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KNEE REPLACEMENT SURGERY · MAKO® ROBOTIC · FRANKLIN, TN

Total Knee Replacement Surgery
in Franklin, TN

Fellowship-Trained Subspecialist · Mako® Robotic Guidance · Dr. Cory Calendine, MD

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Call (615) 791-2630

Total knee replacement surgery replaces the worn cartilage surfaces of the knee joint with metal and plastic components, relieving the pain of knee arthritis and restoring the ability to walk, climb stairs, and return to daily activities. Dr. Cory Calendine performs total knee replacement at the Bone and Joint Institute of Tennessee in Franklin, TN, using Mako® robotic-arm assisted guidance for precise, CT-planned implant positioning. His preferred surgical technique — the subvastus (muscle-sparing) approach — preserves the quadriceps muscles that control knee stability and recovery, enabling faster early rehabilitation for appropriate patients. With more than 700 hip and knee replacement procedures annually, Dr. Calendine serves patients from Nashville, Brentwood, Murfreesboro, Spring Hill, Nolensville, and communities throughout Middle Tennessee — including Columbia, Smyrna, Hendersonville, Mt. Juliet, and beyond.

STRYKER® ROBOTICS

ADVANCED ROBOTIC TECHNOLOGY

700+

HIP & KNEE REPLACEMENTS/YEAR

SUBVASTUS APPROACH

MUSCLE-SPARING KNEE REPLACEMENT

WHAT HAPPENS DURING TOTAL KNEE REPLACEMENT SURGERY

What Is Total Knee Replacement Surgery?

Resurfacing the Joint — What Knee Replacement Actually Involves

Total knee replacement — more accurately called knee arthroplasty or knee resurfacing — does not remove the entire knee joint. It removes the damaged cartilage and bone surfaces from the ends of the femur (thigh bone) and tibia (shin bone) and replaces them with precisely engineered metal components. A medical-grade plastic spacer is placed between the metal components to recreate a smooth, low-friction gliding surface. The undersurface of the patella (kneecap) may also be resurfaced with a plastic component, depending on its condition and the surgeon’s assessment.

The result is a knee joint that moves without the bone-on-bone friction and grinding of advanced arthritis — and without the chronic pain that arthritis pain generates. Knee replacement does not restore the knee to a young, uninjured state. It replaces a joint damaged beyond the reach of conservative treatment with an artificial surface engineered for durability, smooth motion, and long-term function.

Diagram of knee joint anatomy detailing the Femur, Tibia, Patella, Cartilage, and Joint Space, as referenced by orthopedic specialist Dr. Cory Calendine for total knee replacement.
Surgical Step
Total Knee Replacement Technique
1. Prepare the Bone
The damaged cartilage surfaces at the ends of the femur and tibia are removed, along with a minimal amount of underlying bone. Only the surfaces are addressed: the majority of the bone structure is preserved.
2. Position the Metal Implants
Metal components that recreate the contours of the femoral and tibial joint surfaces are precisely positioned and secured, either press-fit into the bone or cemented, depending on bone quality and patient factors.
3. Resurface the Patella
The undersurface of the kneecap is evaluated. If resurfacing is indicated, a plastic button component is secured to the prepared patellar surface. Not all cases require patellar resurfacing.
4. Insert the Spacer
A durable medical-grade plastic (polyethylene) spacer is locked into the tibial component between the two metal surfaces. This spacer is the bearing surface of the new joint: it provides smooth gliding and absorbs load.

The Conservative Care Sequence Before Surgery

Total knee replacement is a destination, not a first step. Before recommending surgery, Dr. Calendine evaluates whether there is meaningful relief still available through conservative treatment: targeted weight management, structured physical therapy and exercise programs, anti-inflammatory medications, corticosteroid, PRP or viscosupplementation (gel) injections, and supportive bracing. The evaluation at BJIT includes a review of medical history, detailed physical examination, and analysis of knee X-rays. Conservative options are pursued before surgery is recommended.

When conservative treatment has provided adequate relief and the patient’s arthritis is not yet bone-on-bone, surgery may not be appropriate yet. When conservative treatment has been genuinely tried and is no longer providing meaningful relief — and imaging confirms the degree of joint destruction — total knee replacement becomes the appropriate next step. The timing of that transition is a conversation, not a protocol.

