Total knee replacement is an advanced procedure performed for severe damage of the knee joint. Total knee replacement is often referred to as total knee arthroplasty, and involves resurfacing and replacing damaged parts of the knee. Osteoarthritis is usually the cause of the knee damage. Osteoarthritis causes knee pain with activity, but pain can also occur at rest. It may be difficult to go up or down stairs, walk long distances, or get up from low seats. There may be swelling, stiffness, or the feeling of instability.

Minimally invasive total knee surgery (MIS) is a giant step forward in performing knee replacement through a smaller incision. MIS quad-sparing total knee replacement entirely spares the quadriceps muscle and tendons, which control the bending of the knee. The splitting or cutting of these tissues causes much of the pain during recovery. Traditionally, knee replacement is done through an incision that is 8″ to 10″ long. MIS knee arthroplasty involves performing the surgery through an incision that is only 3″ to 5″ long. Specialized instruments allow Dr. Penenberg to access the damaged knee joint and place the implant through the smaller incision. The actual resurfacing of the knee joint, and the implantation of the prosthesis, are similar to the traditional technique. The smaller incision and the muscle incision mean potentially less damage to tissue around the knee, and less blood loss in surgery. This can result in less swelling, and less pain after surgery, which can result in faster healing, and accelerated progression in Physical Therapy. Less blood loss can result in less time in the hospital, and a faster return to work and activities.

Contraindication to using MIS technique would be severely obese patients.


Patients undergoing a total knee replacement will most likely never need revision/repair surgery. If there is unusual wear and tear on the prosthesis, or, an incident occurs that damages the bone(s), or the prosthesis, a surgical repair may be necessary. Repairs may be simple or complex. Not all orthopedic surgeons perform total knee replacement revision surgery. The surgeon’s experience with revision surgery is important to a successful outcome.

Dr. Penenberg has extensive experience with knee revision surgery. His experience includes surgical solutions for simple and complex problems. A simple problem may be the replacement of the plastic liner. A complex problem may be an infection requiring the removal of the knee prosthesis, the placement of an antibiotic spacer, and 6 – 8 weeks of intravenous antibiotic therapy to eradicate the infection before re-implanting a prosthesis.

Dr. Penenberg works with a team of specialists in infectious disease management and internal medicine to plan a sophisticate course of treatment.