Cory Calendine, M.D.

10/17/2026

Ask Your Surgeon This Before Knee or Hip Replacement

Patients walk into my office better prepared than ever. They’ve read the articles, watched the videos, and many bring a written list of questions. But there is one question that almost never makes the list, and it isn’t about the surgery. It’s about the week or two after: How do I actually take the pain medicine? How to take it. When, in what order, and whether to wait for the pain or stay ahead of it.

That single question can shape how the first two weeks after a hip or knee replacement feel more than almost anything else. Patients who take their medicine the right way tend to move better, sleep better, and stop chasing pain. Pain medicine always has to be customized to the individual patient. But there is a general structure I use, and I think about it as a triangle. A base you build on a schedule, steps you climb only if you need them, and a safety ceiling most people never hear about.

Full breakdown, including the doses I use, the daily limit that hidden ingredients can push you past, and the order to come off your medicines, is in the complete video at ccmd.pro/pain

👇 Before your surgery, did anyone explain how to take your pain medicine?
*This is general education from my own practice. Always follow your surgeon’s written instructions.

10/17/2026

Some patients come in sure they need both knees or both hips replaced. We do the worst one first. That new joint does its job, it takes pressure off the other side, and the other side often feels better than expected. Many of those patients end up deciding to wait a year or longer before the second surgery.

That's a personal decision, and there is no wrong answer.

When patients do want the second side done, six weeks is the bare minimum between surgeries. That's roughly how long your heart, lungs, and blood count take to recover. Most people wait about three months, until they feel fully recovered.

What about doing both on the same day? It can be done, but I tend to shy away from it. Replacing both knees at once is like signing up for two car wrecks on the same day. Your body takes on double the stress, and the medical risk goes up with it. For most people, doing one side, recovering, and then doing the other is the safer path.

And if you need a hip and a knee that hurt about the same, the hip usually goes first.

Read the full guide: https://corycalendinemd.com/blog/second-joint-replacement-timing/

10/16/2026

Is Being a Doctor Is Impossible Sometimes?

Some words land at exactly the right moment. This message shared by Dr. Alia Issa, aesthetic oculoplastic surgeon, says what most I think many physicians feel and rarely say out loud. Medicine asks us to hold opposites at the same time.

“Medicine is a science of uncertainty and an art of probability.” - Sir William Osler

We train for years to make decisions with incomplete information, and then we carry those decisions home. The balance can be challenging. Every patient deserves a surgeon who is confident enough to lead, honest enough to explain every risk, and present enough to truly listen. Those qualities can pull in different directions - a balancing act no residency could fully teach.

In 1927, Dr. Francis Peabody wrote that “the secret of the care of the patient is in caring for the patient.” That line has outlasted every advance we have adopted since. Better implants, robotic assistance and faster recovery pathways matter, but the human side of the work still shapes how a patient experiences their care.

There is a cost. The habits that protect patients also protect physicians: sleep, exercise, time with family, and honest conversations with colleagues. Caring for ourselves is never separate from caring for patients. It is part of it. The weight you carry is shared, even on the days it does not feel that way. To patients: the doctor who walks in and asks how they can help you today may have just left someone else’s hardest moment. Grace goes both ways. Thank you, Dr. Issa, for putting it into words.

Have a great weekend!
🎙️Dr. Alia Issa • Aesthetic Oculoplastic Surgeon, Moorfields Eye Hospital, Dubai Dr. Alia Issa • Aesthetic Oculoplastic Surgeon

10/15/2026

🛁 Inside the OR: How Your Leg Is Prepped for Knee Replacement

Three things about OR skin prep that might surprise you:

1. Clean skin is not sterile skin. Even after a good shower, bacteria live on the surface. Before a hip or knee replacement, our goal is to drop that number as low as possible right where the incision will be.

2. The patient changes the math. In a study of 99 patients, those with diabetes were 3.6X more likely to still carry bacteria after prep, and higher BMI raised the odds too. That’s why blood sugar and weight conversations start weeks before surgery, not on surgery day.

