The region's most comprehensive musculoskeletal treatment center.

Pioneering Minimally Invasive and Arthroscopic Surgery.

Peter M. Bonutti, MD

Bonutti Orthopedic Clinic, Effingham, IL


Total Joint Replacement Surgery in the 21st Century


Total Knee Replacement Surgery in the 21st Century

This page presents current, reliable information on the latest advances in total joint replacement, to help guide patients in making important healthcare decisions. It is provided by Dr. Peter M. Bonutti, MD, FACS, FAANA.  


New “Limited-Incision” Total Knee Replacement Offers Important Advantages  

Total joint replacement was one of the most significant advances in orthopedic surgery in the 20th Century, and enabled millions of patients suffering from severe joint pain and stiffness to return to active and rewarding lives. In total knee replacement (TKR), diseased or damaged bone and cartilage in the knee joint is removed and replaced with an artificial joint called a prosthesis.

Performed since the 1960s, TKR is one of the safest and most successful types of surgery. Now, a breakthrough surgical technique has been developed for TKR in Effingham, IL, at The Bonutti Clinic – the L-I ApproachTM or Limited-Incision Total Knee Replacement. This procedure adapts the latest advances in minimally invasive arthroscopic surgery and instrumentation to TKR. I want to stress that limited-incision TKR is a total knee replacement (not a partial or unicompartmental knee replacement), and it promises to make TKR in the 21st Century safer and more effective than ever.   


Joints – The Body’s Natural Hinges

Joints are connecting points in your body where two separate bones meet, and they enable your skeleton to rotate or swivel. The ends of the bones are connected by thick bands of tissue called ligaments. For example, the knee joint is formed by the upper end of the shinbone (or tibia) and the lower end of the thighbone (or femur). Cartilage, a smooth, plastic-like tissue, coats the ends of some bones and lines the joint sockets to prevent the bones from rubbing against each other. A delicate membrane called the synovium produces a lubricant to reduce friction and wear in the joint. Normally, all parts of the joint work together, and the joint moves easily without pain.


Conventional TKR

In total knee replacement, the prosthesis is composed of metal, to replace diseased bone, and of polyethylene (a durable, plastic articulating surface), to replace diseased cartilage. One part is attached to the end of the thighbone where diseased bone has been removed, and another is anchored to the shinbone. The standard TKR procedure takes about 2 hours. An 8- to 12-inch incision is made in the knee area, cutting through muscles and tendons and pushing them aside to expose the joint. After the prosthesis is in place, the muscles and tendons are reconstructed and the incision is closed. Frequently, it takes several months to recover from the large incision and muscle disruption.   


Advanced Limited-Incision TKR

The L-I ApproachTM total knee replacement procedure utilizes a different leg position and streamlined instruments and techniques that I have developed and patented. The same high-quality, time-proven TKR prosthesis components are used and are held in place with cement. The actual removal and replacement of the damaged joint is also similar, but the surgical incision is only 3 to 4 inches long. The incision is actually smaller than the joint implant itself. In addition, the surgeon does not have to disturb as many muscles and tendons, for a more natural reconstruction and a quicker rehabilitation.

Our advanced, minimally invasive L-I ApproachTM total knee replacement procedure takes only 1 hour and results in many advantages for the patient, including:

  • Shorter time in surgery

  • Decreased tissue and muscle trauma

  • Less blood loss

  • Fewer complications

  • Quicker time to recovery

  • Reduced risk of infection

  • Less postoperative pain

  • Far less scarring

  • Faster, easier rehabilitation

  • Better motion


World Renowned TKR Expert Observes New Procedure

Dr. Kenneth A. Krackow, a board-certified orthopedic surgeon and Chief of Orthopedics at Buffalo General Hospital in Buffalo, NY, recently visited our clinic to study the L-I ApproachTM total knee replacement procedure. Dr. Krackow is respected worldwide for his research and development of dozens of surgical techniques, devices, and instruments that have advanced TKR surgery. Dr. Krackow was intrigued by what he saw during the procedure, and he took written and verbal notes as well as digital photos of the technique. Dr. Krackow plans to further study potential benefits to patients of this Minimally Invasive TKR procedure.


Click on images below for larger view

Minimally Invasive Incision Size Scar Comparison between Conventional TKR and Minimally Invasive TKRScar Comparison between Conventional TKR and Minimally Invasive TKR Post Operation Pictures of Minimally Invasive SurgeryPost Operation Pictures of Minimally Invasive Surgery  Post Operation Pictures of Minimally Invasive SurgeryPost Operation Pictures of Minimally Invasive Surgery Post Operation Pictures of Minimally Invasive SurgeryPost Operation Pictures of Minimally Invasive Surgery Post Operation Pictures of Minimally Invasive SurgeryPost Operation Pictures of Minimally Invasive Surgery 

The Bonutti Clinic in Effingham, IL, is the first and one of the only facilities in the world where the

 L-I ApproachTM total knee replacement procedure is now performed and taught. 

To reach Dr. Peter Bonutti, please call: (217) 342-3400


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