint replacement, you are almost certainly a candidate for Mako-assisted surgery, since Dr. Calendine uses robotic guidance for the majority of his knee and hip replacement cases. The candidacy question is therefore primarily: are you a candidate for joint replacement?

Joint ConditionWhy Robotic Guidance Is Appropriate
Osteoarthritis (hip or knee)Most common indication. Advanced degenerative arthritis with bone-on-bone changes failing conservative treatment.
Rheumatoid ArthritisInflammatory arthritis causing joint destruction. Robotic planning adapts to the unique anatomy affected by RA.
Post-Traumatic ArthritisArthritis resulting from prior fracture or injury. Often involves anatomical changes that benefit from patient-specific 3D planning.
Avascular NecrosisBone death from blood supply disruption. Hip or knee replacement indicated when conservative treatment has failed.
Failed Conservative TreatmentPT, medications, and injections no longer providing meaningful relief. Joint replacement becomes the appropriate next step.

Which Procedure Is Right for My Joint?

Robotic guidance is used for total hip replacement, anterior hip replacement, total knee replacement, and partial (unicompartmental) knee replacement in Dr. Calendine’s practice. The appropriate procedure depends on which joint is affected, the extent of damage, and individual anatomy. If you are unsure whether hip or knee replacement — partial or total — is the right intervention, that question is answered at the consultation.

  • Hip pain, difficulty walking, stiffness with forward bending → Hip replacement evaluation
  • Knee pain with activity, stiffness after sitting, difficulty with stairs → Knee replacement evaluation
  • Pain in one compartment of the knee with intact remaining compartments → Partial knee evaluation

Total Knee Replacement — When Joint Replacement Is the Right Next Step

WHAT RECOVERY LOOKS LIKE AFTER MAKO® ROBOTIC JOINT REPLACEMENT

Recovery Timeline — Robotic-Assisted Hip and Knee Replacement

How Robotic Precision Affects Recovery

The recovery advantages of Mako® robotic surgery are directly related to its precision. More accurate implant positioning reduces the mechanical stress on surrounding tissues. More targeted bone removal means less disruption to healthy bone and soft tissue adjacent to the implant zone. These factors — not the robotic technology itself, but the precision it enables — are associated with faster early mobilization and less post-operative discomfort compared to traditional manual technique.

Most robotic hip and knee replacement patients are ambulating the same day as surgery. For anterior approach hip replacement specifically, the anterior technique combined with Mako precision means no hip precautions and same-day walking. Recovery timelines below are general for robotic-assisted joint replacement; specific timelines for individual procedures are detailed on each procedure’s dedicated page.

Div
Day of Surgery

Walking right away with a walker for balance. Outpatient or brief inpatient stay depending on procedure and individual factors.

Div
Week 1

Walking with a walker at home. Waterproof bandage allows for showering right away. Home exercises for hips but structured PT for knees.

Div
Weeks 2–3

Follow-up visit. We will remove your surgical dressing. Everybody should be on a cane now — but there is range of normal recovery. You can drive once you are walking steady with a cane and off the narcotics.

Div
Weeks 4–6

The day-to-day should feel pretty normal — back to nearly all jobs and exercising.

Div
3 Months

Endurance and strength largely restored. Now it is time to get stronger.

Div
6 Months

Full recovery for most patients. Keep going.

*Recovery varies by procedure and individual patient factors. For procedure-specific timelines, see the dedicated pages below:

Total Knee Replacement Recovery 
Total Hip Replacement Recovery 

Robotic-Assisted Surgery Is Used for These Procedures

Hip Procedures:

Knee Procedures:

FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions — Mako® Robotic Joint Replacement

What does robotic joint replacement actually mean — what is the robot doing?

Robotic joint replacement is a precision-guided surgical system — not an autonomous machine performing surgery on its own. Understanding that distinction is the starting point for understanding what the technology actually offers.

 

The Stryker® Mako® system used by Dr. Calendine functions as a sophisticated real-time guidance platform. Before surgery, a CT scan of your specific joint is used to build a detailed three-dimensional digital model of your anatomy. Dr. Calendine uses that model to plan your implant placement precisely — size, position, and alignment — before you ever enter the operating room.

 

During surgery, the Mako system tracks the position of your joint in real time and displays it against the pre-operative plan continuously. A robotic arm assists with bone preparation — but it moves only when Dr. Calendine moves it. The system provides boundaries that help maintain the precision of the pre-operative plan, but every cut, every decision, and every adjustment is made by the surgeon. The result is surgery that combines the judgment and experience of a high-volume joint replacement surgeon with a level of spatial precision that is not achievable through manual technique alone.

The surgeon performs the surgery. Every time. The Mako® robotic system does not operate independently, does not make decisions, and does not move without Dr. Calendine directing it. 

A useful comparison is GPS navigation. GPS gives you precise, real-time information about your position and the route ahead — but it does not drive the car. You still steer, you still accelerate, and you still make every judgment call along the way. The GPS makes you more precise and better informed, but the driving is entirely yours. 

The Mako® system works the same way. It gives Dr. Calendine precise, real-time data about implant positioning relative to your specific anatomy. He moves the robotic arm to prepare the bone. If his movement would place the implant outside the pre-planned boundaries, the system provides resistance — a safeguard, not an override. The surgery is his. The precision is the system’s contribution. 

The Stryker Mako® SmartRobotics™ system is a robotic arm-assisted surgical platform developed specifically for joint replacement. It is used by Dr. Calendine for both hip and knee replacement procedures. 

The foundation of the Mako workflow is a pre-operative CT scan. A CT scan is anatomic truth — it captures the precise three-dimensional geometry of your bones, including dimensions, surface contours, and alignment that are not visible on standard X-rays. That data is used to build a patient-specific digital model of your joint. 