3. The debate isn’t fully settled. Chlorhexidine-alcohol clears more skin bacteria than povidone-iodine in randomized trials. Yet a 2025 Tennessee study of 607 hip and knee patients, all prepped with chlorhexidine-alcohol, reported infection rates of 0 to 1.4%, and a head-to-head trial in revision surgery is still underway. A good solution matters, but technique matters just as much. (doi:10.3390/antibiotics14020155)

In the OR, that technique looks like this: clip instead of shave, prep the entire limb working outward from the incision, and let the solution dry fully before draping, since alcohol-based preps are flammable. Patients play a part too: chlorhexidine washes at home, no shaving near the surgical site, and a call to our office about any cut or rash before surgery.

Full discussion at ccmd.pro/skinprep

👇 SHARE your surgery experience & insights

10/15/2026

There's one question almost nobody asks me before a hip or knee replacement, and it isn't about the surgery: how do I actually take the pain medicine?

It matters more than most people expect. How you take your pain medicine shapes how the first two weeks feel.

I think of pain control as a triangle.

The base is two non-opioid medicines taken on a schedule, not when it hurts. If you wait for the pain to arrive, you spend the next two weeks chasing it. Many of my patients never need more than this.

If they do, tramadol comes next, then oxycodone. Staggering doses usually works better than stacking them all at once.

The safety rule: I cap acetaminophen at 3,000 mg a day. It hides in combination pain pills and many over-the-counter cough and cold products, so read every label.

Coming down, wean in reverse. Stop the oxycodone first, then the tramadol, and keep the base going, usually through the first six weeks.

The goal is never zero pain. It's pain that stays manageable enough to move, sleep and heal.

Watch the full video: https://youtu.be/PUPWuMQLJDM

Did someone explain your pain medicine schedule after surgery, or were you handed a bunch of bottles? Tell me in the comments.

The Pain Medicine Question Almost Nobody Asks Before Knee or Hip Re...

10/15/2026

The bruising tends to concern people more than almost anything else after a joint replacement. At two weeks, it can look impressive: purple and yellow down the shin, even around the ankle, far from the incision.

Here's what's actually happening. During surgery, there is some bleeding around the joint. Over several days, that blood slowly moves down the leg under the skin, following gravity. What you're seeing is the blood from surgery on its way to being reabsorbed. It is usually a normal part of healing.

Swelling follows a similar pattern. It usually peaks in the first week or two, then settles gradually over weeks to months. Some foot and ankle swelling is normal too, as long as it goes down when you elevate the leg.

Ice, elevation, and two weeks of compression stockings are the mainstay. The key is getting your ankle above the level of your heart, and to really do that well, you have to be lying down. And don't overdo it early on. Your body is healing.

Call right away for calf pain, swelling that keeps getting worse, or swelling that doesn't go down with elevation. If you're worried, I'm worried.

Read the full guide:

How long swelling after knee or hip replacement lasts, why bruising spreads, what actually brings it down, and the signs that mean you should call.

10/14/2026

Are all triple-taper stems the same?

Tonight I'll be on the panel for an open discussion hosted by JOEI, the Journal of Orthopaedic Experience and Innovation. We'll look at triple-taper femoral stems in total hip replacement: how the designs compare, where they differ, and what that means when choosing an implant.

Panel:
Dr. David Rodriguez-Quintana, UT Physicians
Dr. Elizabeth Gausden, Hospital for Special Surgery
Dr. Cory Calendine, Williamson Medical Center

Moderator: Dr. Ira Kirschenbaum, Editor-in-Chief, JOEI

Wednesday, October 14
8:00 PM Eastern / 7:00 PM Central

This is an open mic format, so bring your questions, turn your camera on, and share your own experience.

Register here: https://us02web.zoom.us/meeting/register/28p3nueDRcWzBCRmQZgqSA #/registration