ANESTHESIA AND PAIN MANAGEMENT 

Anesthesia Options for Total Knee Replacement

General vs. Regional Anesthesia

Patients undergoing total knee replacement at the Bone and Joint Institute of Tennessee in Franklin, TN have the procedure performed under general anesthesia, regional anesthesia, or a combination of the two. General anesthesia provides complete unconsciousness throughout the procedure. Regional anesthesia techniques — spinal anesthesia, epidural anesthesia, and peripheral nerve blocks — numb the surgical area while the patient remains awake and comfortable.

Clinical evidence consistently demonstrates that regional anesthesia options for total knee replacement are associated with reduced post-operative pain, less nausea, and lower narcotic medication requirements during recovery. The anesthesia team at BJIT evaluates each patient’s medical history and overall health before making a specific recommendation. The anesthesia plan is discussed and confirmed at the pre-operative visit, ensuring the patient understands their pain management approach before arriving for surgery.

The Adductor Canal Block — Targeted Post-Operative Pain Control

Advanced peripheral nerve block techniques have become increasingly important for knee replacement pain management. The adductor canal block is now widely used for total knee replacement because it provides targeted pain control for the anterior knee while preserving the quadriceps strength needed for early mobilization and physical therapy. Unlike femoral nerve blocks, which can cause temporary quadriceps weakness and fall risk, the adductor canal block targets the sensory nerve supply to the knee without compromising the motor function required for early walking.

This targeted approach means patients are more comfortable in the hours immediately following surgery — while still being able to work with physical therapy for their first standing and walking session. The combination of regional anesthesia and an adductor canal block is Dr. Calendine’s preferred pain management approach for appropriate total knee replacement patients, contributing to the same-day or next-morning discharge that most patients achieve.

UNDERSTANDING KNEE REPLACEMENT IMPLANT OPTIONS

Knee Replacement Implants — What Patients Should Know

Orthopedic implant manufacturers invest heavily in marketing directly to patients, which means many people arrive at their consultation having seen advertising for specific implant brands, gender-specific designs, and proprietary technologies. The evidence-based message from major orthopedic outcome registries tracking thousands of knee replacement procedures is consistent: no single implant design has demonstrated clear superiority in long-term outcomes over other modern, well-engineered designs. Surgeon expertise, precise implant positioning, patient selection, and surgical technique matter more than brand or design novelty.

This does not mean all implants are identical or that implant selection is unimportant. It means the decision should be made by the surgeon based on the patient’s anatomy, activity level, bone quality, and surgical factors — not by marketing claims. Dr. Calendine selects the implant design and sizing that best fits each patient’s individual anatomy and goals, using a range of proven implant systems rather than a single manufacturer to optimize long-term knee replacement outcomes. 

Anatomical diagram of a total knee replacement implant system showing the four components — femoral component, polyethylene patellar button, polyethylene spacer, and tibial tray — positioned along the knee joint axis between the femur and tibia, as used by Dr. Cory Calendine, MD with Mako® robotic-assisted guidance at the Bone and Joint Institute of Tennessee, Franklin, TN
The four components of a modern total knee replacement: a metal femoral component, a metal tibial tray, a highly cross-linked polyethylene spacer, and an optional polyethylene patellar button — positioned along the natural knee joint axis.

Anatomically Sized Implants

Modern knee replacement implants are available in a wide range of sizes to accommodate variations in knee anatomy. Most current implant systems include designs that address average anatomical differences between patients — including variations in the relationship between femoral width and depth, tibial geometry, and patellar thickness. The goal is a well-fitting component that recreates natural knee dimensions and mechanics. Sizing accuracy is enhanced by the pre-operative CT-based planning that the Mako® robotic system uses, which determines optimal implant dimensions from the patient's own anatomy before the procedure begins.

Fixed vs. Rotating Implants

Fixed bearing knee implants lock the polyethylene plastic spacer securely to the tibial metal tray. Rotating platform designs allow the plastic spacer to rotate slightly on its tibial base. When rotating platform designs were introduced, the theoretical advantages included reduced plastic wear and improved knee kinematics. Comprehensive clinical data from five-to-ten-year follow-up studies, however, has not demonstrated meaningful differences in outcomes between the two designs for the majority of knee replacement patients. Dr. Calendine selects the bearing design most appropriate for each patient's anatomy and activity level.

Mako® Robotic Guidance

Regardless of which implant design is selected, the precision with which it is positioned is the variable most directly linked to long-term outcomes. Implant alignment affects load distribution across the bearing surface, which in turn affects how long your new knee implant lasts and how naturally the knee functions. The Mako® robotic system's CT-planned, patient-specific surgical plan and AccuStop™ haptic boundary technology helps your surgeon ensure that the implant is placed to the exact position determined in the pre-operative plan — a standard of reproducible accuracy that manual technique cannot consistently achieve.

