Cory Calendine, M.D.

Cory Calendine, M.D. Orthopedic Surgeon, Hip/Knee Replacement Specialist, Cory Calendine, MD, Nashville/Brentwood/Franklin https://linktr.ee/corycalendinemd
(5)

03/12/2026

Direct Anterior Approach Hip Replacement | 2026 Update
The direct anterior approach to total has changed the way many think about hip arthroplasty recovery. The concept is straightforward. Rather than cutting through the gluteal muscles or detaching tendons to access the hip joint, we work through a natural interval between the tensor fasciae latae and the sartorius. The muscles are moved aside, not divided. That distinction can have real clinical consequences. Muscles that are not cut do not need to heal, and that translates directly into less postoperative pain, faster mobilization, and fewer movement restrictions after surgery.
One of the biggest advantages is intraoperative imaging. With the patient supine on a specialized table, the pelvis stays level, giving us the ability to use live fluoroscopy (or robotic 3D guidance - more on that later) throughout the procedure. Before closing, we can verify leg length, component alignment, and implant position in real time. That ability to confirm everything before leaving the operating room was one of the primary reasons I adopted this approach. Most of my patients are walking within hours of surgery, and the majority go home the same day. Many report that their surgical discomfort is immediately less than the arthritis pain they had been living with. The anterior approach is not the right fit for every patient or every surgeon. Published literature shows that complication rates decrease significantly after a surgeon has performed ~50 cases, and by 3 to 6 mons, outcomes between anterior vs posterior approaches tend to equalize. Both approaches produce excellent long-term results - the key is matching the right approach to the right patient (and the right surgeon).
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Surgical Technique: SubV KneeThe subvastus approach to is an important technical alternative in how we access the knee...
03/09/2026

Surgical Technique: SubV Knee
The subvastus approach to is an important technical alternative in how we access the knee joint during arthroplasty. In traditional knee replacement surgery, we use a medial parapatellar approach that requires splitting the quadriceps tendon to gain access to the joint. That works, but comes at a cost - cutting through the primary muscle responsible for knee extension. The subvastus approach changes that equation entirely. Instead of cutting through the quadriceps mechanism, we work underneath the vastus medialis obliquus (VMO), preserving its attachment to the patella. The VMO is retracted proximally + laterally while maintaining full continuity of the extensor mechanism. The arthrotomy is made just distal to the muscle belly, and the suprapatellar pouch is released from medial to lateral to allow full mobilization of the extensor mechanism. The patella is subluxed laterally rather than everted, and joint exposure is achieved with the knee flexed to 90 degrees.
Studies comparing subvastus vs traditional approaches demonstrate faster early recovery, improved early pain scores, reduced blood loss, and better short-term range of motion with equivalent complication rates. Patient selection matters. Candidates need mobile subcutaneous tissues to create a working window. Obesity, contractures, significant deformity, and revision cases are relative contraindications. There is a learning curve, but with experience, indications expand and operative times decrease. The combination of a muscle-sparing subvastus approach with modern robotic precision is where joint replacement is heading.
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📸 Endres NK, Minas T. Medial Subvastus Approach to the Knee: Surgical Technique. Brigham and Women’s Hospital.

đź«° Snapping Around Your Ankle?Peroneal tendon subluxation is one of the most commonly missed diagnoses in lateral ankle i...
03/07/2026

đź«° Snapping Around Your Ankle?
Peroneal tendon subluxation is one of the most commonly missed diagnoses in lateral ankle injuries, and it matters. The peroneal tendons run behind the fibula and are held in place by the superior peroneal retinaculum (SPR). When a forceful dorsiflexion injury occurs with sudden peroneal muscle contraction, the SPR can strip away from the bone or tear, allowing the tendons to slip out of their normal groove. This creates a painful snapping or popping sensation behind the lateral malleolus.
The swelling and bruising pattern can closely mimic simple lateral ligament sprain. Studies show that up to 78% of patients with SPR injuries also have concomitant lateral ligament damage, further masking the diagnosis. If you only treat the ligament injury and miss the retinacular damage, the patient develops recurrent subluxation episodes, progressive tendon degeneration, and eventual tearing. Key clinical distinction: lateral ligament sprains produce anterolateral and inferolateral pain, while peroneal tendon pathology generates pain posterior to the lateral malleolus. Patients may describe a popping or snapping sensation, particularly when going up or down stairs. Provocative testing with dorsiflexion and eversion can reproduce the subluxation. Conservative management with immobilization has a high recurrence rate. Surgical repair of the SPR, often combined with groove-deepening procedures, produces reliably excellent outcomes and allows athletes to return to preinjury performance levels.
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🎥 radsource.us/, Surgical Atlas of Musculoskeletal System

