Practice Makes Perfect

The lead article in the October issue of The Journal of Bone and Joint Surgery concluded that patients undergoing a total knee arthroplasty (replacement) with high volume physicians and hospital achieve better outcomes.  The Los Angeles Orthopaedic Institute including Drs. Sisto and Sobeck are very high volume total knee arthroplasty surgeons (greater than 145 per year) and we agree with the recert of this study “Practice does make perfect” and our high volume confirms this.  We strive to have the best outcomes with the lowest complication rates in Los Angeles.  Please visit us to learn more about our success at maximizing your surgical result following a knee surgery.

Keep moving!!!

Dr. Sisto

Practice Makes Perfect

The newest edition of the Journal of Bone and Joint Surgery contains an article titled “Effect of Surgical Caseload and Revision Rate Following Total and Unicompartmental Knee Replacement”. The aeticle is based on the results of 500,000 patient records from England and clearly shows that high volume surgeons attain the best results following partial knee replacements (uni) and total knee replacements.
In other words, the SINGLE most importatnt determining factor to maximize the result of the surgery is to select a knee surgeon who does the most procedures. Dr. Sobeck and myself perform more total knee arthroplasties than any other surgical group in our valleys, PERIOD.
If you have knee pain and have been told that you require a joint replacmeent surgery, the best thing you can do is get a second opinion with us at the Los Angeles Orthopaedic Institute.
We are looking forward to maximizing your result and having you return to an active, pain free life.
Keep Moving!!
Dr. Sisto

Patello-Femoral Replacement (PFR)

Do you have severe pain under or around your kneecap?
Have you been told by your doctor that you may need knee replacement surgery?
Are you interested in learning about a less-invasive partial knee replacement that is custom made just for you?

What are your options?
If you have severe pain under and around your kneecap, your doctor may first recommend conservative treatment involving rest, physical therapy and analgesics. If your pain is not manageable with these measures, you may be a candidate for surgery.

Types of surgery for arthritis around the kneecap

There are several types of surgery intended to treat severe arthritis around the kneecap. These options include soft tissue procedures (such as a lateral release), cartilage replacement, chondroplasty, microfracture, bone and tendon realignment procedures, and replacement of the painful portion of the knee (partial and total knee replacement).
 Replacement of the entire knee joint (total knee replacement) has been used to treat arthritis that is isolated to the kneecap portion of the knee. With total knee replacement, however, all portions of the knee are replaced, even if they are healthy!
Many experts believe that total knee replacement is too aggressive for someone who suffers from arthritis in just one portion of the knee. These experts believe that your knee will function better if you are able to keep the healthy portions in your knee and only replace the area that is damaged. Another consideration is that total knee replacement requires removal of bone from your entire knee and, if the implant does not last you for the rest of your life, the challenges of subsequent repair are increased because there is simply less bone to work with for implantation of the revision knee components.

Read more about PRF at the Los Angeles Orthopaedic Institute…

The Elephant in the Room

Total knee arthroplasty also known as a knee replacement has been an amazing break through procedure. We are able to perform this operation when the smooth articular cartilage is worn off the bones surfaces and the bones are grinding on one another causing pain and stiffness.  The knee arthroplasty replaces the smooth surfaces of the knee and patients are able to function without pain and enjoying a much more active lifestyle.  All surgeries, no matter how successful, do have risks of complications and one, but major, complication of a knee arthroplasty is infection.  Infection is the elephant in the room that no one likes to talk about but it happens in approximately 0.5% of knee replacements.  This is only one out of two hundred but it is devastating and we need to bring the number to zero if we can.

The joint replacement team at The Los Angeles Orthopaedic Institute strives to avoid infection at all costs.  We have our patients take pre-operative cleanses with Chlorhexidine Gluconate (Hibiclens) prior to the surgery to clean the skin.

We also have the patients clean the nostrils with Mupirocin (Bactroban) which sterilzes the nasal passages.  The nostrils have been recognized to harbor staphylococcus which is the primary bacteria that cause knee infections.

In addition, all of our patients receive intra-operative antibiotics and our surgeons are among the fastest to perform the surgery in Los Angeles as it has been recognized that the infection rate goes down if the surgery is performed quickly.  We do more knee replacements than any other group in the valley and our times are the quickest as well.

We are proud of the fact we have one of the lowest infection rates in Los Angeles and we strive every day to get our infections to ZERO.