Mako® Robotic-Assisted Joint Replacement

WHEN KNEE ARTHRITIS REQUIRE REPLACEMENT

Total Knee Replacement — When Surgery Is the Right Answer

Clinical and Quality-of-Life Criteria

Total knee replacement is indicated when knee arthritis has progressed to a point where conservative treatment is no longer providing meaningful, lasting relief — and when the degree of pain and functional limitation is significantly affecting quality of life. This is not a decision made from an X-ray alone. Imaging confirms the structural state of the joint, but the decision to proceed with knee replacement is ultimately based on how arthritis affects the individual patient’s daily function, work, sleep, and ability to participate in the activities that matter to them.

Signs That It May Be Time to Evaluate Knee Replacement

The following signs are common indicators that conservative treatment has reached its limits and that a surgical evaluation is appropriate:

  • Knee pain that wakes you at night or prevents restful sleep
  • Difficulty walking more than a block or two without significant pain
  • Inability to climb stairs, rise from a chair, or get in and out of a vehicle without pain
  • Relying on anti-inflammatory medications daily just to manage normal activity
  • Injections (cortisone or gel) that once provided months of relief now providing only weeks
  • Physical therapy that has plateaued without further functional improvement
  • X-ray imaging showing advanced joint-space narrowing or bone-on-bone changes
  • Knee deformity (bow-legged or knock-kneed appearance) that has worsened over time

Age Is Not the Determining Factor

There is no age requirement for knee replacement surgery. The decision is based on the degree of joint damage, the severity of symptoms, and the impact on function — not on a birthday. Younger patients with advanced arthritis from injury or inflammatory disease may be appropriate candidates at an earlier age than expected. Older patients who are otherwise healthy may be excellent candidates. The consultation is the appropriate place to evaluate whether knee replacement is right for a specific patient’s situation, regardless of age.

TOTAL AND PARTIAL KNEE REPLACEMENT · TECHNIQUE OPTIONS AT BJIT

Knee Replacement Approaches

Not all knee replacements involve the same surgical technique or replace the same amount of the joint. At the Bone and Joint Institute of Tennessee, Dr. Calendine offers total knee replacement and partial (unicompartmental) knee replacement, and performs total knee replacement through either the standard medial parapatellar approach or the muscle-sparing subvastus technique. The appropriate approach and procedure type depend on the extent of arthritis, patient anatomy, activity goals, and other individual factors evaluated at the consultation.

Mako robotic-assisted total knee replacement in the operating room — robotic arm executing precision-guided bone preparation with Dr. Cory Calendine, MD at the Bone and Joint Institute of Tennessee, Franklin, TN

Subvastus Approach — Muscle-Sparing Total Knee Replacement

The subvastus approach — also called the quadriceps-sparing or SubV approach — accesses the knee joint by lifting the vastus medialis muscle rather than cutting through the quadriceps tendon as the standard approach requires. Because the quadriceps tendon is never incised, patients can perform a straight leg raise sooner, experience less first-week pain, and transition from walker to cane faster than with the standard approach. Long-term outcomes are equivalent to the standard technique at six to twelve months. The subvastus approach is Dr. Calendine's preferred technique for appropriate candidates. He performs this approach with Mako® robotic guidance, which compensates for the more confined surgical corridor of the muscle-sparing technique.

  • Subvastus Knee Replacement — Overview

Partial Knee Replacement — Single-Compartment Arthritis

When arthritis has damaged only one compartment of the knee — most commonly the medial (inner) compartment — partial knee replacement (unicompartmental knee arthroplasty) replaces only the damaged compartment rather than all three. This preserves healthy cartilage and bone in the unaffected compartments and the cruciate ligaments, typically resulting in a more natural-feeling knee and faster recovery than total knee replacement. Not every patient is a candidate for partial knee replacement — accurate diagnosis of the extent of joint involvement is essential.

  • Partial Knee Replacement Overview

Mako® Robotic-Arm Assisted Technology

Dr. Calendine uses the Mako® robotic-arm assisted system for the majority of his knee replacement procedures — total and partial. The Mako system creates a patient-specific 3D surgical plan from a pre-operative CT scan and provides robotic guidance during bone resection and implant positioning. For total knee replacement specifically, the precision of the Mako system is particularly valuable for tibial slope, rotational alignment, and component balance — the variables that most directly affect long-term outcomes and implant feel. For partial knee replacement, where the accuracy of tibial slope and implant positioning is critical to joint preservation and longevity, robotic guidance provides a meaningful advantage over manual technique.