William Jason Mixter (1880-1958)Before 1934, sciatica was a medical mystery. Patients suffered debilitating leg pain and...
03/06/2026

William Jason Mixter (1880-1958)
Before 1934, sciatica was a medical mystery. Patients suffered debilitating leg pain and no one could definitively explain why - attributing it to tumors, chronic inflammation, even rheumatism. The more common mechanism - a herniated disc compressing the nerve root - had not been clearly identified or proven. Dr. William Jason Mixter was a Harvard-trained neurosurgeon at Massachusetts General Hospital who, alongside orthopedic surgeon Dr. Joseph Barr, published the landmark paper that first defined intervertebral disc herniation as the true cause of sciatica. That 1934 paper in the New England Journal of Medicine did not just advance spine surgery. It created it. Historians refer to the era that followed as “The Dynasty of the Disc.”
What makes Dr. Mixter remarkable is not just the discovery. He volunteered as a civilian surgeon in France during WWI before the US had even entered the conflict. He served again in WW II. He built the neurosurgery department at Mass General from a 2-bed assignment he shared with his father into a full specialty service. He trained 28 neurosurgeons who went on to establish programs across the country. And in an era when operating room arrogance was considered a surgeon’s birthright, his colleagues described his service as “the friendly service.” One of his most powerful quotes still resonates today. “A true surgeon is never fearless. He fears for his patients, he fears for his shortcomings, his own mistakes, but he never fears for himself or his professional reputation.” Each time we operate, we should practice the discipline (and humility) he emphasized. His story deserves to be remembered.
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Case Discussion: Polyethylene Wear After Primary TKASummary: 76-yo s/p 18 yrs after primary TKA w/ progressive varus-val...
03/04/2026

Case Discussion: Polyethylene Wear After Primary TKA
Summary: 76-yo s/p 18 yrs after primary TKA w/ progressive varus-valgus instability, recurrent effusions, and generalized knee pain. Weight-bearing xrays: valgus deformity (not visible on supine films). Intraop, the 10mm polyethylene insert showed severe posteromedial + lateral damage. Revision TKA performed w/ 8mm of distal femoral augmentation and 22.5mm constrained polyethylene insert to restore stability.
Case highlights polyethylene wear as a (decreasing) cause of mid- to long-term TKA failure. A 2024 study (Rush University Medical Center) found that instability was the most common reason for revision in implants beyond 6.5 yrs, with 70% of retrieved inserts showing delamination in both conventional + highly crosslinked polyethylene. Wear-driven instability may be underreported in registry data vs. early failures like infection. Meaningful progress continues - Modern manufacturing has moved toward direct compression molding, biplanar congruent articular designs, and inert gas sterilization to reduce oxidation-related degradation. Highly crosslinked polyethylene has demonstrated significantly lower linear wear rates vs conventional UHMWPE, and 2nd vitamin E-stabilized formulations aim to preserve mechanical strength while eliminating residual free radicals. Polished tibial trays + improved locking mechanisms have also reduced backside wear. For surgeons - maintain PE thickness, optimize alignment, and select implant designs that minimize contact stress.
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“Advanced Reconstruction: Knee” (The Knee Society, AAOS, 2011)
“Contemporary Conventional & Highly Crosslinked Polyethylene Tibial Inserts,” Asher DP, et al. Arthroplasty Today, 2024
“What Factors Drive Polyethylene Wear in TKA?”. Bone Joint J, 2021
Orthobullets: “TKA Polyethylene Wear & Manufacturing”. Updated Feb, 2026