We look forward to seeing you in the future to discuss our ZERO infection campaign and we look forward to caring for you and your friends and families.

Keep moving!

Dr. Sisto

Congratulations Nasim Kalhor, DPM!

Congratulations to Dr. Nasim Kalhor of Los Angeles Orthopaedic Institute for receiving the Patient’s Choice Winner Award from OpenCare! Dr. Nasim Kalhor is a Board certified podiatric surgeon specializing in the medical and surgical treatment of the foot and ankle.

Meet Nikki!!!

One of the most exciting events which has occurred at The Los Angeles Orthopaedic Institute is our incorporation of physician assistants in our practice.  Physician assistants (PA) are trained to evaluate patients, perform procedures in the office and the emergency room, assist in surgery and make the hospital rounds to treat our surgical patients.  They are a vital link between the surgeons at LAOI and our patients and they are an indispensible part of our team.

Coury Clemens was one of our first PA’s and he has been with LAOI for nearly three years.  We have recently recruited Nikki Sisto to join our group a few months ago. She graduated from Boston University and completed a 2 1/2 year Physician Assistance program at Pace University in New York City.   She grew up in the San Fernando Valley and we were able to convince her to return home. She has been an amazing asset to our office and she has exceeded all of our expectations!!  She is an excellent assistant in the operating room but her true strengths are her breadth of medical knowledge and her compassion for the patients.  She listens to them and makes every attempt to smooth their recovery following a fracture or major recontructive surgery.

The best part is that her prescence has engergized me and has given me more enthusiasm than ever to teach and continue to deliver the best care to all our patients. Nikki, as you may have guessed, is my daughter and I could not be prouder of her or more excited to come to work each day with her. Her joining our team has been a “dream come true” for me and all of our patients will benefit from working with her as well.

All of our patients are MORE THAN EVER in the best hands at The Los Angeles Orthopaedic Institute!

Keep Moving!

Dr. Sisto

What Kobe Bryant’s Surgery Means to You!

Kobe Bryant has recently undergone a rotator cuff repair which has ended his 2015 season and may jeopardize his career. The purpose of this blog is to explain the function of a rotator cuff, how it can tear and what the symptoms are and to outline the various treatment options that are possible. Each patient does not have the same physical demands and expectation of function that Kobe must have and each patient must individualize their treatment program based on their own needs and goals.
The rotator cuff is made up of four tendons that blend together and rotate the shoulder. A tendon is a structure that connects muscle to bone and is the pulley that lifts and rotates the shoulder. A tendon can tear from an acute, significant injury like a fall onto the shoulder or dunking a basketball such as Kobe or it can be a chronic, repetitive stress that tears a degenerative tendon such as merely lifting a suitcase.
The tendon is under tension like a guitar string and pulls apart and can no longer function as a shoulder rotator. The patient will complain of pain particularly on overhead activities and weakness to external rotation.
Patients of all ages who develop these symptoms should be seen by an orthopaedic surgeon as the sooner a diagnosis is made the sooner the appropriate treatment can be initiated based on the patient’s age, level of pain and weakness and their own goals and demands.
An MRI (Magnetic Resonance Image) is the diagnostic test that confirms the diagnosis. (A standard x-ray will not visualize the rotator cuff tendon) All insurance companies will pay for this procedure as it is the standard of care.
The problem with rotator cuff tears is that if untreated many progress in size and lead to more pain and more shoulder weakness and loss of function. A number of the tears, however, do not progress and current reasearch protocols are trying to determine which tears progress and which tear should definitely be treated with surgery.
In general younger patients (less than 60) should be treated with a surgical repair as a tear will progress in younger, more active patients. Older patients (greater than 70) can be treated with physical therapy to build up the surrounding muscles to compensate for the torn muscle-tendon joint. Patients between 60 and 70 need to individualize their care based on their symptoms and goals.
The GOOD NEWS is that a surgical repair of a torn rotator cuff tendon is highly successful with results greater than 90% in most studies.
I spent a year studying the surgical repair of the rotator cuff with Frank Jobe, the legendary shoulder surgeon who founded the Kerlan-Jobe Orthopaedic Clinic. The doctors here at the Los Angeles Orthopaedic Institute have performed thousands of rotator cuff repairs and would welcome the opportunity to outline an appropriate treatment for you and your rotator cuff!
Keep Moving!
Dr. Sisto