  • Mako® Robotic-Assisted Joint Replacement
Robotic-Assisted Joint Replacement

WHAT RECOVERY LOOKS LIKE AFTER TOTAL KNEE REPLACEMENT

Recovery Timeline — Total Knee Replacement

Total knee replacement recovery proceeds in stages, with most patients achieving meaningful functional independence by six weeks and full recovery at three to six months. For patients who undergo the subvastus approach, the early stages of recovery move faster than the standard medial parapatellar timeline because the quadriceps muscles remain intact. By the three-month mark, functional outcomes between approaches are equivalent. The timeline below reflects recovery after subvastus approach TKR performed with Mako robotic guidance at BJIT in Franklin, TN.

Div
Day of Surgery

Walking with physical therapist assistance within hours of surgery. Subvastus patients demonstrate earlier quad control. Most patients discharged home same day or next morning. Wound care, pain management, and discharge instructions provided before leaving.

Div
Week 1

Walking immediately with a walker. Managing stairs. Returning to basic home activities. A waterproof bandage (with all the stitches under the skin) allows you to shower right away.

Div
Weeks 2–3

Most patients transition from a walker to a cane as quad and hip strength return. Increasing walking distance and endurance. You can drive when you are walking steady with a cane and off all narcotic pain medications. Most return to desk work jobs.

Div
Weeks 4–6

Return to virtually any work environment is typically by 4–6 weeks. Do not drive while on narcotics; discuss timing with Dr. Calendine.

Div
3 Months

Majority of patients performing full activities. Endurance and strength largely restored. You are ready for any vacation.

Div
6 Months

Full recovery including return to more demanding physical activity. Keep going.

Knee Procedures at Bone & Joint Institute of Tennessee

FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions — Total Knee Replacement

What types of knee replacement does Dr. Calendine perform?

Dr. Calendine’s knee replacement practice centers on total knee replacement — resurfacing all three compartments of the knee with precision-engineered metal and plastic components. Within total knee replacement, he offers two distinct surgical approaches: the subvastus approach and the standard medial parapatellar approach.

 

The subvastus approach is Dr. Calendine’s preferred technique when the patient’s anatomy supports it. It preserves the entire quadriceps muscle, which powers early recovery of leg strength, and uses a medial oblique incision that sits away from the direct front of the knee. For patients with anatomic complexity that makes the subvastus approach less reliable, the medial parapatellar approach is used. All of Dr. Calendine’s total knee replacements are performed with the Stryker Mako robotic system.

The most significant challenge in knee replacement is alignment — specifically, achieving the implant positioning and limb alignment that will allow the knee to function naturally, move through its full range of motion, and last as long as possible. Even small deviations from optimal alignment have been shown to affect patient satisfaction and implant longevity. 

 

The Stryker Mako system addresses this by replacing estimation with measurement. A CT scan taken before surgery creates a three-dimensional model of your specific knee anatomy. Dr. Calendine uses that model to plan implant size, position, and alignment precisely before you enter the operating room. During surgery, the Mako system tracks your joint in real time and provides continuous positional feedback, allowing the pre-operative plan to be executed with accuracy that manual technique alone cannot consistently achieve.

The knee has three compartments: the medial (inner), lateral (outer), and patellofemoral (between the kneecap and the thigh bone). In total knee replacement, all three compartment surfaces are resurfaced. In partial knee replacement — also called unicompartmental knee replacement — only the affected compartment is addressed, leaving the healthy portions of the joint intact. 

Partial knee replacement has appeal as a concept — preserving more of the native joint sounds desirable. In practice, the best candidates are patients with isolated single-compartment disease, intact ligaments, and no inflammatory arthritis. That is a relatively narrow population. Patients who do not meet those criteria and undergo partial replacement often require conversion to total replacement within a shorter timeframe. 

 

Dr. Calendine’s practice focuses on total knee replacement. If you are wondering whether you might be a partial replacement candidate, this is an important conversation to have during your consultation — along with a thorough review of your imaging. 

This is one of the most honest questions patients ask, and it deserves a direct answer. Total knee replacement does not replicate the exact sensation of a native, healthy knee. The mechanical characteristics of a prosthetic joint are different from biological tissue, and patients do notice this — most commonly as a sense of the knee feeling different rather than painful or problematic. 