03/04/2026

Shoulder Replacement: You Cut What?
Traditional begins with one critical step: the subscapularis tendon must be temporarily detached to access the joint. The is the largest and strongest muscle in the rotator cuff, and it sits directly over the front of the shoulder joint like a gatekeeper. To remove the damaged ball and resurface the socket during total shoulder arthroplasty, your surgeon must carefully move this structure out of the way. There is simply no other path to the joint that allows for accurate implant placement.
Surgeons can use one of a few techniques to manage the subscapularis: a tenotomy - cuts the tendon mid-substance; a peel - lifts the tendon directly off the bone; or a lesser tuberosity osteotomy - removes a thin wafer of bone with the tendon still attached. Each approach has distinct advantages, but all share one thing in common. The tendon must be securely repaired at the end of the procedure, and that repair must be protected during healing. This is where your role as a patient becomes essential. Research shows a 13-47% risk of tendon repair complications, which is why the first 6 wks after surgery come with strict precautions. No resisted internal rotation. Limited external rotation, typically to 20-30 degrees. If the subscapularis does not heal properly, the consequences are significant: shoulder instability, permanent weakness, accelerated implant loosening, and potentially the need for revision surgery. Following your surgeon’s postoperative protocol is not optional. It is the foundation of a successful recovery.
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03/03/2026

Partial vs. Total Knee Replacement: Which Surgery Is Right for You?
Sometimes doing less surgery delivers better results. In this video, we breakdown one of the most important questions in surgery: partial versus total - and how knowing the difference could change your outcome.
Your knee is made up of (3) separate compartments - the medial compartment sits on the inside, lateral compartment on the outside, and the patellofemoral compartment is where the kneecap tracks along the thighbone. Arthritis does not always damage all (3) at once. In some cases, only (1) compartment is affected while the others remain healthy.
Partial (unicompartmental) knee replacement, addresses only the damaged compartment while preserving healthy cartilage, the ACL, PCL, and natural ligament function. The result? Smaller incision, less bone removal, faster recovery, and a knee that consistently feels more natural. Total knee replacement remains one of the most successful operations in medicine, resurfacing all (3) compartments with proven long-term results. When arthritis has spread to two or three compartments, a total replacement is the right call. Only 20-25% of knee replacement candidates qualify for a partial, making proper evaluation critical. The decision depends on which compartments are damaged, ligament stability, leg alignment, and the judgment of a surgeon experienced in both procedures. If you have been told you need a knee replacement, ask whether a partial might be right for you.
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03/03/2026

Can Total Knee Replacement FAIL?
A 76-year-old woman presented 18 yrs after a primary Total (TKA). She had done well until approximately 12 mos before presentation, when generalized instability symptoms with activities of daily living began to develop. She had no symptoms when at rest. Additionally, she was experiencing increasing generalized knee pain and recurrent effusions. She had no constitutional symptoms and no history of infection or wound problems. All screening laboratory test results were within normal limits.
Although a supine AP radiograph (Xray 1) did not show any significant findings, a weight-bearing image (Xray 2) demonstrated a significant valgus deformity. No significant recurvatum deformity was seen clinically. Both varus and valgus instability were present, but with firm end points, demonstrating probable collateral ligament competence.
What’s the diagnosis? Next step in treatment? Top complications to consider? How often does Total Knee Replacement fail?
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About Dr. Cory Calendine

Cory Calendine, M.D., received his medical degree from the University of Tennessee College of Medicine. He completed a residency in orthopaedic surgery at Vanderbilt University Medical Center, followed by fellowship training in adult reconstruction of the hip and knee at the world-renowned Anderson Orthopaedic Research Institute in Alexandria, Virginia.

Dr. Calendine currently serves as chief of the Division of Orthopaedic Surgery for Williamson Medical Center, where he often hosts national and international visiting surgeons who come to learn the latest techniques. He also serves as an elite reviewer for the Journal of Arthroplasty, and in 2018 was selected to serve as a member of the American Board of Orthopaedic Surgery Blueprint Development Exercise Work Group, which creates content for national credentialing exams. Dr. Calendine also lectures nationally and internationally on joint replacement, most recently at the 2018 Chinese Hip Society in Guiyang, China.

When he’s not practicing medicine, Dr. Calendine enjoys golf, movies, racquetball, youth ministry and weightlifting. He also dedicates his time to various nonprofit groups, such as Mission UpReach, City of Children and the Sarah Walker Foundation.