Dr. Calendine uses that digital model to plan your surgery in advance — selecting implant size, determining optimal implant positioning, and establishing the alignment targets that will guide the procedure. By the time you arrive for surgery, a precise plan already exists for your specific anatomy. The Mako system then executes that plan in the operating room, providing real-time positional feedback so that what was planned is what is placed. Every patient receives a plan built from their own anatomy — not a standard protocol applied generically.

Yes — a CT scan is always required before robotic joint replacement with the Mako system. This is not optional. The CT scan is the anatomic foundation of the entire robotic workflow: without it, there is no patient-specific digital model, and without that model, the precision planning that defines robotic joint replacement cannot occur. 

 

Think of the CT scan as the blueprint. A surgeon building with standard tools can work from a general plan. A surgeon using the Mako system is building from your blueprint specifically — the exact dimensions, geometry, and alignment of your joint. That level of individualization begins with the CT scan. 

 

Regarding insurance coverage: the CT scan required for Mako surgery is a covered benefit under most insurance plans. Dr. Calendine’s team works through all insurance considerations to ensure that every patient has access to the most advanced technology available. If any coverage questions arise, the team will help navigate them before your surgery date.

Dr. Calendine adopted the Mako system because the evidence for its precision advantages in joint replacement is compelling — and because precision in implant positioning has direct implications for how a joint replacement performs over time and how naturally it feels to the patient. 

 

His relationship with the Mako system goes well beyond routine clinical use. Dr. Calendine serves as a consultant to Stryker and is involved in the ongoing development of the Mako platform. He is also a national and international trainer on the system — having taught robotic joint replacement technique to surgeons in the United States and abroad, including in China, South Korea, India, and Bali, among other countries. 

 

That depth of engagement with the technology means Dr. Calendine understands the Mako system at a level that goes beyond what most users develop. He knows its capabilities, its limitations, and how to use it to its full potential — information that informs every robotic case he performs. For patients, the practical implication is straightforward: when you have robotic joint replacement with Dr. Calendine, you are being operated on by one of the most experienced and deeply trained Mako surgeons in the country. 

Yes — and in Dr. Calendine’s view, the subvastus approach and the Mako robotic system are not just compatible, they are complementary in a way that makes each more effective than it would be alone. 

 

The subvastus approach to knee replacement preserves the entire quadriceps muscle — but that preservation comes with a trade-off: the surgical window into the joint is smaller, which can limit the surgeon’s direct visual confirmation of implant positioning. Traditionally, this has been the primary reason some surgeons prefer the standard approach for complex cases. 

 

The Mako system resolves this directly. Because it provides continuous real-time positional data referenced against the patient-specific pre-operative plan, the surgeon does not need to rely solely on visual inspection to confirm implant accuracy. The robotic guidance compensates for the reduced visual field — meaning the muscle-sparing benefit of the subvastus approach can be achieved without accepting any compromise in implant precision. 

 

Dr. Calendine considers the combination of subvastus technique and Mako robotics to represent the most complete approach he can offer knee replacement patients whose anatomy supports it.

Yes. Dr. Calendine uses the Mako system for both hip replacement and knee replacement. The robotic platform is adapted for each procedure, and the pre-operative planning and intraoperative guidance principles are consistent across both. 

 

For hip replacement, the Mako system assists with precise positioning of the acetabular cup and femoral stem. Accurate cup positioning in particular is critical for hip stability and long-term function, and robotic guidance provides a level of precision in this that is difficult to achieve consistently with manual technique alone. 

 

For knee replacement, the Mako system guides the preparation of the femur, tibia, and patella to receive the implant components with alignment specific to each patient’s anatomy. Knee alignment is one of the strongest predictors of long-term implant satisfaction, and the personalized planning the Mako system enables is a meaningful advantage. Whether you are considering hip or knee replacement, robotic assistance with the Mako system is part of how Dr. Calendine approaches both procedures.

The three-dimensional data the Mako system generates is already being applied to revision joint replacement cases, and this application is expanding as the technology develops. Dr. Calendine, as a Stryker consultant involved in the platform’s ongoing development, is part of that evolution. 

 

In primary joint replacement — surgery on a joint that has not been replaced before — the Mako system’s full robotic workflow is established and well-validated. In revision surgery, where an existing implant must be addressed and replaced, the surgical complexity is greater and the workflow continues to be refined. The detailed anatomic information the CT-based planning provides is genuinely useful in revision cases, particularly in understanding the existing implant geometry and planning what comes next. 

Yes. Dr. Calendine performs robotic hip and knee replacement for patients from throughout Middle Tennessee and the surrounding region. His office and surgical facilities are located in Franklin — at the Bone and Joint Institute of Tennessee and Williamson Medical Center — and patients travel to Franklin from communities across the area for robotic joint replacement surgery. 

 

Dr. Calendine regularly performs robotic joint replacement for patients from Nashville, Brentwood, Murfreesboro, Spring Hill, and Nolensville — as well as Smyrna, Hendersonville, Mt. Juliet, Columbia, Antioch, Thompson’s Station, Gallatin, Belle Meade, Fairview, La Vergne, Arrington, College Grove, Leipers Fork, and communities throughout Middle Tennessee. Out-of-state patients are also welcome. 

FRANKLIN, TN · SERVING ALL OF MIDDLE TENNESSEE

Ready to Learn If Robotic Joint Replacement Is Right for You? Dr. Calendine Is Accepting New Patients.

Schedule a consultation at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. No referral required. Dr. Calendine will review your imaging and explain whether Mako® robotic surgery is appropriate for your hip or knee.

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