What Clients Say
The results speak for themselves! Return to Pain-free mobility and Athletic Performance.
A total knee replacement can transform the quality of life for those who have suffered a significant injury, or pain and stiffness from osteoarthritis. Dr. Thomas Boerger performs hundreds of successful total knee replacements, using the latest operative techniques, including the CORI Robotic Surgical System. See surgeon & client videos below.
This procedure addresses the pain and discomfort caused by knee arthritis, joint wear & tear, and associated cartilage degeneration.
When cartilage within the joint degrades, bones rub together, becoming worn, causing painful inflammation. A knee replacement successfully addresses this.
Dr. Thomas Boerger templates your existing bones to create a unique prosthetic that is perfectly tailored to your joint.
Years of expertise in total knee replacement means that Dr. Boerger’s procedures lead to very positive clinical outcomes and satisfied patients.
Dr. Thomas Boerger consults in Gibraltar and Marbella. Simply complete the contact form or call your nearest clinic, listed on our Clinics page.
Following experience with Robodoc at HC International Hospital (Marbella) in the 1990s, the CORI (Smith & Nephew) Robotic-assisted Surgical Joint Replacement System is the latest technology in Joint Replacement Surgery at HC.
CORI is an image free system which does not require CT images or virtual implant positioning before surgery. With CORI the I can 'register' the dynamic leg and knee anatomy at the start of your operation. The system allows for precise recognition of individual knee shape, ligament length and tension and leg alignment.
Before the actual knee bones are cut I can virtually determine implant size, implant position in all six planes-of-freedom along with ligament laxity/tension.
The removal of residual cartilage and bone close to the joint is then carried out with the hand-held robotics-guided CORI burr. I can follow this on the monitor. Excess bone removal is prevented by the super-fast retraction of the burr tip in a fraction of a second. The result is a super flat bone surface that is cut within an error margin of less than 0.1 mm.
The bone preparation of the femur and tibia is followed by trial implantation, using a mock implant with an identical shape and size to the definitive implants followed by cementation of the definitive implants. A standard set of conventional mechanical instruments will always be available as back-up.
A more precise implant position resulting in exact ligament balance throughout the range of knee motion is thus achieved.
Similarly, increases in accuracy of patella-femoral joint position are achieved. The patella-femoral joint remains a typical problem area in conventional mechanical knee replacement surgery and accounts for a proportion of the reported patient dissatisfaction.
Leg alignment can be predicted at the planning stage and modified if required.
The more accurately balanced knee and aligned leg is expected to bring about improved final function of the knee, reduced residual symptoms, enhanced reliability with activities such as mounting stairs etc.
Navigation and Robotic-assisted joint replacement systems are especially relevant and advantageous for patients with unusual leg alignment or knee anatomy.
The aim of a Total Knee Replacement is to offer pain relief and knee mobility with normal leg alignment.
Total Knee Replacement may become necessary in patients with advanced arthritis affecting more than one compartment of the knee when other pain relieving measures are no longer effective. Similarly, patients with loss of full straightening and/or bow-or-knock-knee deformity can expect to have their knees straightened with a Total Knee Replacement. How far the knee eventually bends in everyday life depends on a multitude of factors including the patient’s efforts at rehabilitation.
Assessment
Dr. Boerger assesses all potential knee replacement patients carefully. This includes a functional review including gait assessment, lower limb joint examination and extended radiological investigation. Typical x-ray images taken include both knees standing frontal view, true lateral view with calibration marker and axial patella view.
Preparation
All joint replacement patients undergo a pre-operative review with Dr. Boerger’s Nurse Assistant, Tanya Keble, and a review with a HC International Hospital anaesthetist. Basic investigations include screening blood tests and ECG. To minimize the risk of a peri-operative joint infection multiple skin and nose swabs are taken for MRSA and MSSA. Patients testing positive for skin colonisation are treated with body washes and ointment at home until repeated test results are negative.
If deemed necessary, a medical review will be scheduled. If cardiac problems are known or anticipated, a full cardiac work-up including stress test and heart catheterisation can be performed at HC International Hospital.
Advantages of Total Knee Replacement over Partial Knee Replacement:
- Relief of arthritic knee pain in advanced bi- or tri-compartmental osteoarthritis (arthritis in more than one knee compartment
- Correction of flexion deformity (when one I is unable to fully straighten the knee)
- Correction of varus and valgus (bow- and knock-knee) deformity
- Correction of joint instability in cases where ligaments are stretched or torn
Total Knee Replacement Prosthesis:
Dr Boerger has used the Journey II CR and BCS (Smith & Nephew) with and without patella resurfacing for most of his TKR patients in the past 6 years. He used Genesis II (Smith & Nephew), a predecessor to the Journey II, for the 13 years before that. The nearly two decades worth of combined experience with this family of implants is invaluable in achieving success for his patients.
Dr Boerger will continue to use the Journey II total knee replacement now with Navigation and Robotics- assistance (CORI).
A Total Knee Replacement typically requires a hospital stay of 3 to 5 nights, as the procedure is more comprehensive than a Partial Knee Replacement.
The time in hospital is used for pain relief and physiotherapy. Some patients are able to be discharged earlier. Some patients request further in-house rehabilitation for another week or two. This can be arranged at HC International Hospital. Procedures are in a private hospital with very comfortable private rooms.
From your initial consultation, a comprehensive, personalised treatment plan is created. In preparation for your recovery, there is a specific pain-relief plan established for you to minimise post-operative discomfort.
A Total Knee Replacement requires comprehensive rehabilitation as part of your patient treatment plan. In addition to our expert physiotherapy offered during your short hospital stay, some patients request further in-house rehabilitation for another week or two. This can be arranged at our HC International Hospital. In addition, as an out-patient, we are also happy to liaise with your preferred rehabilitation professional to design a recovery plan.
Although risks of complications are higher than for a Partial Knee Replacement, patient satisfaction for a Total Knee Replacement is very high. You can once again expect to be able to walk with a stable, pain-free knee.
Expected implant survival times are often more than 15 years. Dr. Boerger uses implants with validated long survival times and operative techniques that minimise risks and complications, including surgery performed in a laminar flow theatre and the use of astronaut-style helmets with all joint replacement surgery.
Before surgery, patients will meet a physiotherapist at HC International Hospital, and will be taught how to use crutches, transfer in and out of bed safely and perform basic daily tasks.
Smokers must stop for 6 weeks before and after surgery in order to minimise the risks of post-operative complications such as cardio-respiratory problems, delayed wound healing, infection, and blood clot formation.
Most patients are maintained on anti-coagulation for 4 weeks after surgery.
Dr. Thomas Boerger personally follows up all his patients at 2 weeks, 6 weeks, 6 months and 1 year with new x-rays.
Partial & Total Knee Replacement procedures offer a return to an active lifestyle, with pain-free movement.
Proven surgical techniques, advanced implant templating and custom-made implant technology assure very positive results.
Reconstruction of the Anterior Cruciate Ligament of the knee can often be provided on an out-patient basis.