What has changed significantly with modern technique and robotic precision is the frequency of patients who describe their replaced knee as feeling “natural enough” that they rarely think about it. In Dr. Calendine’s experience, patients who receive a precisely aligned implant with preserved soft tissue balance are far less likely to report the persistent aching, stiffness, or sense of mechanical wrongness that characterized outcomes in an earlier era of knee replacement. 

 

The goal is not a perfect biological replica — it is a knee that moves well, does not hurt, and allows you to do what you want to do. For the large majority of patients, that outcome is consistently achievable.

Knee replacement is one of the most studied and performed surgical procedures in medicine, with a long safety record and well-characterized risk profile. Understanding the risks does not mean they are likely — it means you can make an informed decision and know what to watch for during recovery. 

 

The most significant risks include infection (rare but serious, occurring in roughly 1–2% of cases and requiring prompt treatment), blood clot formation in the leg or lung (mitigated by early ambulation and blood thinners), stiffness that limits range of motion (most often related to inadequate early rehabilitation), and implant-related issues over the long term such as wear or loosening (uncommon with modern implants at 10–15 years). Nerve or blood vessel injury during surgery is rare. Anesthesia-related risks are discussed with your anesthesia team before surgery. 

 

Dr. Calendine will review your specific risk profile at your consultation, including any factors that may modify your individual risk — prior surgeries, medical conditions, medications, and anatomy all play a role.

Range of motion recovery after knee replacement follows a predictable trajectory, though the timeline varies by individual. The goal in the immediate post-operative period is to prevent stiffness from developing — which is why early physical therapy begins the day of or the day after surgery. 

 

Most patients achieve 90 degrees of flexion — enough to climb stairs comfortably — within the first two weeks. By six weeks, the majority are at 110–120 degrees, which covers virtually all daily activities including driving and most recreational pursuits. Full range of motion for that patient’s anatomy continues to improve through three to six months. 

 

The subvastus approach, by leaving the quadriceps intact, gives many patients a head start on both flexion and extension strength in the first two to four weeks. This early advantage in quad function translates directly to faster physical therapy progress. 

Yes. Patients travel to Dr. Calendine for knee replacement from throughout the region. His practice is located at the Bone and Joint Institute of Tennessee in Franklin — accessible from across Middle Tennessee via I-65 and US-31 — and the majority of his patients come from surrounding communities. 

 

He regularly performs knee replacement for patients from Nashville, Brentwood, Spring Hill, Nolensville, and Murfreesboro, 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 Williamson, Maury, Rutherford, Davidson, and Sumner counties. Out-of-state patients are welcome. 

Yes. Revision knee replacement — surgery to address a failed or failing primary knee replacement — is performed by Dr. Calendine. His fellowship training at the Anderson Orthopaedic Research Institute included extensive revision experience, and his practice sees patients who had their original surgery elsewhere and are now experiencing pain, instability, stiffness, or implant failure. 

 

Revision knee replacement is among the most technically demanding procedures in orthopedics. The reasons for failure vary — wear, loosening, infection, component malposition, or ligament instability — and each requires a different surgical approach. Dr. Calendine’s evaluation of a potential revision patient begins with a thorough review of prior records, current imaging, and examination to establish precisely what is failing and why before discussing surgical options. 

The questions that matter most when evaluating a knee replacement surgeon are about volume, specialization, technique, and technology. How many knee replacements does this surgeon perform each year? Is joint replacement their primary focus, or one subspecialty among many? What surgical approach do they use and why? Do they use robotic guidance, and what system? 

 

Volume is not the only measure of quality, but it is a meaningful one. Surgeons who perform knee replacement at high volume develop technical fluency, pattern recognition, and familiarity with the range of anatomic and intraoperative situations that arise. The literature on this is consistent. 

 

Dr. Calendine performs more than 700 hip and knee replacements annually. Joint replacement is his entire surgical practice. He uses the subvastus approach and the Mako robotic system as his standard tools, and he trains other surgeons nationally and internationally on robotic technique. A consultation appointment is the right setting to ask these questions directly and to assess whether the relationship feels right for you. 

FRANKLIN, TN · SERVING NASHVILLE, BRENTWOOD, SPRING HILL, COLUMBIA & MIDDLE TENNESSEE

Knee Arthritis Limiting Your Life? 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 give you a direct, honest assessment of whether total knee replacement is appropriate for your situation.

Schedule Consultation
Call (615) 791-2630